Scar Revision

The severity of a scar depends on many variables. A scar may develop an undesired appearance as a result of blood supply to the area as it heals, the depth of the wound, or the color and thickness of the skin. Additionally, the way a wound is closed initially as well as the way it heals, contribute to its appearance.

Revising can make a scar less noticeable. Several types of scars respond well to revision procedures:

• Keloid scars – scar tissue that forms in a thick, puckered form and may be itchy. Keloids occur when the body continues to produce a fibrous protein after the wound heals. The keloid grows beyond the edge of the wound itself and may be red or darker than the surrounding skin.
• Hypertrophic scars – similar to keloids, hypertrophic scars are thick, red and raised above the skin, but reman within the outline of the original incision.
• Contractures – occur when a large area of skin is lost, such as with a burn, and the skin pulls together to close the wound. This closure often impacts the adjustment of muscles and may restrict movement.

The procedure:

• Keloid and hypertrophic scars are corrected either by the injection of a steroid medication into the scar or the surgical removal of the scar tissue and re-closure of the wound. The steroid medication may effectively alleviate the itching and redness, and in some cases may lessen the size of the scar. Steroid medication and removal may be used in combination to discourage the development of new keloids or hypertrophic scars.
• Contractures are often corrected with a skin graft or tissue expanders.
• Facial scars are corrected by cutting out the undesired scar and closing the incision with delicate stitches to create a thinner, less noticeable scar.
• A Z-Plasty repositions a scar to make it less noticeable by aligning it with natural lines in the skin. A Z-Plasty may also be used to loosen a contracture as an alternative to a skin graft. The scar is removed by making incisions on each side of the scar creating small, triangular skin flaps. The flaps are arranged to cover the wound in a z-shaped pattern.

Healing process:

Scars will not disappear completely but will become less noticeable and more tolerable in appearance as the revision heals.