Scar Revision

Scar Revision

Introduction:

Scars can be unsightly, disfiguring and embarrassing. Facial scars may be particularly problematic. Scars elsewhere on the body can at least be covered by clothing but can still be embarrassing. In general females will be more embarrassed by scars than males. In children scars may be psychologically disturbing and lead to teasing and bullying.

Causes of Scars:

  1. Birth defects
  2. Trauma – accidents and other injuries
  3. Surgical operations

Treatment:

Treatment options for scars are as follows:

No  Intervention – Monitor

All scars improve spontaneously with the passage of time. The rate of improvement may be very slow, therefore you must be patient. It is however remarkable how time and nature improve scars. Therefore it is important not to opt for premature surgery before nature has had a chance to work. You can assist nature by carrying out various conservative measures:

  1. Massage
  2. Silicone gel
  3. Elastic compression
  4. Laser – can reduce the redness in scars
Steroid Injection

This may be used to treat overly active scars. Two or even three injections may be required over a period of three to six months to make a difference. Scars sometimes fail to respond to steroid injections.

Surgical Revision

Surgical revision of scars is indicated when

  1. Time and nature have failed to improve a scar.
  2. Conservative measures have failed.
  3. It is clear from the outset that time alone will not improve the scar.
  4. A scar affects the workings and movement of a vital structure such as the eye, lips or fingers.

The Procedure:

Revision of most scars can be carried out under local anaesthetic as an outpatient. Larger scars may require sedation in addition to the local anaesthetic. Occasionally a general anaesthetic may be required. Surgery usually entails excision of the old scar and careful repair of the tissues and skin in a manner which reduces the risk of an unsightly or troublesome scar developing again.

I use dissolving sutures under the skin which cannot be seen and do not need to be removed. In the face skin stitches are used and are removed after about five to seven days. Approximation of the skin edges is reinforced with steri-strips.

Aftercare and Recovery:

The use of long lasting local anaesthetic ensures post operative discomfort will be slight and controlled or relieved by simple pain relief – I advise my patients to use the painkiller that works best for them i.e. what they would normally take for headache. Skin sutures will be removed five to seven days post operatively. After three weeks you will begin gentle massage of the scar using a simple skin lubricant such as E45 or Vaseline.

Many patients ask about creams such as Vitamin E cream, Bio Oil, Arnica and others. There is no clear scientific evidence that these skin applications and indeed many others on the market today possess special healing powers. They are not prescribed medicinal compounds therefore they have not been subjected to the rigorous controlled testing which is standard for prescribed drugs. However I would not dismiss their value, bearing in mind that many individuals worldwide attest to their special benefits. Many of my own patients speak convincingly of these preparations. I am therefore very happy to advise my clients to use Arnica and similar herbicidal / homeopathic applications as skin lubricants.

Scar massage must continue for months to derive the benefits of this technique. You must be patient. Massage however is a simple manoeuvre that can be carried out on a daily / regular basis in your own home. If you look at your scar on a daily or regular basis you may fail to appreciate the improvement that takes place over a longer period of time. Therefore I obtain serial photographs to demonstrate the gradual improvement in a scar with the passage of time.

The second technique that is very helpful is elastic compression. This technique like massage will help to keep the scar flat, soft and pale. A raised lumpy and red scar is what tends to form naturally unless steps are taken to prevent this outcome.

It is important to understand that it may take twelve to twenty four months for a scar to mature fully following surgery and sometimes longer. Patience is therefore essential.