Scar formation is part of the body’s natural healing process after the skin has been cut or damaged. After an initial phase of healing, scars usually fade but they do remain permanent and visible to some degree. Some scars heal better than others. Troublesome scars can be thick or painful and can cause emotional and physical distress because of their appearance or location.
- Significantly change a person’s appearance
- Are painful, itchy or inflamed
- Inhibit the ability to move
Aesthetic plastic surgeons may use a range of surgical and non-surgical techniques to improve your appearance and decrease any physical discomfort related to scars. A good surgeon will listen to your concerns and discuss which procedures would be best for you.
Dr. Ginger Xu uses her extensive technical training to give you the best results possible. Dr. Xu is a board-certified plastic surgeon with specialty training in aesthetic plastic surgery from Harvard. She is now based in the San Francisco Bay area.
Scar revision procedures cannot completely erase scars but will improve a person’s appearance and function by removing an old problematic scar and replacing it with a less noticeable scar. The surgeon’s aim is to make the scarred area less obvious and eliminate pain or irritation. There are many possible surgical and non-surgical techniques for scar revision and your surgeon can recommend the best approach to suit your situation.
Many women seek revision of cesarean section delivery (C-section) scars, which can appear distorted with puckering of surrounding skin and tissue. The location and appearance of these scars on the abdominal area can cause emotional distress and impact self-esteem. Some C-section wounds are deliberately left open because of the possibility of infection (also known as “healing by secondary intention”). These wounds heal slowly and in a less controlled way, resulting in more inflammation and a thicker scar.
Aesthetic plastic surgeons can treat a range of other types of scars including:
- Abdominal scars from major surgery such as appendectomies
- Scars from traumatic injury that may have healed poorly due to the chaotic nature of the initial wound, causing inflammation and resulting in thicker scars
- Facial scars from accidents or severe acne
- Scars from previous surgeries or plastic surgery that did not heal well
People seek advice about scar revision for a range of scar types including:
- Hypertrophic scars – raised and red scars that are often painful
- Keloid scars – raised and red scars that can grow beyond the edges of the original wound and may be itchy
- Contractures – scars that pull the skin and underlying tissue together and can restrict movement – these are more common after burns
- Facial scars – these can negatively impact self-esteem because they are in an obvious location on a person’s face
People are good candidates for scar revision if they:
- Have a scar that initially healed poorly due to conditions that can now be controlled or changed
- Have an idea of what they would like to achieve with their surgery
- Have realistic goals for what can be achieved with the procedures
- Understand what the procedures involve
- Are non-smokers or have not smoked for six weeks or more – smoking affects wound healing
Although scar revision has the potential to dramatically improve the appearance of scars, there is no guarantee of how the new scar will heal. There are many possible techniques for scar revision. Each technique has the potential to give different results depending on your original scar and your skin type.
During a consultation, Dr. Xu can recommend the best technique for you after she examines you and has a good understanding of your concerns. She will also give you careful instructions about how to care for your skin after the procedure, which is crucial to give the best possible results.
When a scar begins to appear thickened or show concerning signs of hypertrophic or keloid scar formation, a steroid injection is often the first step to stop or reverse this process. A dose of steroid medication is injected using a small needle inserted directly into the scar. There is usually improvement seen, especially when caught early, and the treatment can be repeated over time.
Laser treatment is a non-surgical option that uses laser energy to remodel scar tissue at very precise locations and skin depths. Laser scar revision can help the appearance of dark or thick scars but this also depends on your skin type.
Direct scar excision is the most common way to revise a scar. The original scar is cut out and the surgical incision is carefully closed using stitching techniques that minimize tension on the skin and stabilize the wound. This gives the body a new chance at healing and forming a less perceptible scar under more ideal, controlled conditions.
Fat can be taken from another part of your body and injected into an area of scarring to improve the contour and skin quality. This is beneficial when there is an indentation surrounding the scar due to prior trauma and loss of fat. Stem cells from the fat can also encourage tissue regeneration and improve the overall skin texture.
Z-Plasty or W-Plasty are soft tissue rearrangement techniques that are useful for scars that are tight, tethered or contracted (eg. for burn scars). These may leave more scar marks but improve the overall appearance by changing the shape of the skin and the tension across the scar.
Skin grafts and skin flaps are more complex surgical procedures. They replace damaged skin in larger scarred areas that may have contracted and affect the ability to move. This can occur after traumatic injuries such as burns.
Skin grafting involves totally removing a piece of healthy skin from another part of the body and placing it over the area where scar tissue has been removed.
Flap surgery also moves healthy tissue to a scar site. For flap surgery, the flap of skin is not totally detached from the healthy site but remains attached to fat tissue, blood vessels and sometimes muscle.
All scars are permanent and even scar revision techniques cannot completely erase scars. The aim of scar revision is to have the new scars heal in a controlled way so that when they fade, they will become far less noticeable.
Scar revisions are more likely to create a dramatic improvement where the original scar was poorly formed because of problems at the time of healing (eg. infection, open wound, wound separation). During scar revision, the focus is on creating ideal healing conditions for the revised scar.
Like all scars, the revised scar will be inflamed and raised during the early phases of healing, with maximum inflammation at six weeks. The scar will continue healing and remodeling for up to 18 months, at which time it will be much more faded.
The final appearance of scars cannot be exactly predicted because genetics, skin type and skin color all play a role in healing. In some cases, scar revision may not improve the appearance of a scar.
You and your surgeon must communicate and work together so you have a good understanding of the process that will give you the best results. The goal of a good surgeon should be to arm you with the knowledge to understand the factors affecting your scar revision.
Dr. Xu can discuss how your age, skin type, and health affects the choice of technique and the results you can achieve.
It is important you have a realistic understanding of:
- How your skin may look after treatment
- The limitations of the procedure
- Any short- and long-term effects such as scarring
- Any possible complications
- The potential need for more scar treatment
People have different levels of scarring they can tolerate. Dr. Xu can explain which technique she would recommend for your situation and whether your scar is likely to be improved by revision.
Dr. Xu encourages open and honest communication about your body, your lifestyle and what you want for the future. Your medical history is also important and any information regarding your medical conditions should be openly discussed.
Things to also discuss with Dr. Xu include:
- Why you want scar revision
- Your future lifestyle goals
- What appearance you hope to achieve
Dr. Xu understands the responsibility of transforming a person’s appearance to better reflect their identity and build self-esteem. Her top priority is understanding your vision and concerns.
Once Dr. Xu has examined your skin, she will use her technical expertise to recommend an approach to your surgery that will best suit your goals.
During a consultation, Dr. Xu will explain:
- Whether you should pursue scar revision
- The likelihood that scar revision will improve the condition of your scar
- The different types of scar revision procedures
- Which scar revision procedure would best suit your needs
- What types of incisions or other treatments will be needed
- Any need for further procedures
- Potential complications or side effects
Once you and Dr. Xu have agreed on an approach to your surgery, Dr. Xu will book your surgery time and give you instructions on what to do before and after your surgery.
Dr. Xu will also let you know which medications you should and should not take prior to your surgery and what to do on the day of your surgery. It is important to stop smoking at least six weeks prior to surgery.
You may need to get a blood test or undergo additional testing depending on your medical history. Dr. Xu may also correspond with your primary care doctor to ensure you are in an optimal state of health prior to surgery.
In the weeks before surgery, recommendations to help you prepare include:
- Making sure you get enough sleep and rest
- Eating a healthy diet with adequate protein and nutrition
- Exercising or engaging in physical activity to strengthen your body
- Maintaining a positive state of mind
- Prioritizing your well-being and reducing stress levels
It is essential that you feel comfortable about your upcoming procedure and fully understand the process. Dr. Xu encourages her patients to ask any questions about their surgery or recovery.
After scar revision surgery, you will feel mild to moderate discomfort. The amount of pain you feel depends on a number of factors such as:
- The type of scar revision procedure used
- Your age
- Your health before the surgery
Prescription pain medications might be needed for the first few days. After this time, any pain should be relieved with over-the-counter or non-opioid medications.
Recovery time depends upon the size of the treated area and the technique used. Ask Dr. Xu when you can return to work and return to a full range of activities. You should follow Dr. Xu’s instructions regarding care of the wound as this is crucial to achieving the best possible result. During recovery, you should avoid:
- Stretching or disrupting the wound
- Putting any tension on the wound
- Exposing your wound to the sun
Scar healing is a slow process and can take up to 18 months for full outcomes.
The healing of scars is affected by many factors including:
- Size and severity of the initial injury
- Tension across the scar over time
- Exposure to the sun or chronic irritation
- Inherited skin condition
- Ethnic background
- Skin color
- Medical conditions – eg. diabetes
- Complications during healing – infection, wound separation
The risks related to some of these factors can be decreased by following your surgeon’s instructions after surgery or other treatments.
You should allow up to 18 months after full healing of the original scar. Scars need this amount of time to fully mature and remodel. After this time, you and your surgeon will have a better idea of how to best treat your scar.
Your risk for complications will depend on your skin type and the specific technique used. Dr. Xu will make you aware of these before you have a procedure. The risk of some common complications (such as infection, bleeding, and wound separation) can be decreased by following your doctor’s post-surgery instructions.
Potential complications after scar revision include:
- Bleeding or hematoma (a collection of blood)
- Seroma (fluid collection) requiring drainage procedures later
- Wound separation or breakdown
- Lack of improvement after the scar revision procedure
- Recurrence or worsening of unfavorable scarring
- The potential need for additional revision surgery to obtain your desired result
- Chronic pain
- Suture irritation or extrusion
The cost of scar revision will depend on the extent of surgery and the type of scar revision technique used.
The best way to understand the costs of the procedure or surgery is to schedule a consultation with Dr. Xu, a board-certified plastic surgeon.
Many people are unaware of the full scope and possibilities of plastic surgery. Dr. Xu will listen to your vision for your body, review the treatment options available to you, and advise you of an optimal surgical plan to best meet your needs.