Scar revision is surgery to improve or reduce the appearance of scars. It also restores function, and corrects skin changes (disfigurement) caused by an injury, wound, or previous surgery.
Keloid revision; Hypertrophic scar revision; Scar repair; Z-plasty; Tissue expansion
Scar tissue forms as skin heals after an injury (such as an accident) or surgery. The amount of scarring may be determined by the wound size, depth, and location; the person's age; heredity; and skin characteristics including color (pigmentation).
Depending on the the extent of the surgery, scar revision can be done while you are awake (local anesthesia), sleeping (sedated), or deep asleep and pain-free (general anesthesia).
Medications (topical corticosteroids, anesthetic ointments, and antihistamine creams) can reduce the symptoms of itching and tenderness. A treatment called silicone gel sheeting or ointment has been shown to benefit swollen, hypertrophic scars. There is no evidence showing that any other topical (applied directly to the scar) treatment works. In fact, Vitamin E applied directly to the skin may actually cause the wound to heal more slowly and may cause irritation.
When to have scar revision done is not always clear. Scars shrink and become less noticeable as they age. You may be able to wait for surgical revision until the scar lightens in color, which can be several months or even a year after the wound has healed. For some scars, however, it is best to have revision surgery 60-90 days after the scar matures.
There are several ways to improve the appearance of scars:
Problems that may indicate a need for scar revision include:
Risks for any anesthesia are:
Risks for any surgery are:
Exposing the scar to too much sun may cause it to darken, which could interfere with future revision.
For keloid revision, a pressure or elastic dressing may be placed over the area after the operation to prevent the keloid from coming back.
For other types of scar revision, a light dressing is applied. Stitches are usually removed in 3 to 4 days for the facial area, and in 5 to 7 days for incisions on other parts of the body.
When you return to normal activities and work depends on the type, degree, and location of the surgery. Most people can resume normal activities soon after surgery. Doctors usually recommend that you avoid activities that stretch and may widen the new scar.
If you have long-term stiffening of the joint, you may need physical therapy in addition to surgery to restore full function.
Avoid exposure to the sun for several months after treatment. Use sunblock or a dressing (such as a Band-Aid) to keep the sun from permanently tanning the healing scar.
No scar can be removed completely. How much the scar improves will depend on the direction and size of the scar, the age of the person, the skin type and color, and hereditary factors that may affect the healing process.
Thomas JR, Mobley SR. Scar revision and camouflage. In: Cummings CW, Flint PW, Haughey BH, Robbins KT, Thomas JR, eds. Otolaryngology: Head & Neck Surgery. 4th ed. Philadelphia, Pa: Mosby Elsevier; 2005: chap 24.
Zurada JM, Kriegel D, Davis IC. Topical treatments for hypertrophic scars. J Am Acad Dermatol. 2006;55(6).