Surgical Procedures - Skin Treatments

• Skin Management
• Injectable Fillers
• Laser Resurfacing
• Scar Revision
• Blue Peel
• Wrinkle Relaxing Injections

SCAR REVISION

Surgical techniques to improve the appearance of scars.

Scars - whether from accident or surgery - are unpredictable in the way they form. How they look during and after healing depends as much on your body as on the original injury or the surgeon's skill. Variables that affect the degree of scarring include the size and depth of the wound, the blood supply to the area, the thickness and colour of your skin, and the direction of the scar. Again, how much the appearance of a particular scar bothers you is a personal matter.

Scars cannot be removed completely, but a skilled plastic surgeon can often improve their appearance by the injection or application of certain steroid medications or through surgical procedures known as scar revisions. What can and should be done in your case will depend on a Consultation with your surgeon. However the following introductory paragraphs will, we hope, give you a basic understanding of the most common types of scars, the procedures available to treat them, and the results you can expect.

Deciding

Scars that appear large and unattractive immediately after surgery naturally become less noticeable with time. Some initial tenderness and itching can also be relieved by treatment with steroids. For these reasons, many plastic surgeons recommend waiting as long as a year or more after the injury or surgery before you decide to have scar revision. Your first step, if scarring is bothering you, is to consult a qualified plastic surgeon. The surgeon will examine you and discuss the available treatments, the risks and benefits involved and the possible outcomes. Be frank about your expectations to make sure they are realistic and bring up all your questions and concerns. Insurance usually does not cover cosmetic procedures. However, if scar revision is performed to minimise scarring from an injury or to improve your ability to function, it may be partially covered. Please check with your insurer.

Some Risk

Scar revision is normally safe but complications can include infection, bleeding, a reaction to the anaesthesia, or further unsightly scarring. Reduce your risks by choosing a well-qualified surgeon and following his or her advice closely before and after surgery.

• KELOID SCARS

  These thick, puckered, itchy clusters of scar tissue grow beyond the edges of wounds and incisions. Often red or of a darker hue than the surrounding skin, keloids appear when the body continues to produce the tough, fibrous protein known as collagen after a wound has healed. Keloids can appear anywhere on the body, but are most common over the breastbone, on the earlobes, and on the shoulders. They occur more in dark-skinned people than in fair ones. The tendency to develop keloids lessens with age.

  The initial treatment is often the injection of a steroid medication directly into the scar tissue to reduce redness, itching, and burning. Sometimes this also shrinks the scar. If steroid treatment is inadequate, the scar tissue can be cut out and the wound closed with one or more layers of stitches. This is generally an outpatient procedure, performed under local anaesthetic. You should be back at work in a day or two, and the stitches can be removed after a few days. A skin graft is occasionally used, although the site from which the graft is taken may itself develop a keloid.

  Unfortunately keloids have a stubborn tendency to recur whatever techniques are used and sometimes they may be even larger than before. Combining scar removal with steroid injections, direct application of steroids during surgery and radiation therapy may all help. Another treatment is to wear a pressure garment over the area for as long as a year. Even so the keloid may return so that repeat procedures are necessary every few years.

• HYPERTROPHIC SCARS

  Like keloids hypertrophic scars are thick, red, and raised but are different because they remain within the boundaries of the original incision or wound. They often improve on their own taking a year or more to heal fully. Steroid applications or injections can help. Alternatively hypertrophic scars can often be improved surgically. The surgeon removes excess scar tissue, and may reposition the incision so that it heals in a less noticeable pattern. This surgery may be done under a local or a general anaesthetic. Steroid injections during surgery and at intervals for up to two years afterwards can help prevent the scar from reforming.

• CONTRACTURES

  Burns or other injuries where a large area of skin is lost may form a scar that pulls the edges of the skin together. The resulting 'contracture' may affect adjacent muscles and tendons and so restrict normal movement. Surgical correction usually involves cutting out the scar and replacing it with a skin graft or a flap. In some cases a procedure known as Z-plasty may be used. New techniques, such as tissue expansion, are also playing an increasingly important role. Physiotherapy may be needed after surgery to restore full muscle function.

Facial Scars

Some facial scars may be made less noticeable by cutting them out and closing the wound with tinier stitches to leaving a thinner, less noticeable scar. Others can be softened using 'dermabrasion' or the CO2 laser to achieve a controlled removal of the top layers of the skin. These techniques leave a smoother skin surface but will not completely erase the scar.

• Z-PLASTY

  This surgical technique repositions a scar so that it follows a natural line or crease in the skin more closely and so is less noticeable. It can also reduce the tension caused by contracture. Z-plasty is not right for all scars however. Essentially the old scar is removed and new incisions are made on each side, creating small triangular flaps of skin. These flaps are then rearranged to cover the wound at different angles, giving the scar a Z-pattern. Fine stitches are used to close the wound and are removed a few days later. Usually performed as an outpatient procedure under a local anaesthetic, Z-plasty can make some scars less obvious, but cannot make them disappear. A portion of the scar will still remain outside the lines of relaxation.

• SKIN GRAFTING AND FLAPS

  Skin grafts and flaps are more major forms of scar surgery and are more likely to be carried out in hospital using a general anaesthestic. Treated areas may take several weeks or months to heal, and a support garment or bandage may be necessary for up to a year. Grafting involves the transfer of skin from a healthy part of the body to cover the injured area. The graft is said to 'take' when new blood vessels and scar tissue form in the injured area. Sometimes grafts do not take and all leave some scarring at both donor and recipient sites. Flap surgery is a complex procedure in which skin, along with the underlying fat, blood vessels, and sometimes muscle, is moved from a healthy part of the body to the injured part. In some flaps, the blood supply remains attached at one end to the donor site; in others, the blood vessels in the flap are reattached to vessels at the new site using microvascular surgery. Both techniques can greatly improve function. However the cosmetic results may be less satisfactory because of the difficulty of matching skin colour and texture. Flap surgery produces better cosmetic results than skin grafts.

After Scar Revision

Carefully follow your surgeon's recovery instructions to make sure the wound heals properly. You may be up and about very quickly but your normal activities should be resumed only gradually. Keep in mind that no scar can be removed completely and that the degree of improvement depends on the size and direction of your scar, the nature and quality of your skin, and how well you care for the wound after the operation. Your scar may look worse at first but do not panic. Chances are you will be pleased with the final results which may actually not become apparent for a year or more.

Contact us for your skin treatment consultation.