Our skin is often at risk of external injuries (burns, cuts, surgeries or aftermath of acne at puberty). As a general rule, each of these traumas heals with some type of scar. In other words, once formed, the scars remain permanent, but they can be made less visible or surgically corrected to make them less noticeable through a procedure called scar revision.
Fortunately, in some cases, the so-called scar revision. This is especially the case in the head and neck region. If the scar is visible and prominent on the face or near the eye, mouth or nose, you should definitely consider removing or concealing it.
There is no ideal technique or way to completely remove a scar. The main goal of treatment is to improve the appearance of the scar by covering it, changing the direction in relation to the skin surface and bringing it to the level of the skin (if it protrudes above or below the surface).
Some scars are unacceptable due to exposure to the gaze, while others become visible through speech, laughter, or other facial movements. Skin color and type, age, and wound healing are important factors for discussion before surgery, as well as the timing of surgery selection. Some surgeons do not recommend surgery even up to a year after the scar has formed. This time is needed to complete the natural healing process. It is often the case that a scar that does not look satisfactory at first eventually takes on a perfectly acceptable shape.
Different types of scars require different approaches in treatment. For example, severe burns cause hard scars that often heal with contractures. Then the muscles and tendons that are under the skin are affected by the healing process and contraction (tightening).
Keloids are scars that result from the excessive formation of collagen connective fibers after healing is complete. Such scars usually form as growths at the site of the initial scar. Hypertrophic scars , unlike keloids, do not cross the border of the scar area but become thick, above skin level.
The experience of the significance of a scar on the face or neck is very individual and different. Sometimes more than one procedure, or more than one technique, may be needed to achieve the maximum effect of therapy.
TECHNIQUES AND METHODS – SCAR REVISION
There are several surgical techniques suitable for different types of scars (scar revision).
- The most common way to remove a scar is its own excision in full or serially (in multiple acts) and rejoining of skin edges. It are works applying a gentle surgical technique with the help of microsurgical instruments and suturing the skin with thin stitches. In the case of a scar that is compressed (contracture), the operation generally consists of removing the scar in its entirety. After excision (removal), a skin flap is formed that consists of the surrounding healthy skin. This flap is raised from the substrate to move towards the area of the removed scar. If it is not possible to use the flap in such a way, a skin graft is taken from another suitable area and moved to the area of the excised scar. The time it takes for blood vessels and soft tissue to develop plays a very important role in healing.
- So called Z – plastic is a method by which we move the scar from one area of the skin to another, usually in the natural furrows and lines of the skin. This way we can reduce its visibility. So, with Z – plastic, we do not remove the scar, but make it less noticeable.
- Dermabrasion and laser revision Scars are methods that the operator uses to make scars with a rough surface or those that are above the skin level less visible. The upper layers of the skin are removed by abrasion or laser beam. In other words, the scar will remain, but will be softer, smoother and less visible.
- Excessively dark or hyperpigmented skin can be improved by applying whitening creams or chemical peeling . These products reduce the intensity and number of granules in the skin, reducing the color contrast.
- It happens sometimes keloids begin to treat with corticosteroid injections or some other means (silicone cream) which is applied directly to the surface. If these measures are not met, the scar is excised and the edges of the incision are sutured with fine sutures.
AFTER THE INTERVENTION
After the revision of the scar, you can expect mild swelling, hematoma and redness. Although the sutures are removed after a few days, it should be borne in mind that the healing is not over yet. Limited physical activity after surgery, raising the headboard, and applying cold compresses are generally recommended. It is also recommended to avoid activities that involve moving the operated area . You should inform your surgeon about any medications you take after surgery.
In all types of scar revision, special attention should be paid to limiting more intense sun exposure for a period of 6 to 12 months.
Scar tissue after surgery requires at least 1 year for complete healing and maximum effect of improvement in appearance. In some cases, unfortunately, the scar (usually in the form of a keloid or a highly hypertrophic scar) is very stubborn and resistant to any therapy and the possibilities for improvement are limited.