Scar Treatment Procedure
Scarring is the natural process of the body repairing a surgical wound or incision. Acne scars can occur after an acne lesion heals. Scar tissue can be red or brown in color and can sometimes have a raised texture and restrict movement. Scars are especially prominent after surgery to the ears, nose and throat. Cosmetic scar revision surgery is performed to remove or reduce the prominence of scars.
Your doctor will evaluate your scars and discuss appropriate treatment depending on the extent and location of the scar, your skin type, color, age, ethnic background and rate of healing. The outcomes of different treatments are discussed as well as your expectations. Your doctor may recommend waiting until your scar is fully healed before performing revision surgery. More than one procedure or technique may be recommended to improve outcomes.
Cosmetic scar surgery is performed under anesthesia. It may involve removal of contracted scar tissue and extension of a skin flap from adjacent healthy skin to close the defect. When a skin flap cannot be extended, a skin graft may be obtained from another part of the body. Once the graft is in place, tissue and blood vessels slowly grow into the graft. Sometimes a scar may be repositioned so that it is less noticeable. This procedure, known as a Z-plasty, does not remove the scar, but hides it in a natural crease or fold in the face or neck.
Excisional surgery or acne scar excision is a method to treat depressed acne scars. The goal is to convert a big, deep scar to a small, flat scar, which can then be treated with laser resurfacing. All the techniques listed below are performed under anesthesia.
- Punch excision: Punch excision is a technique used to correct icepick and deep boxcar scars. In this method a round, sharp and small-sized (matched to the size of the scar) punch biopsy tool is used to remove the entire defect. The edges will be sutured.
- Punch elevation: Punch elevation is a technique used for wide boxcar scars. A punch tool similar to a punch excision tool is used to excise the base of the scar, but the walls of the scar remain intact. After the scar is removed, the remaining basal tissue is then raised to the surface of the skin and attached with sutures or steri-strips.
- Subcutaneous incision: This technique is used to treat rolling and depressed scars. A special needle is inserted under the skin to separate the skin from the scarred surface. The scarred surface will then be flattened.
- Shave excision: Shave excision is a technique to treat elevated and hypertrophic scars or keloids. The scar is removed with a flexible blade or scalpel to bring it in level with the surrounding skin.
- Fusiform (elliptical) excision: This commonly used technique is preferred for elevated and hypertrophic scars as well as depressed wide scars.
Following scar revision surgery, you may experience some discomfort, redness, swelling and bruising. You can use cold compresses to the area to lessen pain and swelling. Wound care instructions will be provided, which you should follow carefully. You may have certain activity limitations depending on the surgical technique and location of the scar. Your head should be elevated while lying down. Complete healing can take up to a year at which time you will be able to appreciate the full effect of surgery.