Tyler Plastic Surgery

Dr. James R. Motlagh, MD

Certified by the American Board of Plastic Surgery
Cosmetic, Plastic and Reconstructive Surgery
700 Olympic Plaza Circle, Suite 420 | Tyler, Texas 75701 | 903-526-2500

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700 Olympic Plaza Circle,
Suite 420
Tyler, Texas 75701
903-526-2500

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Scar Revision

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Keloid scars may be removed scar revision surgery.

 

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Hypertrophic scars may tighten surrounding skin (contracture) and limit movement.

 

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Using Z-plasty, the scar is removed and several incisions are made on each side, creating small triangular flaps of skin. Then the flaps are rearranged and interlocked to cover the affected area.

 

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The incision is closed with a Z-shaped line of sutures. The new scar is thinner and less visable, and allows the finger to be extended.

 

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The scar crossing the natural line, or crease, between the nose and mouth is removed and repositioned using Z-plasty. The forehead scar, located in the natural lines, is excised with tapered ends. The skin is then loosened and brought together with stitches.

 

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The repaired scars now lie partly within the natural skin crease, where they are less visible.

 

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If you experience skin trauma that results in large, abnormal or unsightly scars, scar revision surgery may be recommended to improve the appearance of your scars and the functionality of scarred body areas.

About Scar Revision


Candidates For Scar Revision

When can scar revision help?

Scars are unpredictable. Cuts, scrapes, burns and any type of trauma or damage that affects layers of skin below the superficial outer layer can result in scarring.

Adult men and women, as well as teens and children who have large, unsightly, itchy or abnormal scars may be candidates for scar revision.

Those prone to abnormal keloid scars (thick scars that grow beyond the initial injury) or hypertrophic scars (raised, enlarged scars) are especially likely to seek scar revision surgery when other treatment methods alone, such as steroid injections, are ineffective.

Scar revision surgery is not scar removal surgery. You may not be a good candidate for scar revision if you expect complete removal of your scar, or if scar revision is unlikely to improve the appearance of existing scars.

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Scar Revision Surgery

Surgery for scar reduction and improvement

Scar revision may be performed using a number of different surgical techniques, such as:

  • Excision procedures
  • Z-Plasty or W-Plasty
  • Flap surgery
  • Tissue expansion
  • Skin grafting

Excision procedures, including shave excision, fusiform excision and serial or partial excision, involve cutting away scar tissue and re-closing the wound in an effort to diminish the size and appearance of the scar. Excision is often used to treat keloid scars and hypertrophic scars.

Shave excision is ideal for flattening raised scars, while serial or partial excision is a multi-step scar excision process used to treat large scars. Fusiform excision involves the removal of an elliptically-shaped area surrounding a smaller scar.

Z-Plasty or W-Plasty are local flap surgeries that are often used to treat irregularly-shaped facial scars. They involve repositioning and reshaping of the scar such that it resembles a Z- or W-pattern, improving the scar aesthetic and is more easily hidden in natural skin contours. Z-Plasty is also often used to treat scar contracture, which causes surrounding skin to contract, often restricting movement and function in the area.

Tissue expansion may also be used to treat contracture if there is not enough adequate skin near the scar to facilitate Z-Plasty. In tissue expansion, an inflatable device is surgically placed under healthy skin and slowly filled with sterile saline solution over time. Once the skin has grown to accommodate the tissue expander, the expander is removed and the excess healthy skin in the area is used to treat nearby scars.

Skin grafts and non-local flap surgeries are more serious types of scar revision surgery because they require skin to be removed from a donor site and transplanted in a location elsewhere on the body.

They're more likely to be performed using general anesthesia, on an inpatient basis, as opposed to other scar revision procedures that usually require only local anesthesia with IV sedation and are performed on an outpatient basis.

Grafting involves transferring healthy skin from one body area (donor site) to cover the injured area, allowing new blood vessels and scar tissue to form in the injured area. All grafts leave some scarring at the donor and treated injury sites.

Flap surgery is one of the most complicated reconstruction procedures. It involves moving skin, fat, blood vessels and occasionally muscle from a donor site to an injured body area.  In some flap procedures, the blood supply remains attached to the donor site, whereas others reattach blood vessels from the donor tissue to blood vessels at the injury site using microsurgery.

Skin grafting and flap surgery are usually performed to improve function moreso than form. Aesthetic outcomes are secondary in these procedures, but flap surgery generally produces better cosmetic results than skin grafts.

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Scar Revision Recovery

Healing after scar revision surgery

After scar revision surgery, a light dressing is applied, except in the case of keloid scar revisions. Pressure must be applied to sites prone to keloid scarring, so an elastic dressing will be applied in this case.

If stitches are used instead of dissolvable sutures, they will be removed in 3-4 days from facial areas and 5-7 days from other body areas.

The amount of downtime needed after scar revision depends on the surgical technique used for your revision, as well as the location and size of your scar. Most normal activity may be resumed shortly after surgery, however activities that may cause the revision wound to stretch or widen should be avoided until healing is complete. It is also important to protect your scar revision wound from the sun after surgery, as sun exposure can cause permanent scar darkening.

During the recovery period, your scar may look worse at first. As you heal, the scar appearance will improve, however it is important to remember that you will still have a scar. Scar revision is designed to minimize the appearance of scars, not remove them completely.

Wound care is an especially important part of ensuring the best possible scar revision result, so be sure to follow post-operative instructions carefully and keep all follow-up appointments at Tyler Plastic Surgery.

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