Our skin is often at risk of external injuries (burns, cuts, surgeries or aftermath of acne at puberty).
Undeniably, each of these traumas heal with some type of scar. In other words, once formed, the scar remains permanent. Certainly, we can make it less visible or surgically correct to less noticeable. Basically, we do it through a procedure that we call scar revision.
In particular, this is especially the case in the head and neck region. As an illustration, for visible, prominent scars on the face or near the eye, mouth or nose, we should definitely consider removing or concealing it.
Some scars are unacceptable due to exposure to the gaze. Moreover, 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.
At the same time, some surgeons do not recommend surgery even up to a year after the scar has formed. To put it differently, this time is needed to complete the natural healing process. Surprisingly, it is often the case that a scar that does not look satisfactory at first eventually takes on a perfectly acceptable shape.
Overall, different types of scars require different approaches in treatment. For example, severe burns cause hard scars that often heal with contractures. Consequently, scars affect the muscles and tendons that are under the skin, prolonging the healing process and causing contraction (tightening).
Keloids are scars that result from the excessive formation of collagen connective fibers after healing is complete. In effect, 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 scar needs more than one procedure or technique, 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 excision in full or serially (in multiple acts) and rejoining of skin edges. We do it by applying a gentle surgical technique with the help of microsurgical instruments. We then put sutures to the skin with thin stitches. In the case of a compressed, contracted scar the operation generally consists of removing the scar in its entirety. After excision (removal), a skin flap is formed from surrounding healthy skin. Surgeon raises this flap dividing it from the deeper tissues. then move it towards the area of the removed scar. If it is not possible to use the flap in such a way, we take a skin graft from another suitable area and move it 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 – plasty is a method by which we move and reorient the scar from one area of the skin to another. It is usually in the natural furrows and lines of the skin. This way we can reduce its visibility. So, with Z – plasty we do not remove the scar, but make it less noticeable.
Dermabrasion and laser scar revision are methods that the surgeon uses to make scars of rough consistence or those that are above 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.
Applying whitening creams or performing chemical peeling can improve excessively dark or hyperpigmented skin.
Mainly, these products reduce the intensity and number of granules in the skin, reducing the color contrast.
Sometimes we treat keloids with corticosteroid injections or some other means (silicone cream) which we apply directly to the surface. In case of unsuccesful measures, we excise the scar and sutur the edges of the incision 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.