Scar Revision

Injuries to the facial soft tissues inevitably produce some measure of scar formation. Superficial, partial-thickness injuries, otherwise known as abrasions, often heal quite well through supportive wound cares with antibiotic-based ointments and moisturizing ointments. Deeper, full-thickness injuries are referred to as lacerations or avulsions; these injuries can result in a discernible scar despite the best efforts of the health care provider undertaking the initial repair.

Is this surgery right for you?

"Ideal" scars are thin, faint, flat, and smooth. Perhaps most important, the "ideal" scar is also imperceptible to the casual observer. Conversely, unattractive scars are wide, elevated/raised, firm, hypo- or hyper-pigmented (discolored), and rough. These scars may attract undue attention and may cause the bearer to become uncomfortably self-conscious. When some of these less desirable features of a scar arise, scar revision procedures can be considered. While suboptimal scars cannot be completely erased, scar revision surgery can oftentimes render dramatic improvements. During the initial consultation, your surgeon will discuss methods to optimize the appearance of your facial scars.

Pre-Surgical Consultation

During the pre-surgical consultation, a detailed examination of the scar is performed. A comprehensive plan, customized to address each patient's cosmetic and functional concerns, is developed and carefully explained.

Surgical Approaches

Lasers can reduce persistent erythema (redness) associated with a scar. Laser therapy is performed in the office. Anesthesia is typically not required, and there is essentially no "down time" expected following the procedure. Several sessions may be required to produce optimal results.

Textural and contour irregularities (such as elevated or hypertrophic scars) can be improved with both lasers and dermabrasion. Laser therapy in this circumstance is administered in the office under topical and sometimes local anesthesia. Dermabrasion improves textural irregularities through the controlled removal of the outermost layers of skin. Depending on the size of the area to be treated, dermabrasion can either be performed in the office or in the operating room. Laser therapy and dermabrasion can each be used independently or in combination with additional scar revision techniques.

In selected circumstances, suboptimal scars may be completely surgically excised (removed) and then immediately repaired with a number of reconstructive techniques. In addition to narrowing the width and improving the contour of scars, these techniques can camouflage scars through the principles of irregularization and re-orientation. Re-orientation methods are designed to place scars parallel to existing facial wrinkles and parallel to creases that the human eye expects to see during normal facial expression. For example, it is oftentimes preferable to reposition scars to lie vertically in the lips, where they can blend with existing philtral ridges and "lipstick lines." Irregularization methods are designed to disrupt long, continuous, straight scars, to which the eye is attracted. Running W-plasty and geometric broken line closures are two techniques that can effectively disrupt scar continuity and thereby reduce undue attention. These reconstructive techniques are performed in either the office or the operating room, depending on the complexity of the repair. Your surgeon will work with you to determine which venue will maximize your comfort. Patients are then closely followed post-operatively to ensure that healing proceeds as well as possible.