Scar Revision Guide

How Can I Treat Scars?

Scar revision surgery minimizes the appearance of a scar by making it blend with the surrounding skin tone and texture. Patients often seek the help of a plastic surgeon after they have exhausted non-invasive treatments such as creams, ointments and silicone sheets. Since there are several types of scars, a doctor will need to evaluate the scar to determine which surgical method is appropriate. The treatment will be determined by several factors including:

  • The anatomical location of the scar
  • Type of scar
  • Skin quality
  • Skin type
  • Availability of surrounding tissue
  • Current functional impairment
  • Possibility of decreased functionality after surgery

Scar Revision with Excision

The most common form of scar revision is excision and primary closure. In fact, scar excision is the most effective method to improve deep, wide or long scars. Excision may be necessary if the scar has healed in an unusual way. This method of scar improvement involves cutting the scar out and then rejoining the skin with layered sutures to close the wound. Although it will create another scar, the new scar will be straight and thin and have a chance to heal more discreetly.

In some cases, the closure may require some tissue arrangement. After cutting the scar away, the surgeon will realign the scar with geometric rearrangements such as a z-plasty to elongate or change the direction of the scar. If a patient does not have enough healthy tissue to suitably close the wound, the surgeon may need to use a skin graft. A pharmaceutical tissue substitution can be used to cover a large area, if needed, in cases such as a patient having large scars caused by burns. After healing from scar revision surgery, the patient generally ends up with a scar that is less noticeable than before. It can take six months before the patient sees an improvement and up to a year to see the final results.

Alternative Treatments

There are many methods for treating scars including non-invasive and natural remedies. However, not all scars will respond to minimal treatment.

Laser therapies are often restricted to treating a recent scar, scars that are persistently red in color and light skin resurfacing for scars.

During scar revision with laser treatments, the surgeon uses a laser light beam on the scar and the surrounding skin. The laser removes the outer layer of skin by burning it off and this begins the regeneration of new skin. After it has healed, the new scar will look smoother as well as lighter in color. It may take multiple sessions to gain the desired appearance. Although laser therapy can make mild improvements, it is not an effective solution for most scars. Deep laser resurfacing and dermabrasion may work well for wide, raised scars that are not appropriate for excision.

Follow Post-Op Instructions

Scar revision is about improvement and not about “erasing” a scar since scars can never be completely removed. Furthermore, the lifestyle of a patient after scar revision surgery can impact the long-term outcome. Following post-op instructions and limiting sun exposure can help the scar heal better. Patients should cover the scar or apply sunscreen SPF 30 (or higher) before going outside to maximize the healing process.

-SP

New Science Helps in Healing Victims of War

Traumatic Injures of War

A young child in Mosul, Iraq is playing in a war torn neighborhood. Chasing a ball made of newspaper in tape she inadvertently steps on an IED. Outside Kabul a coalition humanitarian worker and a soldier a bring aid to an Afghan family. There vehicle hits a landmine they are severely burned and scarred from burns and loss of muscle. New technology promise hope for such victims.

University of Pittsburgh doctors have helped a soldier injured in Afghanistan regrow muscle to restore his strength and range of motion in his severely injured leg. McGowan Institute for Regenerative Medicine, at the University of Pittsburgh is headed by Stephen Badylak, doctors there are pioneering cutting edged treatments for recovery of traumatic battlefield wounds. These injuries include burns and blast injuries. These amazing treatments include wound healing, craniofacial reconstruction, and limb regeneration.

Wounded Soldier Facial Reconstruction

“Wounded Soldier Facial Reconstruction -Midway through surgical series.”

A new therapy developed at the institute is called the “skin gun.” It is actually a spraying device used to spray wounded areas with skin cells over burns on the ears and face. Skin can regrow over the affected burn areas in just a matter of days. The Bioreactor Group is under the direction of Professor Joerg Gerlach, they are the developers of this exciting restorative treatment.

There are three innovative treatment programs headed by the McGowan medical team. Extensive research on biominerlization (scaffolding) and bioceramic nanoparticles in non-viral DNA gene delivery. Professor Charles Sefeir leads the studies focused on the role of extracellular matrix in tissue engineering and biominerliazation.

One of the most critical areas of the centers work is the reconstruction of soldiers’ faces with the most normal looking appearance as possible for the patients. A cross functional team led by Professor J. Peter Rubin coordinate their complimentary expertise to bring about positive results with the advancement medical treatments of the McGowan Institute.

A Scars Story

Scar Truths and Tales

Scars, who doesn’t have one? A little annoying insect bite gets scratched obsessively becomes infected and though not deep it scars. The athletic endeavors of youth, life threatening accidents, surgery or to the catastrophic injuries of war can all leave our bodies scared. Scars can be the source of pride for some an icebreaker to tell an embellished tale at a family event or hob-knobbing with friends.

Scars can just be minor footnotes to our lives or major source of emotional and psychological angst. One on my right palm once stretched the full width; now, it is barely noticeable unless pointed out. It marks a dramatic bloody incident of falling in a 2nd grade foot race at recess. Then there is the one near my right eye a story that I don’t often want to recount. The visible one on my right shoulder blade always invites comment in a shirtless pickup game of basketball. Scars can be mileage markers on the amazing journey of our life. Sometimes, those scars bare even more tragic consequences to some people. They can infringe upon their well-being and devastate their quality of life.

View Amazing Scar Revision Surgery on Young Girl

The more I reflect my hands begin to braille my body through my clothing and my mind shuffles through vignettes of memories of burns and bruises, scrapes and scabs; bumps and lumps. Limbs and torso marked by stitches and scratches, gashes and slashes; all with the requisite blood; some of these scars bleeding more profusely causing parental angst and a flood of tears.
My active childhood, athletics and sporting lifestyle have given my dermis a lifetime of stories and embellished tales to share. Not a one would I remove. They are my story for better and worse.

By now you’re asking the purpose of this tale. My many scars have left to date only memories to be romanced and morphed into heroic tales. This is not true for many people. Scarring can deeply mar the psyche of a person and impact their life at every level.

Scar revision provides an opportunity to effect positive change on such people’s self image and esteem. The effect of scarring can be compounded by the onset of depression; a too often debilitating life-cycle if untreated.

It can be a vitally important step in their journey to inner and outer healing to treat the scar through the wonderful advancements in scar revision treatment. If you or a family member or friend struggle with issues regarding scars; consult with a dermatologist and or cosmetic surgeon. Scar revision in the 21st century has come a long way in providing wonderful results for many.

Types of Surgical Scar Revision


Description of Types of Surgical Scar Revision


Listed below are the most common surgical techniques utilized in scar revision.
Z-plasty Before & After

Z-plasty is a reconstructive surgery procedure. Its utilization is for improving the functional and aesthetics of scars.  Functionally refers to the lengthening of the scar the lengthening of a scar which helps relax or release linear burn scar contractures. The availability of mobile adjacent skin is a predicator for the use of this medical procedure. Z-plasty can procedurally make the scar less noticeable. Re-alignment of the central element can place the scar in natural skin tension lines and thereby disguise it. Utilizing this procedure the surgeon can rotate the tension line of a scar and or make a contracted scar elongated. In Z-plasty the midline of the Z-shaped incision is made along the meridian of highest tension or contracture. Triangular flaps are raised on the opposite ends of this incision. The flaps are than transposed and closed.

W-plasty is another reconstructive plastic surgery technique used for the excision of unaesthetic scarring. The excised edges of the scar are cut in a zig-zag pattern is like a connected row W’s. The borders are interdigitated for suturing. This method is very effective in rendering a linear scar irregular and less visible.

W-plasty Diagram

W-plasty revisions the scar into a ‘pinking shear pattern; which will interlock when sutured. Optically, it is more difficult for the eye to follow an irregular line. This makes W-plasty a favored method for revisioning linear scars. Often there is no discreet skinfold to hide a scar. Think of areas such as the forehead, the side of the face or cheek. Still is the irregular pattern is uniform visibility is not obscured. For that reason W-plasty is most often combined with

Geometric Broken Line Closure (GBLC).

W-plasties are not usually employed on their own throughout the entire scar. Visibility of the scar can be better reduced by combining other patterns with the W pattern. This is a more sophisticated procedural technique of scar revision is known as geometric broken line closure (GBLC).  W-plasty is the basic technique and then other shapes besides triangular flaps are utilized for interdigitation creating a very irregular irregularity. This procedure offers the optimal potential for camouflaging the scar. Added to this is also dermabrasion which is done approximately two to three months after the surgery.

M-plasty

The object of electing M-plasty in reconstructive surgery is to better preserve healthy tissue and to reduce the chance of secondary tissue deformity.  Proper technique in M-plasty reduces the loss of surrounding health tissue by nearly fifty percent.  The M-plasty is performed by creating two separate thirty degree angles instead of a single one.

 
 

Adjunctive Techniques of Scar Revision

 

Dermabrasion

  • precisely and in a controlled deliberate manner superficial abrading of the scar and surrounding skin. The end result is a smooth texture and in some cases further reduced visibility.
  • Abrasion can be used in a process that will improve the appearance of uneven scar edges including: scar edges, grafts and or flaps.
  • Dermabrasion works best on lighter complexions because of the lower risk of dyspigmentation.

Intralesional Steroids

  • Hypertrophic linear scars, bulky grafts and flaps, can be treated with intralesional corticosteroids. Injections can be instituted at approximately 1 month postoperatively.
  • A small amount (as little as 0.1 mL) of low-dose triamcinolone acetonide  at 5 to 10 mg/mL is injected into the scar; this dosage can be repeated monthly until the scar has flattened.
  • Side effects include atrophy (if the injection leaks out into healthy skin ),  hypopigmentation and telangiectasias when injected in higher concentrations into the dermis.

Contraindications

The reasons for a patient not to undergo scar revision include:

  1. The present psychological status of the patient does not prepare the patient for a positive outcome.
  2. The patient’s expectations are unrealistic limiting the opportunity for a favorable visible outcome.
  3. An individual’s history for hypertrophic and or keloid scarring represent a poor risk for a pleasing aesthetic result.
  4. Patient’s with thickened skin from the trauma reducing compliancy endure the risk of a compromised scar revision.

Innovative Treatment for Scalp Scar Revision

Follicular Unit Extraction (FUE)

Innovative Treatment for Scalp Scar RevisionFUE for Scar Revision

Follicular units (FUs) are the individual removal of the tiny organs that produce our hair shafts. Hair loss is a growing elective surgery but very beneficial for people who are suffering from low self image and quality of life issues from hair loss.

Like all surgeries hair transplants leave a scar. Dr. Parsa Mohebi, medical director of US Hair Restoration center is pioneering method of combining two procedures to render these scars virtually undetectable in many cases. The combination of FUE and SMP are small procedures that can be used in the revisioning of a hair transplant scar.

Donor Hair Scar Revised

The surgeon can extract a small number of grafts from the permanent zone and artistically and strategically place them in the scar. This process of using FUE uses hair to obscure and blend the margins of the scar to the surrounding scalp. Scalp Micro-pigmentation (SMP) can be used to further blend the scar in many cases.

Scalp Micro-Pigmentation

SMP for Scar Revision

Scalp Micro-Pigmentation is the process of using special pigments and fine needles to create the shade of stubble or shaved hairs on the scalp. SMP utilizes dermal pigments that match the patient’s hair color. Used in scars like FUE it can artistically applied revises the margins of the scars. This revision results in the obscuring or blending of the scars margins to the surrounding scalp.

FUE and SMP

FUE and SMP are a very non invasive way of revisioning a hair transplant scar. Patients can consult a hair transplant surgeon for recommendations on achieving the best results. These modern advances in scalp scar revision are performed in Los Angeles leading hair transplant centers like US Hair Restoration.

Abdominal Scars

Abdominal Surgical Revision

Abdominal scar tissue is forms through the healing of the connective fibers surrounding incision sites or traumatic wound. These are the natural fibers the body creates to heal tears in the skin. Abdominal scar removal is a way to repair or replace damaged skin. The severity of the wound surgical or traumatic helps determine the realistic level of success of any abdominal scar removal technique or revision.

Surgical Revision

Surgical scar revision is often used to reduce the abdominal scar. Surgical revisions work by moving the scar toward a natural crease in the skin. Scarring is ofthen cause by too much tension on the wound. In an abdominal surgical scar revision a less prominent scar will result because of he conrol of the woud tension which is lessend by the surgeons expertise.

View an actual abdominal scar revision with dermabrasion.

Punch Graft Scar Revision

A punch graft is a surgical technique designed to minimize the appearance of a scar. By removing an area of tissue from another area (normally less visible area of the body) and replacing it where the scar was located. If the abdominal scar is severe, a punch graft may be used and the skin is placed over the abdomen and stitched in place. Again, the tension in the stitching or closure of the surgical wound lends to a more aesthetic or less obvious scar. In addition after full healing of the punch graft dermabrasion or laser resurfacing can be utilized to diminish the appearance of scars.

Considering Scar Revision Surgery

Enhancing your appearance with scar revision surgery

There is not a person on the planet who is scarless or a tleast it is highly unlikely. Scars are visible signs that remain after a wound has healed. Scars are unavoidable results of injury or surgery, and the results of this natural healing process can be very unpredictable. Some people naturally heal well; others do not… Poor healing may contribute to scars that are unsightly or disfiguring. Even a wound that heals well can result in a scar that affects your appearance. Scars may be raised or recessed, different in color or texture from surrounding healthy tissue or particularly noticeable due to their size, shape or location.

Facial Scar on Young GirlYour treatment options vary based on the type and degree of scarring and can include:
• Simple topical treatments
• Minimally invasive procedures
• Surgical revision with advanced techniques in wound closure

Scar revision surgery is meant to minimize the scar so that it is more consistent with your surrounding skin tone and texture.
Although scar revision can provide a more pleasing cosmetic result or improve a scar that has healed poorly, a scar cannot be completely erased.

Should I Elect Scar Revision?

Scar revision is a highly individualized procedure and you should do it if it adversely effects your self image and esteem.. Scar revision can be performed at any age and is a good option if:

• You are upset by a scar anywhere on your body
• You are physically healthy
• You do not smoke
• You have a positive outlook and realistic goals for your scar revision surgery
• You do not have active acne or other skin diseases in the area to be treated

Ethnicity and Scarring

Skin Color and Scarring

Increasingly in pluralistic social cultures in the western societies people’s outward appearance may not be the best indicator of the inherited ethnicity. Ethnicity plays a significant part of how skin heals from injury or after surgery.

According to a national report in treating skin of color (SOC), expert physicians necessarily should consider not only patients’ desires and skin color. Additionally, and of prime importance is also the consideration of the patient’s ethnicity and history of scarring, post-inflammatory response, hyperpigmentation (PIH) and tanning.

Dr. Elliot Battle is CEO and President of Cultural Dermatology and Laser Center, Washington, and clinical instructor of dermatology, Howard University College of Medicine. He emphasizes that skin color and ethnicity are separate factors. He comments that out of 1,000 people with the identical skin color, “We would most likely have 1,000 different combinations of African, Caucasian, Latin, Spanish, Indian and Asian ethnicities,” he continues, adding that along with skin color, “Those combinations of ethnicities determine how one’s skin reacts to lasers and skin products.”

Understanding this it is important that your dermatologist to cultivate the habit of asking about a patient’s ancestral history — the ethnicity of their parents and grandparents. “We see many patients who might appear to be Caucasian, but one of their parents or grandparents might be a person of color,” he says. “The future of skin treatments will add ethnicity to the criteria for choosing parameters.

When concerned about scarring for any type be certain that your chosen physician has a good understanding of ethnicity and how it effects scarring.

Healing the Scars of War Victims

No single group deals with more debilitating scarring then victims of war; both military and civilians. The decade of wars heralding in the 21st Century has left millions of people suffering from life changing injures. Along with the emotional and tragic psychological scars are the physical scars as a reminder. There are organizations globally seeking to help people who unfortunately suffering from the life lone effects of debilitating human conflict. Share this resource with any person who can benefit.

Thanks the MEDSCAR team.

AFIRM
The Armed Forces Institute of Regenerative Medicine (AFIRM) is a multi-institutional, interdisciplinary network working to develop advanced treatment options for our severely wounded servicemen and women. They develop advanced treatment for severely wounded servicemen and women. This organization is designed to speed the delivery of regenerative medicine therapies to assist the most injured service members. The five major research programs include Burn Repair, Compartment Syndrome Repair, craniofacial Reconstruction, Limb and Digit Salvage, and Scarless Wound Healing.

Air Force Wounded Warrior
The Air Force Wounded Warrior ensures great care, services, and assistance before and after wounded warriors separate or retire. They have a strong emphasis on ensuring wounded airmen individualized guidance and support to help them transition out of the Air Force and back to civilian life. The Air Force Wounded Warrior, working closely with the Secretary of Defense programs, will keep these men and women on active duty.

Iraq Star, Inc.
Iraq Star is a recently founded non-profit organization. It offers surgery for disfigured veterans. Iraq Star recruits plastic surgeons across the country to provide free cosmetic surgery for soldiers who want to fix their deformities including scars.

Scars To Freedom
Scars to Freedom Foundation, provides FREE scar revision to all Military Veterans. This is our way of thanking them for their sacrifice and service for our Country.

New Cosmetic Procedures for Scar Revision

Scarring negatively affects a person’s self image. Advancements in cosmetic procedures surgical and non-surgical provide alternatives in revising hair transplant scars or scars in other areas of the body that have hair.

FUE and SMP Transplant for Scalp Scar Revision
Follicular Unit Extraction (FUE) allows a hair transplant surgeon to individually remove donor grafts without a measure incision in the patient’s scalp. This means a small number of grafts can be used and placed within recipient sits within a scar. This means scars in other places that have hair (eyebrows, pubis etc…) can be treated by transplanting of a small number of follicular units into the scar and on its margins to blend it to the surrounding area.

Scalp Micro-pigmentation is used to simulate stubble hair making it also good for obscuring scars.
Scalp Micro-pigmentation is used to simulate stubble hair making it also good for obscuring scars.

Scalp Micro-Pigmentation
SMP for Scar Revision

Scalp Micro-Pigmentation (SMP) is a non surgical cosmetic procedure that can be used in scar revision. It can works well with scalp scars. Special pigments are injected into the scar. The appearance is like stubble hair. It is injected into the scalp in a manner to obscure the scar or make it blend into the surrounding area.

These more recent advances in cosmetic procedures; FUE and SMP are performed in Los Angeles hair transplant centers like US Hair Restoration.