When the skin is in the process of recovering from an injury, whether the result of an accident, surgery, a burn, or acne, scarring will occur wherever multiple layers of the skin have been affected. Once a scar forms, it is permanent but may be made less visible or relocated surgically.

With very few exceptions most people are self-conscious about facial scars. Some people may also experience diminished functioning of the eyes, mouth, or nose due to scarring. If you've wondered how facial scar revision could improve your appearance, your self-confidence, or your level of facial functioning, you need to know how scar revision works and what you can expect from this procedure.

Candidacy

The most basic requirement for all surgery is good health. Other requirements are more subtle and should be carefully considered in discussion with your surgeon. Expectations of the surgery and of the surgeon must be realistic. A person considering facial scar revision must understand that there is no way to remove scars completely. The goal is to improve the appearance of the scar either by disguising it, relocating it, or minimizing its prominence. Skin color and type, age, and the type of scarring, are all important factors that must be part of the discussion prior to surgery.

Different types of scars respond to different plastic surgery techniques. Timing of surgery is another important choice. Some surgeons advise against any scar revision in cases of injury for a period that might extend up to a year after the injury. This interval allows the body enough time to heal fully.

Making the decision for treatment

Whether the surgery is desired for functional or cosmetic reasons, your choice of a facial plastic surgeon is of paramount importance. Your surgeon will examine the scar in order to decide upon the proper treatment and inform you of outcomes that can be expected from facial scar revision surgery.

Different scars require different treatments. For example, severe burns that destroy large sections of skin cause the skin to heal in a puckered way. As the skin heals, muscles and tendons may be affected in this "contracting" movement. Keloid scars are a result of the skin's overproduction of collagen after a wound has healed. These scars generally appear as growths in the scar site. hypertrophy scars, unlike keloids, do not grow out of the boundaries of the scar area, but because of their thick, raised texture, can be unsightly and may also restrict the natural movement of muscles and tendons.

Some facial scars are unattractive simply because of where they appear on the face, while others affect facial expressions. All surgical possibilities will be discussed in the initial consultation along with risks involved for each type of scarring. The agreement between you and your surgeon on how to proceed is a prerequisite for successful surgery. After you both decide to proceed with scar revision, your surgeon will inform you about the anesthesia, the surgical facility, any supportive surgery options, and costs.

Because scars are highly individualistic and the patient's attitude toward scars is so personal, maximum improvement in facial scars may require more than one procedure, and more than one technique may be employed.

Keloids and hypertrophic scars

Scars such as keloids and hypertrophic scars sometimes respond to steroid treatment or Silicone gel therapy. If that fails, a plastic surgeon can attempt to remove the scar tissue surgically. Because these scars can be stubborn, your plastic surgeon may treat them steroid injections during surgery.

Contractures

When a large area of skin is injured, particularly due to burns, the skin tends to pull together or pucker. This type of scar tissue is called contractures. Not only is the scar unsightly, but also muscle and tendon movement may be restricted because of contractures. Treating contractures typically involves removing the scar tissue and replacing it with healthy skin flaps or skin grafts. Particularly when muscle function of a scarred area is affected, skin grafting and flap surgery usually can offer the best results. In some cases, tissue expansion or a procedure called Z-plasty may be used.

Dermabrasion or laser resurfacing

Dermabrasion or laser resurfacing may be used to improve facial scars. Both techniques serve to remove the superficial layer of the skin and flatten or plane down a raised scar. Laser resurfacing of a scar appears to work best when the scar is treated early or even at the time of wound closure. Both dermabrasion and laser resurfacing cause redness that resolves over time, sometimes taking months to fade.

Z-Plasty

Z-plasty is a surgical technique most commonly used to change the direction of a scar and, therefore, make the scar less visible. Scars that lie in the lines of facial expression tend to be less visible than scars that cross these lines of facial expression. The Z-plasty is used to put these scars in the lines of facial expression. While this will not make the scar disappear, it often makes the scar less visible and minor in nature.

Skin grafting and flap surgery

Skin grafting is used to correct scar Contractures or to close large areas of skin deficit such as burn scars. The skin graft is performed more for functional purposes (that is, to release the scar contracture), than it is to improve appearance. Split-thickness skin grafts are used to cover very large areas. In such cases, these grafts are usually taken from the thigh. For extensive burns, however, skin grafts may be needed for many areas. Full-thickness skin grafts are used to cover smaller areas where color match is important such as the nose, eyelid or other areas of the face.

Flap surgery

Flap surgery is used to bring in healthy tissue to an area of skin loss. A flap will undergo less contraction than a skin graft. It also provides better soft tissue cover and match for the reconstructed area. However, the surgery does leave scars in the flap donor site.

Tissue expansion

Tissue expansion employs saline-filled implants to stretch areas of skin so that it can later be used as a flap. A temporary expandable implant, or balloon, is placed under the skin. The balloon is gradually expanded using saline, or salt water (Expansion could take up to several months depending upon the size of the area to be corrected). Once the skin over the expander has been stretched enough, the expander is removed, and the flap procedure can be performed.

Tissue expansion offers several advantages. The match of skin is nearly perfect; the success rate is high because the skin retains its own blood and nerve supply; and scarring is reduced. The downside is that while the skin is undergoing expansion, the patient has a temporary swelling at the repair site.

Frequently asked questions?

What is the risk?

All surgeries carry a certain degree of risk. Although rare, risks associated with scar revision include infection and bleeding. It is also possible that the improvement in the scar is less than one may have hoped for. Improvement cannot be guaranteed.

What to expect after the surgery?

You can expect to feel some discomfort after facial scar revision surgery. Some swelling, bruising and redness are generally unavoidable. It is important for you to follow your surgeon's after care recommendations .Though the sutures will be removed within days after the surgery, your skin needs time to heal. Surgeons generally insist on decreased activity after surgery and instruct the patient to keep the head elevated when lying down, to use cold compresses to reduce swelling, and to avoid any activity that places undue stress on the area of the incision. Depending on the surgery performed and the site of the scar, the facial plastic surgeon will explain the types of activities to avoid. No medication should be taken without first consulting the surgeon. It is important to remember that scar tissues require a year or more to fully heal and achieve maximum improved appearance.

Facial plastic surgery makes it possible to correct facial flaws that can undermine self-confidence. Changing how your scar looks can help. It changes how you feel about yourself.

What types of scar revision surgery are available?

When a scar is of the contracture type, surgery generally involves removing the scar tissue entirely. Skin flaps, composed of adjacent healthy, unscarred skin, are then lifted and moved to form a new incision line. Where a flap is not possible, a skin graft may be used. A graft involves taking a section of skin tissue from one area and attaching it to another, and time must be allowed following surgery for new blood vessels and soft tissue to form. Z-plasty is a method to move a scar from one area to another, usually into a natural fold or crease in the skin to minimize its visibility. While Z-plasty does not remove all signs of a scar, it does make it less noticeable.

Dermabrasion and laser resurfacing are methods a surgeon uses to make "rough or elevated" scars less prominent, by removing part of the upper layers of skin with an abrading tool or laser light. Clearly, the scar will remain, but it will be smoother and less visible.

Keloid or hypertropic scars are often treated first with infections of steroids to reduce size. If this is not satisfactory, the scars can be removed surgically. And the incisions closed with fine stitches, often resulting in less prominent scars.

What can I expect after scar revision surgery?

You can expect to feel some discomfort after facial scar revision surgery. Some swelling, bruising and redness are generally unavoidable. It is important for you to follow your surgeon's after care recommendations to the letter.

Though the sutures will be removed within days after the surgery, your skin needs time to heal. Surgeons generally insist on decreased activity after surgery and will instruct you to keep your head elevated when lying down, to use cold compresses to reduce swelling, and to avoid any activity that places undue stress on the area of the incision. Depending on the surgery performed and the site of the scar, the facial plastic surgeon will explain the types of activities to avoid.

No medication should be taken without first consulting the surgeon. It is important to remember that scar tissues require a year or more to fully heal and achieve maximum improved appearance.