This thick, over-grown cluster of scar tissue on the earlobe is a keloid. Here it has been removed and the incision closed with stitches, leaving a thin scar.
This hypertrophic scar has formed a contracture, restricting finger motion.
Using Z-plasty, the scar is removed and several incisions are made on each side, creating small triangular flaps of skin. Then the flaps are rearranged and interlocked to cover the affected area.
The incision is closed with a Z-shaped line of sutures. The new scar is thinner and less visable, and allows the finger to be extended.
The scar crossing the natural line, or crease, between the nose and mouth is removed and repositioned using Z-plasty. The forehead scar, located in the natural lines, is excised with tapered ends. The skin is then loosened and brought together with stitches.
The repaired scars now lie partly within the natural skin crease, where they are less visible.
Scars are permanent, and no cosmetic treatment can completely remove them, but scars can be reduced and faded through a reconstructive procedure called scar revision. Depending on the characteristics of your scar or scars, scar revision may involve:
- Surgical excision
- Filler injections
- Steroid injections
- Skin resurfacing with chemical peels, dermabrasion or lasers
- Light therapy
- Skin lightening products
Many variables can affect the severity of scarring, including the size and depth of the wound, the blood supply to the area, the thickness and color of your skin, and the direction of the scar.
Is scar revision right for you?
The nature of the skin injury that caused your scars doesn’t matter in scar revision. Whether yours scars were caused by an accident, self-harm, acne, past surgery, animal attack or some other reason, scar revision may be able to help get rid of prominent, ugly or embarrassing scars.
Dr. Weston will review your medical history and complete a thorough assessment of your physical and mental health during your consultation. She will also evaluate your skin and its scarring tendencies before determining whether scar revision can help you.
What to expect during scar revision
Skin resurfacing for scar revision involves removing upper skin layers to stimulate collagen production and promote skin remodeling. This encourages healthy skin to grow, at least superficially, in place of scarred skin, improving skin texture.
Light therapy and skin lightening creams provide non-invasive pigmentation improvement, fading dark scars through a series of treatments or prolonged use, while dermal fillers like JUVEDERM® and Restylane are injected into depressed scars, adding volume so the scars meet the level of surrounding skin.
If you are prone to keloid scars (thick, itchy clusters of scar tissue that grow over time) or hypertrophic scars (thick, red, raised scar tissue), steroid injections and possibly excision may be used to improve their appearance.
If you wish to correct a contracture, or a large scar that has contracted surrounding skin, muscles and tendons, surgical excision with skin graft or flap closure or a Z-Plasty procedure is typically necessary.
Surgical scar excision and Z-Plasty involve essentially replacing an old scar with a new one that is more aesthetically pleasing and less noticeable.
Flap surgery is a complex procedure in which skin, along with the underlying fat, blood vessels, and sometimes the muscle, is moved from a healthy part of the body to the injured site. In some flaps, the blood supply remains attached at one end to the donor site; in others, the blood vessels in the flap are reattached to vessels at the new site using microvascular surgery.
Skin grafting and flap surgery can greatly improve the function of a scarred area. The cosmetic results may be less satisfactory, since the transferred skin may not precisely match the color and texture of the surrounding skin. In general, flap surgery produces better cosmetic results than skin grafts.
Scar revision recovery
Depending on the treatment method used for your scar revision, it may take anywhere from a few days to a several months to heal and see your final results. More intensive skin resurfacing procedures and surgical excision will typically require more downtime and a longer recovery period than minimally invasive injectable fillers and light therapy.
Skin grafts and flaps are more serious than other forms of scar surgery. They're more likely to be performed in a hospital as inpatient procedures, using general anesthesia. The treated area may take several weeks or months to heal, and a support garment or bandage may be necessary for up to a year.
Grafting involves the transfer of skin from a healthy part of the body (the donor site) to cover the injured area. The graft is said to "take"when new blood vessels and scar tissue form in the injured area. While most grafts from a person's own skin are successful, sometimes the graft doesn't take. In addition, all grafts leave some scarring at the donor and recipient sites.
Dr. Weston will coach you on the procedural details of your customized scar revision treatment and provide you with post-procedure care instructions. It is important to keep all follow-up appointments with Dr. Weston so she can monitor your healing and ensure optimal scar revision results are achieved.