A scar is a visible mark of an injury or prior surgery. Although by definition a scar is a permanent mark, it may be altered so that it no longer appears unsightly.
A scar can be modified by various methods – surgical as well as non-surgical.
Surgical methods include – scar revision, dermabrasion, excision with grafting (for hypopigmented or hypertrophic scars) and tissue expansion.
Scar revision is the surgical alteration of a scar, i.e. replacement of an undesirable scar with a more pleasant and favorable scar.
Various factors determine whether a scar is amenable to scar revision procedure.
- Hereditary – intrinsic tendency to nasty scar formation.
- Etiology – what caused the scar?
- Site of scar – sternal and shoulder scars are notorious to form nasty scars.
- Alignment of scar – scar direction may be beneficial or deleterious.
- Nature of scar – healthy / stretched / depressed / atrophic / hypertrophic / keloidal.
- Pigmentation – i.e. color of the scar.
- Contracture – i.e. deformity of adjacent structures.
These factors will be discussed during your consultation and assessed during your examination.
Non-surgical measures include scar creams / gels, silicone gels / sheet, pressure garments and intra-lesional steroid injections.
How is scar revision performed?
The procedure is generally performed as a day care procedure. The procedure is commonly done under local or regional anesthesia.
Once the area is completely numb (pain free) the scar is removed and the resultant gap is closed either directly or after realigning (changing the direction) the scar with a delicate surgical technique leaving a less noticeable scar.You will have a dressing over the operated site for 2 to 5 days. Any pain or discomfort will be minimized with adequate medication.
The decision to remove the stitches depends on the site of the scar and the individual’s healing process. Generally, sutures on the facial area are removed by 5th day. Initially, the scar may appear red or brownish as well as swollen – this settles over a few weeks.
After scar revision, the new scar is immature i.e. not yet settled. Therefore, it is very important to follow the instructions of cosmetic surgeon to guide the scar to a more favourable outcome. Always remember to handle the area gently – even when you are advised to massage the area.
Exposure to sunlight can induce pigmentation (dark colour) in an immature scar. Sunblocks / sunscreens may be prescribed and should be used as instructed.
Some cases, physical barriers such as caps / umbrella etc may be suggested.
Depending on individual cases, certain creams may be advised to be massaged locally over the scar area for several weeks to help smoothen and soften a scar.
Some special cases – depending on site of scar, tendency to form thick, hard scars etc may be recommended adjuvants such as –
- Steroid injections into the new scar
- Silicone sheets
- Pressure garments
Scar revision is a surgical procedure and can have some associated side-effects.You will be asked to sign consent forms to ensure that you fully understand the procedure and any risks and potential complications.
- Anaesthesia related risks
- Swelling, bruising
- Wound dehiscence
- Altered sensations
- Unfavourable scarring – thin stretched out scar or thickened scar
This procedure is commonly used for improving uneven pigmentation and scars on the face (e.g. Post-acne scars). There are several methods for dermabrasion – microdermabrasion, derma-roller, surgical dermabrasion (manual or motorized burrs) or laser.
The procedure involves meticulous scraping of the superficial layers of skin to a precise depth so as to ensure spontaneous healing. The new skin that develops is fresher, firmer, more evenly surfaced and pigmented.
Post-operative sun protection is vital.
REMOVAL OF SMALL LESIONS
Tiny, tit-bit lesions (tattoos, moles, cysts etc) on the face and body can be a source of nuisance and irritation. Such lesions can be aesthetically removed with a well-placed innocuous and barely noticeable scar.