Surgical Scar Revision: An Overview

Formation of a scar is the inevitable after-effect of wound healing, in which the body naturally replaces the damaged skin. Scars are usually made of fibrous tissue and could be caused because of various reasons including infections, injury, surgery or inflammation of the tissue. Scars serve as proof that a wound has healed; however, they are often unaesthetic and unappealing. Also, in cases, where the surgical procedure was not ideal or there was poor wound healing – scars can be pretty obvious and also quite disfigured. Scars could be noticeable due to their difference in colour from the normal skin tone, size, shape or even the location. In some cases, the scars could even be slightly raised or depressed and may significantly vary from the surrounding skin tissue. They can appear anywhere on the body and can also be painful or itchy in certain situations.

Patients who are unsatisfied with the manifestation of the scar can opt to medically minimize its appearance through a scar revision surgery. A scar revision surgery is a medical procedure which attempts to reduce the scar to the minimum possible so that it is less noticeable and easily blends with the nearby skin tone and texture. It also aims to restore function to the area of the body which was restricted by the scar.

Scar revision surgery can include various forms of procedures depending on the type of scar and the degree of scarring. These procedures include:

  • Topical treatments
  • Minimally invasive methods
  • Advanced wound closure techniques

That said, a scar revision surgery can only minimise the appearance of the scar and make it more aesthetically appealing; however, it cannot completely erase the existence of a scar.

Types of Scars 

Some common types of scars include:

Keloid scars and scar tissue removal: These types of scars are categorized by irregular clusters that are thick, round and tend to appear on the edges of the wound. They are red and distinctly distinguished from the surrounding skin tissue. These scars are formed due to the process of multiplication of skin cells and connective tissue to repair the damage to the area. Keloid scars can appear anywhere on the body and are commonly found on the face, neck, ears, chest or shoulders. These scars can appear even after a year of trauma.

Discolouration, surface irregularities and others: These are typically subtle scars which do not impair function or result in any physical discomfort. These can be easily improved through cosmetic surgery and other treatments as suggested by the plastic surgeon. Such scars include acne marks, minor injury marks or previous surgery incision marks.

Hypertropic scars: These are prominent scars which form directly at the site of the wound and appear as thick clusters of tissue. Generally, such scars tend to be red and tend to increase in size over time. These could either be lighter (hypopigmented) or darker (hyperpigmented) in colour as compared to the surrounding skin and can be slightly uncomfortable.

Contractures: These are the densest form of scars which tend to hamper the free movement of the area concerned. These scars are formed due to pulling together of skin and the scar tissue at the time of healing. Contractures typically occur in cases where there is excessive loss of tissue such as after a burn. In some case, contractures appear where the wound passes through a joint, restricting movement.

The kind of treatment depends on the type of scar.

Procedure and Type of Treatment of Scar Revision

Before beginning the procedure, the patient is administered with local anaesthesia, general anaesthesia or intravenous sedation – depending on the type of treatment method. In some cases, the surgeon may perform two courses of treatment either simultaneously or one after the other. While in other cases, a single technique can prove very useful in improving scar appearance. However, the impact of scar revision treatment depends on the severity of the scarring and also the type, size and the location of the scar.

Some basic techniques of scar revision include:

Topical Treatments: Such types of treatment encompass gels, tapes and external compression devices which help to close the wound and promote healing. These methods are also effective in regularizing the pigment of the scar tissue and the nearby skin; moreover, these reduce the ability of the skin to produce more irregular pigment. These treatments are used for minor scars and in many cases, used as an after therapy of a more intense scar revision treatment method.

Injectable Treatments: As the name goes, this type of treatment required injecting special liquids which help in scar fading such as derma filler which help to fill sunken or concave scars. The results of this treatment depend on the type of liquid injected and scar conditions. In many cases, the doctor can also use steroids to reduce collagen formation in the skin, which will help to alter the scar in terms of size, texture, colour, etc.

Surface Treatments: These treatments mainly aim to enhance the cosmetic appearance of scars by softening the irregularities of the surface and minimizing uneven pigmentation. These treatments also involve removing the top layer of the skin or altering the overall nature of the tissue. Some surface treatment choices include:

  • Dermabrasion is a method to mechanically polish the scarred skin and even its tone
  • Laser or light therapy is used to alter the surface of the scarred skin to promote the growth of new and healthy skin
  • Chemical peeling solutions help to soften irregularities of texture and colour of the scarred skin
  • Skin Bleaching medications are applied on the surface to lighten the dark and scarred skin

In cases involving deeper scars, the surgeon might make an incision to surgically remove the old scar to help the new scar fade.

Z- Plasty: In case of very large scars – where there has been extensive loss of tissue and the movement of muscle, joint or tendon is restricted – the surgeon may perform a Z-plasty to remove the excessive scar tissue. In this method, several small incisions are made on both sides of the scar site to create V-shaped skin flaps, this re-orients the scar enabling it to closely blend with the natural skin folds and loosen up. This leads to a thin, lesser prominent scar ultimately.

Skin Grafting: In this surgical scar revision method, the surgeon uses a thin, healthy layer of skin tissue from another part of the body and puts it over the scarred area. A skin graft procedure involves softening of the entire skin tissue and the mechanism involving nerves, fat, blood vessels and muscles. This technique is primarily used when the event has resulted in a large amount of skin being lost at the time of injury or accident. Moreover, in a case when the actual aim of the surgery is to not enhance the appearance but improve the function.

Apart from these are other scar revision methods which are used depending per case in terms of severity and type of scarring.