The following information is about having a scar revised or improved in some way. Please note that each and every operation is tailored to the individual needs of the patient, so no two operations are exactly the same. It is therefore important to discuss your aspirations and concerns with your surgeon.
What is a scar revision?
Treatments for scars aim to improve the appearance of scars to make them less visibly noticeable and more cosmetically acceptable. Scars may occur from a number of causes including following surgery, burns, infections such as chickenpox or acne. The treatment options available are diverse and include laser therapy, dermabrasion, surgery or medical management such as steroid or other injections. Sometimes, in cases of depressed scars, a filler may be injected underneath the skin to raise the level of the scar up to that of the surrounding skin. The best treatment offered will depend largely on your particular scar.
Another type of treatment being offered is chemical peeling. This is particularly useful in people with diffuse, widespread scarring such as following acne, or in people with naturally thick, pitted skin. Peels can be administered in different strengths according to the degree of the problem, and are in general extremely safe. They do need to be repeated over the course of several weeks.
Unfortunately it not possible for anyone to guarantee complete removal of a particular scar. Invisibility is rarely achieved and is not realistic, although the techniques used aim to make the scar less obvious, more natural and with a better colour balance to the surrounding skin and complexion. The overall objective is to ensure that someone else’s attention will not be drawn to the treated scar, even if you yourself may be able to find the scar if you look hard enough.
Scar revision can usually be performed under a local anaesthetic and as a day case, or in the case of peels in the clinic setting without any anaesthetic at all. There will be instances where a general anaesthetic and/or an overnight stay may be recommended, for example in cases of complex scarring, multiple scars at different sites or if a skin graft is required. Please consult with your surgeon for further advice.
Risks and benefits
Scar revision is a safe operation which almost invariably gives immense satisfaction to patients. As with any surgical procedure there are certain side effects and risks that can occasionally occur. These will be discussed in detail with your surgeon on more than one occasion, initially in general terms at the time of the first outpatient consultation in order to allow you to make a fully informed decision about whether to proceed with surgery. There will also be other opportunities to discuss the pros and cons, either during a subsequent consultation, or just before the operation.
The main benefits include an improved cosmetic appearance and reduced visibility of the scar which should be almost immediately apparent. In addition, as most patients feel self conscious about the scar, there should be increased self-confidence arising from its repair.
The main risks of the procedure include bleeding from the wound and/or infection, which can be of the skin or surrounding tissues. Redness and soreness of the skin can also occur particularly after laser therapy or dermabrasion. In addition, there may be pigmentation changes in the skin which can rarely follow laser therapy and can also occur after chemical peeling, although in this latter case the effect can be greatly diminished by the use of preparatory topical creams and agents for 3-4 weeks prior to the procedure. Pigmentation changes can mean either under or over pigmentation (ie. Lighter or darker spots respectively). A haematoma (blood clot) beneath the skin is also a possibility although unusual, and this may require drainage.
Unfortunately it is not possible to guarantee that the scar will disappear completely, and also that it will disappear forever. Depending on the degree of initial scarring and its location in the face, an element of residual scarring may persist although hopefully this will be very much reduced.
Before scar revision surgery – what to expect
There is little preparation required before scar revision surgery. In the case of a chemical peel, it may be necessary to apply a range of topical creams and agents which will be recommended and prescribed to you by your specialist. Full instructions will be given to you at the time.
Scar revision surgery – the operation
The operation may be carried out either with you asleep under a general anaesthetic or with a local anaesthetic.
Laser therapy & dermabrasion:
- Laser: A precise laser beam uses heat to degrade the skin in a stepwise fashion in order to ‘resurface’ the scar, reducing irregularities or rough areas thereby softening the appearance.
- Dermabrasion: This uses a rapidly rotating wire brush containing multiple diamond particles which acts as a rough surface to bring about smoothening of a raised or lumpy scar.
After both techniques, it is usual to expect a little bleeding from the site as well as some redness and soreness for a few days.
This is used to remove an unsightly scar which is perhaps not raised not depressed, but is nevertheless unappealing cosmetically and perhaps visible to others. Several techniques are available:
- Excision and closure: the scar is cut out and the skin sutured together to create a new, neater scar
- Excision and repositioning or realignment: in this the scar is cut out as above, but the resuturing of the wound edges is done is such as way that the direction of the new scar is changed. This is often used when the new scar needs to fall more naturally into an existing skin crease.
- Excision and flap or skin grafting: as before, the scar is first cut out. If the area left behind is too large to be directly closed by the method described above, it may be necessary to fill in the gap with alternative tissue. This can usually be obtained by creating a flap of skin adjacent to the excised scar and rotating it into the defect, or by harvesting a skin graft from elsewhere in the body (usually behind the ear, below the neck line or inner arm aspect). Although a skin flap or graft can be performed under local anaesthetic, there is a higher chance of a general anaesthetic being required.
What can I expect after scar revision surgery?
You will be taken from the operating theatre to the recovery room where you will wait for the effects of the anaesthetic to wear off. You will be under close supervision at all times. Then you will go back to your room on the ward where you will rest. A nurse will maintain close supervision and will check your temperature, heart rate and blood pressure, particularly if a general anaesthetic has been given. You will be given painkillers for the first few days although the operation should not generally cause much discomfort, and possible also antibiotics. You can begin to eat and drink when you feel comfortable to do so, starting with fluids, and get up and out of bed once the nurse is happy with your progress.
If a dressing has been applied, it can initially feel quite tight although this sensation should subside relatively quickly. Please telephone the hospital or consult your surgeon if you are concerned.
If your operation was planned as a day case and you have had a general anaesthetic, you will need to make arrangements for someone to drive you home.
Recovery at home
It is advisable not to drive, drink alcohol, sign legal documents or operate heavy machinery for 48 hours after a general anaesthetic as this can affect concentration, co-ordination, awareness and motor skills.
After laser therapy or dermabrasion, the skin may feel sore and this sensitivity can last for several months, although it should subside with time. In general the operation does not cause significant pain so simple analgesics are usually sufficient. You may also experience some redness around the wound and it is important to avoid direct sunlight until your own skin pigment returns.
After scar excision, a dressing may or may not have been applied. In either case, keep the wound dry and away from water contact, and avoid any direct pressure or stretching of the area. As for laser and dermabrasion, protect the site from direct sunlight until it has completely healed.
Once any stitches have been removed, a simple moisturiser can be applied to soften the wound further, perhaps aided by periodic massaging to maximise the blood flow to the area and improve healing.
Your surgeon will arrange to see you one to two weeks after the operation. At this stage the wound may look a little swollen, red and bruised but nevertheless you should still be able to notice the improvements in the appearance of the scar even at this early stage.
If you have had a chemical peel, you will be given some creams to apply to the face. It is important to avoid direct sunlight and to wear sun block creams when going outside. You may also need to have a series of peel treatments over the course of several weeks to gain maximum benefit, and a treatment plan will be discussed with you and carefully tailored to your own individual requirements and wishes.