Changing the Appearance of Scars with Surgical Scar Removal / Revision
Scar formation is your body’s natural response to injury of the skin. It is an important and integral part of wound healing. Some cultures use scar formation as body adornment, intentionally injuring the skin in patterns similar to a tattoo, but defining the design with scar tissue. For some individuals a scar can be a badge of courage; evidence of an event of importance or trauma.
For the majority of us, however, scars are not usually desired or showcased. While mostly harmless, scars can become unsightly and undermine our self-confidence.
Among the most common causes of scars are surgery (cesarean section, orthopedic operations, etc.), skin cancer removal (Moh’s procedure), dog bites, car accidents and other skin injuries. Scars that occur as a result of trauma often heal poorly because of the tissue damage associated with the injury.
While the scar appearance is usually quite acceptable, occasionally the scar can raise, thicken, or become red. This type of scarring is called “˜hypertrophic scarring.’ Some individuals may even develop an extreme form of scarring called a “keloid.’ The vast majority of scars heal in a cosmetically acceptable manner. However, when the scarring process is too vigorous, the over-healing process results in a hypertrophic scar or keloid. Keloids are raised, rubbery, usually firm growths that overtake the wound and continue to develop beyond the wound boundaries.
At Changes, we offer several treatments for scars of all sizes and severity.
Dr. Gilbert Lee at Changes Plastic Surgery in San Diego remarks that scars cannot be removed completely, but they can be minimized in prominence using a variety of techniques. For any cosmetically undesirable scar, a consultation at Changes Plastic Surgery & Spa can determine which scar treatment is most appropriate for you.
Scar Revision Surgery
Scar revision surgery is reserved for scars which have failed to improve with non-surgical treatments. Surgical removal of the scar remains one of the most effective and immediate treatments for scarring. By excising the scar and carefully closing the new wound with plastic surgical techniques, patients can see dramatic improvement. This technique requires the skill of a plastic surgeon with excellent technique in wound closure. Dr. Lee is meticulous in revising unsightly scars.
Scar Revision with Dog Ear Correction
A component of some plastic surgery wound closures is a resulting puckering at the end of the scar. It can occur after the repair of certain skin defects and at the end of skin-tightening incisions. The resultant puckering is cone-like in shape and is commonly known in plastic surgery as “dog-ears”. At Changes Plastic Surgery & Spa, we often use a multi-procedure approach for dog ear correction.
This patient suffered a bullet ricochet wound to the cheek which was repaired leaving a dog ear both above and below the repair site. Dr. Lee performed an excision of the dog ears followed by RFAL (radio frequency assisted lipolysis) to debulk the areas until a nice flat contour was achieved.
There are also several new non-surgical treatments for scarring including laser treatments, dermabrasion, silicone gel sheeting, and steroid creams and injections.
Silicone Gel Sheeting
Silicone sheeting or semi-occlusive silicone based topical gels are one of the main non-surgical methods for scar improvement. Clinical studies have scientifically shown that silicone products reduce inflammation associated with scar formation. Silicone gel products are applied twice daily for approximately 2-4 months. Silicone gels provide an invisible coating and can be worn with makeup. Some topical scar treatments include a silicone gel with a steroid to diminish wound redness and inflammation, and some silicone gels include sunscreen to prevent wound darkening from sun exposure.
Radiation therapy has proven beneficial in decreasing the activity of cells that form scar tissue. For those with recurrent or particularly dramatic keloids, Dr. Lee may recommend low dose radiation therapy in conjunction with scar revision to prevent keloid recurrence. The radiation is performed on three consecutive days beginning with the scar revision.
Pressure dressings applied to the wound work by applying constant pressure to surface blood vessels and eventually causing the scar to flatten and become softer. A compression bandage prevents overstretching of the area of the wound as a result of frequent movement, which can promote the development of excessive scar tissue. In addition, continual pressure acts as a stimulus for the transformation of the scar into well-functioning tissue and increases the elasticity of the developing scar.
Steroid (Kenalog) injections directly into the scar formation help to soften the tissue, reduce inflammation and minimize the chance of hypertrophic scarring. Only small amounts are injected at a time but repeated treatments may be necessary.
For scars of all sizes and severity, a consultation at Changes Plastic Surgery & Spa can determine which scar treatment is most appropriate for you.