The degree of improvement that can be achieved with scar revision and the type of scar reduction treatment plan that will be recommended will depend on the severity of your scarring, and the type, size and location of the scar.
Surface treatments are most often used for cosmetic improvement of scars. These methods can soften surface irregularities and reduce uneven pigmentation. Surface treatments mechanically remove the top layers of skin or change the nature of the scar tissue. These treatment options include:
- Topical treatments, such as gels, tapes or external compression, which can help in wound closure and healing, or reduce the ability of skin to produce irregular pigment or hypertrophic scarring. These products may be used to treat existing surface scars and discoloration, and to aid in healing of scar revision procedures. Skin bleaching agents are medications applied topically to lighten the skin
- Injectable treatments are often used to fill depressed or concave scars. One form of injection therapy uses steroidal-based compounds to reduce collagen formation and can alter the appearance, size and texture of raised scar tissue
- Chemical peel solutions penetrate the skin's surface to soften irregularities in texture and color
- Dermabrasion is a mechanical buffing of the skin to smooth scar tissue
- Laser or light therapy scar reduction techniques cause changes to the surface of the skin that allow new, healthy skin to form at the scar site
Surgical scar revision procedures to diminish scars and improve appearance include:
- Skin grafts which involves removing healthy skin from other areas of your body, such as the abdomen or thigh, to revise a scar
- Pharmaceutical tissue substitutes, such as artificial dermis or injectable collagen may be used if ample healthy tissue is not present for closure of a scar excision
- Tissue expansion involves the use of an inflatable balloon called a tissue expander which is placed under the skin near the scar site to stretch additional skin to be used to revise a scar. Once the skin is sufficiently stretched the expander and the scar is removed
- Z-plasty or W-plasty are surgical technique that creates angled flaps on either side of the original scar site that reposition or change scar direction, interrupt scar tension or improve scar flexibility. These techniques can redirect scars to conceal them in natural lines or creases
- Advanced techniques in scar revision include complex flap closure to reposition a scar so that it is less conspicuous, or improve flexibility where contracture has restricted mobility. Sometimes depressed scars will need to be released from deeper scar tissue to correct puckering or dimpling
In many cases, a single technique may provide significant improvement. However, your plastic surgeon may recommend a combination of non-surgical and surgical scar revision techniques to achieve the best results.
Scar revisions may be performed as an office procedure, out patient procedure or in-patient depending on the severity and type of scar. Surgical scar revisions are performed under local, intravenous sedation, regional or general anesthesia.