We are often able to improve the appearance of raised or disfiguring scars with well-planned and carefully executed facial plastic surgery. Scar tissue formation is a natural result of wound healing. Any break of the skin, for whatever reason, will result in a scar. Trauma, infection, acne or a poorly repaired wound may result in a thickened, prominent scar.
The purpose of scar revision is to replace an unsightly or disfiguring scar. Ideally, the result is a thin scar, level with the surrounding skin. The final appearance of the scar is dependent on many factors, most important your own healing capability.
The Procedure
The skin incisions are carefully marked prior to removal of the scar. We attempt to place these incisions in natural skin creases, in areas that can be readily camouflaged, or along lines of “minimal skin tension.” Depending upon the nature and extent of the scar, the repair will require ½ to 2 hours. Scar revision in adults is usually performed in the office under local anesthesia with light sedation. For children, the procedure is performed in the hospital.
Post-operative Care
Most often we will apply a tape dressing over the scar revision area. You should maintain this dressing for one week, at which time we will remove the tape and the sutures.
On occasion, we will not place a dressing over the scar revision area (especially around the eyes, nasal crease, or mouth). In these instances, we ask that you clean the suture line with hydrogen peroxide and a Q-Tip three to four times per day. This should be followed with the application of Vaseline or an antibiotic ointment to keep the sutures and incisions soft and moist.
Once the sutures have been removed, you should cleanse the scar revision daily with mild soap and water. You will note that the scar will initially be hard, red and slightly raised. This will subside over the next six weeks to three months. Full maturation of the scar will require at least one year.
You may apply cosmetics after 10 days to camouflage the scar revision. We will ask you to follow-up with us periodically over the first year so that we can monitor your healing.
Limitations
Patients are occasionally disappointed with the immediate results of scar revision. You will need to be patient. It takes time for the scar to become soft, white and level with the surrounding skin. On occasion, healing of the scar will be encouraged with massage, skin dressings, and/or cortisone injections.
Laserbrasion may be required six weeks to three months following the scar revision to improve blending of the scar with the adjacent tissue. Large scars may require multiple operations in order to excise and reorient the scar into the least conspicuous position.
Finally
The goal of scar revision must be improvement, not perfection. A facial plastic surgeon cannot remove a scar entirely, but he can replace a disfiguring mark with a less conspicuous one.