Scars and Scar Revision

Any time skin is cut through its full thickness, a scar will form; unfortunately, all scars are permanent in the sense that they cannot ever be erased. They can, however, be manipulated to optimize function and apperance. In general, every scar goes through what is called a maturation process. In adults, a scar takes about one year to fully mature. One can expect a surgical scar to generally look its worse approximately 6 weeks to 3 months following the surgery. This is during the most active healing period when the body is forming collagen to heal the initial wound. Unless there is a fundamental problem with the scar, such as the need to alter the direction of the scar or to remove unhealthy tissue, it is generally best not to consider revision in less than approximately 1 year. During scar maturation, one can encourage and support ideal healing with silicone sheets or gels and strictly protecting the scars from the sun with sunscreen. A new product called Embrace® uses silicone sheeting on scars to reduce the tension across the wound.

Unfavorable scars from surgery can be avoided if the scar is made in the most expert fashion and the wound is closed with the lowest of amount of tension possible. A prime example of this is an abdominoplasty (tummy tuck) scar. The key to having an optimal tummy tuck scar is placing it in the right location and closing it without tension. Achieving this goal requires that the entire procedure being performed in a skilled manner. With over 20 years of experience with scar revision, Dr. Rapaport’s surgical expertise will ensure that your scar is closed in the most expert way possible.

At What Age Can Scar Revision Surgery be Performed?

In adults, scars generally take one full year to mature. Therefore, scar revision surgery is usually recommended for scars that are one year or more in age. In children, scars frequently take as long as two years to mature. Therefore, it is usually appropriate to wait longer before revising scars on children. One must also consider the child’s stage of growth when properly strategizing the timing of scar revision. One may choose to wait until after a growth spurt before revising a child’s scar, which will clearly be subjected to the tension of that growth spurt.

Scar revision may involve a variety of surgical and non-surgical techniques used to alter the appearance of a scar, with the intention of improving the appearance and function of a scarred area. Scar revision surgery may not remove a scar completely, but can dramatically improve the appearance of an unfavorable scar. Scar revision surgery may be employed to improve keloid scars, acne scars, burn scars, hypertrophic scars, depressed or retracted scars, facial scars, as well as scars caused by injury or previous operations.

What Does Scar Revision Surgery Entail?

Surgical scar revision generally refers to the excision of an existing scar followed by reconstruction of the wound through reapproximation of the tissue, possibly with flap reconstruction or Z-plasty (a type of skin manipulation performed to alter the direction of a scar).

Non-Surgical Scar Treatments

Dr. Rapaport advises that patients to be careful before deciding to treat scars with lasers. It is his experience that most commonly, lasers do not improve the appearance of scars. Lasers may be used to reduce pink coloring of a scar, or can act like microdermabrasion to essentially sand down the rough edges of an acne scar.

Laser treatment of acne scars can soften the scars but does not remove them. A consultation with Dr. Rapaport will be the best way to determine whether a scar may be improved surgically or by other means.

In some cases, a steroid called triamcinolone (tradename Kenalog) is injected into a thick scar to reduce its thickness, and thereby minimize its appearance. Frequently, this injection is performed once a month for three consecutive months. While Kenalog injection may reduce the thickness of a scar, it can be accompanied by a side effect of scar widening. Other side effects include the formation of tiny spider-type veins in the injected area, and atrophy or reduction in volume of fatty tissue. This can result in a pitting appearance when Kenalog is used to treat cystic acne. It is for these reasons that Dr. Rapaport does not rush to inject early scars with Kenalog. When Kenalog is selected as the best treatment option, he uses it carefully and sparingly to avoid its potential negative side effects.
In recent years, injectable products, particularly hyaluronic acid (HA) fillers, have been used successfully as filler agents for the treatment of superficial scars. HA products such as Restylane or Juvederm have been used to successfully treat the pitting resulting from treatment of cystic acne with Kenalog, as well as for the treatment of superficial scars caused by surgery or injury. Other HA products such as Belotero are specifically formulated for more superficial “etch” type scars or wrinkles, and may be selected by Dr. Rapaport for scar treatment during your consultation.
Dr. Rapaport often recommends that patients start using silicone therapy after a scar revision in order to improve the appearance of the new scar. Dr. Rapaport will either recommend a topical silicone gel or Embrace® Advanced Scar Therapy, an innovative therapy that reduces tension in a healing scar and can greatly improve its appearance. Dr. Rapaport will discuss these options thoroughly during your consultation.

Who is a Candidate for Scar Revision Surgery?

There are several factors to consider when determining if a patient is a candidate for scar revision surgery. To assess whether a scar is appropriate for revision, Dr. Rapaport thoroughly considers the size and depth of the wound, the blood supply to the area, the thickness and color of the skin, the direction of the scar, the tension on the wound, and the way the patient’s body heals (based on the examination of the scars). During the consultation, Dr. Rapaport will discuss all of these factors to determine the best treatment option for each individual patient.

Anesthesia

Scar revision surgery can frequently be performed as a minor procedure under local anesthesia. Of course, more extensive scars may sometimes require IV sedation or general anesthesia.

Where Will My Scar Revision be Performed?

Scar revision surgery is almost always performed at Dr. Rapaport’s fully accredited, on-site surgical suite in his Manhattan office.

If you have questions concerning treatment options or would like to schedule a consultation with Dr. Rapaport, please call 212.249.9955 or email info@drrapaport.com.

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