¬ Scar Revision

As a result of  trauma and injury scar can remain in various degree. While some scars are subtle, some of them become raised, widen, disfiguring  and visible. Especially, scars on some parts of the body such as arms, face, neck  are much more detectable. Being subjected to questions  relating to scars all the time and being obliged to answer them can cause psychological problems to the patient. Unfortunately, blade scars made in the childhood and teenage years on arms can be more noticeable. On the other hand they may result in an unsightly outlook. This may impair self-esteem and damage quality of life. 

Type of injury or incision is important in scar formation. While a straight and smooth incision may leave a more acceptable scar, on the other hand potentially traumas and injuries like crushing and friction may leave irregular and raised scars .

Scar also has relation with age. Generally, in the childhood associated to skin elasticity scar remains less whereas adults may experience worse.

Degree of scar may vary depending upon the part of one’s body. For instance; as the skin on eyelids is very thin  it is a region  where a scar is subtle or insconspicous but back,chest and shoulders are the regions that are prone to unsightly scars. The reason is for that is associated to muscles’structure there is more tighteness. . Scar is less likely observable which remains on thin skin area because there is less tighteness.

Another factor affecting the scar negatively is the sun exposure in the initial healing process. Sun light may cause connective tissue to escalate in the scar and discoloration. Scar is also associated with genetic factors. Sometimes scar revision might be avoided in the patients for familial reasons. Similarly,  patient who has an unsightly scar as a result of the past surgery should be evaluated carefully. Another indicator is the scar after vaccination. If scar remained after vaccine is unusual patient should be warned.

A relatively good scar may be described as ;thin, skin coloured, not raised,not itchy, and not painful. Also, scar should be parallel to natural skin lines. Unattractive scar may be described as; raised, reddish, itchy, conspicous ,wide and hard. Generally scar develops redness in the eraly stage then gradually colour improves and hardness reduces. After 6 months  and up to a year if  the scar still remains red, raised and thick  the operation decision should be taken after a detailed evaluation.

A scar can not be cleared up completely  no matter which treatment technique is used. It may only be optimized. In some areas it may be concealed or made less remarkable. If a surgical method is determined for  a scar revision it may be performed under local or general anesthesia.

Scar revision is being performed frequently by plastic surgeons.Despite the advances in the science of medicine and  the various treatment techniques, scars remain permanent.A plastic surgeon can minimize the appearance of scar by scar revision. For this reason, various methods in scar revision are defined.

What is required for preventing a scar to be formed?

After a  surgery or a trauma determining diagnosis and initiating the treatment as soon as possible is strictly advised. The main approach involves gently making aesthetic sutures and  appropriate scar care to prevent infection. Another crucial step is to avoid sun exposure. If there is red and raised scar it is called as immatur or uncompleted hypertrophic scar .It is often hard to anticipate whether it will turn into a hypertrophic scar or not. If redness continues more than 1 month, probably it will become a linear hypertrophic scar which means scar. In this instance pulse dye laser and following treatments are important and useful.A silicon gel layer or cream application will help reduce the tighteness and if necessary steroid injection and compress application can be started. That is why to keep contact with surgeon is ver y important and regular follow-up visits after the surgery.

What can be done to treat scar? 

In the early phase as mentioned above silicon gel layer or cream application if necessary steroid injection and local compress are the first treatment options.

Also in the late stages, the surgical procedure can be performed if found necessary. Scar revision surgeries include scar excision; involves  cutting out the scar and closing the incision, dermabrasion; involves treating the top layer of skin ,z-plasty; involves cutting the scar in  Z or W pattern to relocate in the natural folds of body and skin grafting; involves ttaking the healthy sking and and cover the scar tissue  .The main goal is to minimize the appearance of scar and make less noticeable and acceptable like in the instance of blade scar. Scar revision surgery  or scar treatment should be performed after wound healing. That may continue 3 months to 1 year. In scar revision fat or filler injections also help reduce the appearance of  concave scars.

What should I do after surgical scar revision?

After surgery the opearated area is covered with a special dressing and should be kept dry  for while.  Frequency of changing the dressing will be notified by your surgeon.After surgical scar revision or scar revision to reduce tightness of tisue and to support special bands can be placed. If the procedure is performed on arms or legs having a rest is advised.

Removal date of sutures will be notified. It often ends with a worse scar when removed earlier.

Feeling pain and tighteness is common after the surgery. Üçüncü günden sonra bir rahatlama olması beklenir. On the third day following surgery ytou will relieve.. 3-4th day post-op you should be warned about a leakage from the scar, redness and sensitivity .You are required to see your surgeon in this case.

The first 3-4 th month  after surgery scar will be in its worst appearance. At this point you should follow the instructions strictly, take the precautions mentioned and  avoid skipping follow-up visits . 

Prof. Dr. Muhitdin Eski