Scar Revision

Unhappy with your scars?

The way a scar develops depends as much on how your body heals as it does on the original injury or on the surgeon's skills. While no scar can be removed completely, dermatologic surgeons can often improve the appearance of a scar, making it less obvious .

Using several techniques, including our KTP and medlite lasers, Portrait resurfacing, injectable cortisone, soft tissue fillers, surgical realignment, we can minimize all unsightly aspects of scars including depth, texture, and color. All done with local anesthesia and with minimal downtime.

Keloid Scars

Keloids are thick, puckered, itchy clusters of scar tissue that grow beyond the edges of the wound or incision. They are often red or darker in color than the surrounding skin. Keloids occur 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 they're most common over the breastbone, on the earlobes, and on the shoulders. They occur more often in dark-skinned people than in those who are fair. The tendency to develop keloids lessens with age.

Keloids are often treated by injecting a steroid medication directly into the scar tissue to reduce redness, itching, and burning. In some cases, this will also shrink 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 anesthesia. No matter what approach is taken, keloids have a stubborn tendency to recur, sometimes even larger than before. To discourage this, we may combine the scar removal with steroid injections, direct application of steroids during surgery, interferon injections, or laser therapy. Or you may be asked to wear a pressure garment over the area for as long as a year. The keloid may return, requiring repeated procedures every few years.

Hypertrophic Scars

Hypertrophic scars are often confused with keloids, since both tend to be thick, red, and raised. Hypertrophic scars, however, remain within the boundaries of the original incision or wound. They often improve on their own-though it may take a year or more-or with the help of steroid applications or injections.

If a conservative approach doesn't appear to be effective, hypertrophic scars can often be improved surgically. The surgeon will remove excess scar tissue, and may reposition the incision so that it heals in a less visible pattern. You may receive steroid injections during surgery and at intervals for up to two years afterward to prevent the thick scar from reforming.

Facial Scars

Because of its location, a facial scar is frequently considered a cosmetic problem, whether or not it is hypertrophic. There are several ways to make a facial scar less noticeable. Often it is simply cut out and closed with tiny stitches, leaving a thinner, less noticeable scar.

If the scar lies across the natural skin creases (or "lines of relaxation") the surgeon may be able to reposition it to run parallel to these lines, where it will be less conspicuous. Some facial scars can be softened using a technique called dermabrasion, a controlled scraping of the top layers of the skin using a hand-held, high-speed rotary wheel. Dermabrasion leaves a smoother surface to the skin, but it won't completely erase the scar.

Z-Plasty

Z-plasty is a surgical technique used to reposition a scar so that it more closely conforms to the natural lines and creases of the skin, where it will be less noticeable. It can also relieve the tension caused by contracture.

In this procedure, 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 a different angle, giving the scar a "Z"pattern. The wound is closed with fine stitches, which are removed a few days later. Z-plasty is usually performed as an outpatient procedure under local anesthesia.

While Z-plasty can make some scars less obvious, it won't make them disappear. A portion of the scar will still remain outside the lines of relaxation.

Dermal Grafting

Dermal grafting is a technique that is combined with subcision for acne scars and other depressed scars.  Subcision involves making a tangential incision beneath a depressed scar to release the tethering of the scar and induce new scar formation to lift the depressed scar up over a series of treatments over many months.  In contrast, dermal grafting occurs immediately following the subcision of the scar and results in an immediate and more dramatic correction of the depressed scar.

Dermal grafting begins with an excision of skin from behind the ear followed by suturing of the donor site area.  The removed tissue is then divided into small discs that match the width and depth of each of the depressed scars.  The discs of skin are then inserted through the subcision incision to fill the depressed scar for an immediate correction.  Since each scar is treated individually, there is a high success rate with a single session.

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