Scars, whether they're caused by accidents or by surgery, are unpredictable. 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.

Many variables can effect the severity of scarring, including 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. How much the appearance of a scar bothers you is, of course, a personal matter.

While no scar can be removed completely, plastic surgeons can often improve the appearance of a scar, making it less obvious through the injection or application of certain steroid medications or through surgical procedures known as scar revisions. If you're considering scar revision, this web site will give you a basic understanding of the most common types of scars, the procedures used to treat them, and the results you can expect. It can't answer all of your questions, since a lot depends on your individual circumstances.

If you have further questions, feel free to email your enquiries, or freecall us on 1 8000 8000 1 to take advantage of our free consultation.

Making the Decision

Many scars that appear large and unattractive at first may become less noticeable with time. Some "hypertrophic" or raised and lumpy scars can be treated with steroid injections to relieve symptoms such as tenderness and itching. Your surgeon may recommend waiting as long as 18 months after an injury or surgery before you decide to have scar revision. Scar maturation takes 18 months to complete so you may experience spontaneous improvement in scar quality for that length of time. However, if it is clear that the process of scar maturation will not correct suboptimal aspects of the scar's appearance, then scar revision may reasonably be performed far earlier. 90% of the scar maturation process is complete within 6 months.

If you're bothered by a scar, your first step should be to consult a qualified plastic surgeon. Your surgeon will be happy to examine you and discuss the possible methods of treating your scar, the risks and benefits involved, and the possible outcomes. Be frank in discussing your expectations with him, and make sure they're realistic. Don't hesitate to ask any questions or express any concerns you may have.

Medicare and health insurance will generally contribute to the costs of scar revision.

All Surgery Carries some Uncertainty and Risk

While scar revision is normally safe, there is always the possibility of complications. These may include infection, bleeding, a reaction to the anaesthesia, or the recurrence of an unsightly scar. Your scar could conceivably be worse or no better, but will generally be much improved.

You can reduce the risks by choosing a qualified plastic surgeon such as your surgeon and closely following his advice, both before surgery and in follow-up care.

Keloid Scars

Keloid scars are thick, puckered, itchy clusters of scar tissue that grow beyond the edges of the original 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 the wound has healed.

Keloids can appear anywhere on the body, but they're most common over the breastbone, on earlobes, and on the shoulders. They occur more often in dark-skinned people than in those who are fair. True keloid scars are uncommon in Caucasian people.

Keloids are often treated by injecting a steroid medication directly into the scar tissue to reduce the redness, itching and burning. In general, 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 performed under local anaesthesia. You should be back at work in a day or two, and the stitches will be removed in a few days.

No matter what approach is taken, keloids have a stubborn tendency to recur, sometimes even larger than before. To discourage this the surgeon may combine the scar removal with steroid injections, direct application of steroids during surgery, or rarely radiation therapy. Or you may be asked to wear a pressure garment over the area for as long as a year. Silicone placed on the skin has been shown to reduce hypertrophic and keloid scars, such that a silicone pad or ointment will often be applied also. Even so, the keloid may return, requiring repeated procedures.

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, and are much more common than keloids. They often improve on their own though it may take more than a year, 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. Your surgeon will remove excess scar tissue, and may reposition the incision so that it heals in a less visible pattern. This surgery may be done under local or general anaesthesia, depending on the scar's location and the preferences of all involved. You may receive steroid injections during surgery and at intervals afterwards to prevent the thick scar from reforming.

Contracture

Burns or other injuries resulting in the loss of a large area of skin may form a scar that pulls the edges of the skin together, a process called contraction. The resulting contracture may affect the adjacent muscles and tendons, restricting normal movement. Correcting a contracture usually involves cutting out the scar and replacing it with a skin graft. In some places a procedure known as Z-plasty or flap repair may be used.

New techniques, such as tissue expansion, are playing an increasingly important role. If the contracture has existed for some time, you may need physiotherapy after surgery to restore full function.

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 in layers with tiny stitches, leaving a thinner, less noticeable scar. If the scar lies across the natural skin creases (or lines of relaxed skin tension), your 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 handheld, high-speed rotary wheel. Dermabrasion leaves a smoother surface to the skin, but it won't completely erase the scar. Laser resurfacing may similarly help make some scars less noticeable. For more information click on these topics.

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. Not all scars lend themselves to Z-plasty, however, and it requires an experienced plastic surgeon to make such judgments.

In this procedure, the old scar is removed and new incisions are made on each side, creating small flaps of skin. These flaps are then rearranged to, position the main scar 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 a day procedure under local anaesthesia.

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 relaxed skin tension.

Skin Grafting and Flap Surgery

Skin grafts and flaps are other forms of scar surgery. The treated area may take several weeks to heal. Grafting involves the transfer of skin from a healthy part of the body (the donor site) to cover the injured area. The graft is said to "take" when new blood vessels allow the graft to derive a blood supply in the injured area. While most grafts from a person's own skin are successful, sometimes the graft doesn't take. In addition, all grafts leave some scarring at the donor and recipient sites.

Flap surgery is a complex procedure in which skin, along with the underlying fat, blood vessels, and sometimes the muscle, is moved from a healthy part of the body to the injured site. 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.

Skin grafting and flap surgery can greatly improve the function of a scarred area. The cosmetic results may be less satisfactory, since the transferred skin may not precisely match the color and texture of the surrounding skin. In general, flap surgery produces better cosmetic results than skin grafts.

After Scar Revision

With a any kind of scar revision, it's very important to follow your surgeon's instructions after surgery to make sure the wound heals properly. Although you may be up and about very quickly, he will advise you on gradually resuming your normal activities.

As you heal, keep in mind that no scar can be removed completely, 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. If your scar looks worse at first, don't panic - -the final results of your surgery may not be apparent for a year or more.

If you have further questions, write them down and ask your surgeon and helpful staff at your consultation.