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Scar Revision

body-liftingIf you have a scar that is raised, red or lumpy, this is not normal and can be improved. Of course everyone scars differently, and scars take about 18 months to mature. A good quality scar should be flat, not puckered or raised, and should fade to either just a shade lighter or darker than your skin tone. If you are concerned by the appearance of a scar, whether it is caused by an accident, or by previous surgery, then chances this can be improved.

The way a scar develops depends on where it is situated on your body, on how your body heals, your ethnicity, on the original injury and on your 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. This may also depend on whether it is visible to others or not.

It is important to realise that no scar can be removed completely. Various treatments can improve  the appearance of a scar, making them less obvious, but your scar will always be there. Be wary of claims of totally removing scars, this is not possible.

If you’re considering scar revision, this  site will give you a basic understanding of the most common types of scars, and the procedures used to treat them.  It will not take the place of a consultation with Dr McGovern, since a lot depends on your individual circumstances.

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. Dr McGovern will  recommend waiting a minimum of three months and 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 scar is not healing as normal, revision may reasonably be performed  earlier. 90% of the scar maturation process is complete within 6 months.

If you’re bothered by the appearance of your scar, your first step should be to consult a series of qualified plastic surgeons. Dr McGovern will be happy to examine you and discuss the various methods of treating your scar, the risks and benefits involved, and the possible outcomes.

Wherever possible, we prefer to try non-surgical modalities first. If your scar is red and raised, but not widespread, Dr McGovern will recommend you start with a silicone gel ointment. Most people find this less invasive and easier to use than the silicone sheets that need to be  taped to the body.

The silicone gel is applied twice daily to clean dry skin. The aim is that it is in contact with the skin as for as much as possible. This is kept up for six months or so, and in many cases is all that is required.

If however, the application of the silicone gel is unsuccessful, or if the scar is aggressively raised and twisted, Dr McGovern may recommend the injection of a steroid medication. This is performed simply and quickly in our rooms. Repeated injections are often required, but most scars respond after between 3 and 6 treatments.

If the scar is widespread, then the only means of reducing this is with surgery. Scar revision surgery can be performed under local anaesthetic in our rooms, or in a day hospital if you prefer. Medicare and health insurance will generally contribute to the costs of scar revision.

While scar revision surgery is normally safe and uneventful, there is always the possibility of complications. These may include infection, bleeding, a reaction to the anaesthesia, or the recurrence of an unsightly scar, though these complications are rare. Dr McGovern will be frank with you, and will tell you  if he feels that your scar cannot be improved.

You can reduce your risks by always choosing  qualified plastic surgeon. To find a list of plastic surgeons in your area  go to www.plasticsurgery.org

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 such as the those from Pacific Islands, and are rare in those who are fair. True keloid scars are uncommon in Caucasian people.

The most common treatment for keloid scars is  by the  injection a steroid medication directly into the scar tissue. This treatment shrinks the keloid and helps to reduce the redness, itching and burning.

If steroid treatment is inadequate, the scar tissue can be excised and the same steroid is injected along both new, raw edges of the wound before sewing this back together.This is generally performed under local anaesthesia in our rooms, but can be performed in a day hospital with some sedation if preferred.

Hypertrophic Scars

Hypertrophic scars are often confused with keloids as they look similar. 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. If you are of Caucasion decent, it is likely that your scars are hypertrophic and not true keloid scars.

Hypertrophic scars are treated in the same manner as keloid scars.

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. Severe contracture may affect adjacent muscles and tendons and restrict normal movement.

To correct a contracture the entire scar must be removed. Of course this will leave a large defect. The size of this defect, and it’s placement on the body will determine the type of repair required. It the defect is relatively small the tissue may be closed directly. Wherever possible this type of closure is used. If the wound is a little too large for this, or to create movement and to reduce the possibility of recurrence of the contracture, a procedure called as Z-plasty or flap repair may be used.

In areas of large complex contractures, or where the skin is tight, Dr McGovern may recommend a two stage procedure  such as tissue expansion. This involves placing an empty balloon like implant under adjacent tissues, and slowly inserting saline into this over a  period of months to slowly expand the overlying tissue. When the expansion has created enough skin for reconstruction, surgery is performed to remove the expander, the problematic scar tissue, and reconstruction of the defect.

Dr McGovern has a lot of experience in this area. If you have problems of contracture from burns or other injuries, a consultation with Dr McGovern will show you just what can be done to improve your situation.

Facial Scars

Facial scars , because of their visibility are the most disliked scars. Once again if the scar is red, raised, lumpy or widespread, then Dr McGovern will be able to help you to gain improvement using the techniques mentioned above. We cannot however, make a scar disappear.

Some facial scars such as acne 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.

Ice pick type acne scars can be simply excised in our rooms under local anaesthetic. you will still be left with a scar, but it will be very small and fine, and a lot less noticeable than the deep ice pick scar it replaced.

Many people suffer with the surface irregularity of previous acne. If you have defined areas or concavities, these may be treated with a dermal filler. This can be very successful if you have a small number, but it is impossible to treat large areas and have the skin perfectly smooth. Being realistic is the key here and discussing your problem with an experienced injector will help you to decide your best course of action.

Z-Plasty

Z-plasty or W-plasty are surgical techniques used to reposition a scar so that it more closely conforms to the natural lines and creases of the skin.  This creates a more normal appearance and the scars are less likely to be noticed. 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. Dr McGovern has been performing this type of surgery for more than two decades.

Z-plasty or Q-plasty requires removing the old scar and  a series of new incisions are are made on each side of the wound, creating small flaps of skin. These flaps are then rearranged to position the main scar at a different angle, giving the scar a “Z” or “W” pattern. The wound is closed with very fine stitches, which are removed at five to six days following surgery later. This procedure is usually performed as a day procedure under local anaesthesia either in our rooms, or at the Sunshine Coast Day Surgery.

Can I do more to help my new scar?

If you have had scar revision surgery on the face, Dr McGovern will recommend that you use a silicone gel for at least six months to help mature the scar more quickly and to avoid problems.

If your surgery has been on the body, Dr McGovern will recommend that you use a non-allergenic tape to support the wound for three months. We will provide this tape and show you how to use it to support the new scar. This tape helps to keep your scar fine and prevents any tension on the healing tissue.