What is surgical scar revision like?

Plastic surgeon scar revision Charlotte area

Most people have at least one scar somewhere on their body. If it’s a relatively well-healed scar that’s in a location where it’s not too obvious, this is generally not really a problem. 

However, some scars can be more of an issue. Rather than becoming flat, narrow, and pale after healing, some scars are raised, wide, dark, and/or oddly shaped. A scar in some locations, such as on the face, may be particularly challenging to hide. This can create problems with a person’s self-esteem and confidence.

If you have a scar that bothers you, there are some nonsurgical options that may help, including laser therapy, microneedling, or dermal fillers. However, these may not be enough to address the problem. In these cases, surgical scar revision may be a good option.

How does surgical scar revision work? What can you expect from this procedure?

Surgical scar revision

During a surgical scar revision, the plastic surgeon will actually remove the unwanted scar entirely. This is done by cutting the skin around the scar and taking out the unsightly scar tissue. The edges of the wound will then be brought back together. In many cases, this procedure can be done in the office under local anesthesia.

Of course, this procedure itself creates a new scar. Because every type of surgical procedure creates a scar, it’s not possible to completely get rid of a scar using surgery. However, with scar revision, the goal is to create a scar that’s more discreet.

Within the skin, the tissues are oriented along lines known as tissue planes. Scars that run parallel to the tissue planes tend to be more flat and narrow after healing, while those that cross tissue planes tend not to be as discreet after healing. Using detailed knowledge of the tissue planes, a plastic surgeon can determine how to orient a scar to give it the best chance of healing well.

How is surgical scar revision performed?

There are a variety of different surgical techniques that can be used for scar revision. Different techniques will work well in different situations. Plastic surgeons spend a lot of time training in these techniques so that they can use the best one for each particular patient. In general, a plastic surgeon is the most skilled type of surgeon at scar revision, because they have specific training in this area.

In some cases, the scar is already oriented along the tissue planes. However, it may have become wide or dark as it healed, due to issues like too much tension on the wound or an infection that developed as it was healing. In these cases, an elliptical incision may be used. This involves making a football-shaped incision around the scar, and creating a new scar in the same location. Careful postsurgical care can then help the scar to be more narrow and pale after it heals.

In other cases, the scar may cross tissue planes, causing it to be raised and more obvious. Reorienting the scar along the tissue planes can help it to be more discreet. This is possible using a technique known as Z-plasty. This involves removing the scar tissue, and then making incisions outward from it. The pieces of tissue are rotated to reorient them. The new scar will have the shape of a Z. When this is done skillfully and careful postsurgical care is used, it can make a significant difference in a scar’s appearance.

When a scar is wide or unusually shaped, a W-plasty may also be an option. For this technique, the scar is removed. Small alternating triangles of skin are also removed on each side. When the two sides are brought together, the result is a jagged line that goes back and forth like the letter W. One advantage of this is that jagged lines actually tend to be less obvious to the eye than straight lines, so the new scar may have less impact on the person’s appearance. 

In addition, the longer an incision is, the more difficult it is to keep tension off of it. This tends to result in widening of the scar. With a W-plasty, there’s a series of short scars instead of a single longer one. This results in less tension across the incision, and the scar tends to be narrower after it heals.

For scars that cover larger areas, skin grafting may be necessary. When a large scar (like a burn scar) is removed, the remaining skin may not be able to stretch to cover the area. Tissue can be removed from another area and transferred to cover the area of removed skin.

Caring for the incisions after surgical scar revision

Keep in mind that one of the most important factors in the appearance of a scar is how the incision is cared for while it’s healing. The first few weeks are crucial for determining the later appearance of the scar. You’ll need to be diligent about keeping your incision dry and clean, protecting it from sunlight, reducing tension across it, and using any medications (such as antibiotics) exactly as directed. We will give you specific instructions about how to care for your incision after your scar revision procedure.

In addition, the use of silicone scar therapy has been shown to help improve healing of incisions, resulting in scars that are paler, flatter, and narrower. This involves alternating the use of silicone gel and silicone sheeting over the incisions. There’s even a version of the gel that contains sunscreen to help prevent darkening of the scar. By keeping the tissues hydrated and reducing tension over the incisions, this helps to create scars that are as discreet as possible. We generally recommend using silicone scar therapy in most cases, because patients are usually happier with their scars if they use it.

Plastic surgeon scar revision Charlotte area

If you’re bothered by the appearance of a scar, and you’d like to learn more about what the options would be for addressing the problem, you’ll need to consult a qualified plastic surgeon. After examining the scar and learning more about your situation, they’ll be able to recommend a course of action. In some cases, nonsurgical options may be able to provide good results. In other cases, surgical scar revision may be the best way to achieve the results that you’re looking for.

If you’re in the greater Charlotte area, we invite you to schedule a consultation with Dr. Miles. As a double-boarded plastic surgeon, he has extensive training and experience in dealing with problematic scars. He’s also dedicated to making sure that each consultation is a positive and useful experience for every patient. To schedule your appointment, please contact our front desk.