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 it is formed, the scar remains permanent, but can be made less visible or surgically corrected to make it less noticeable.
Fortunately, in some cases, the so-called scar revision can be performed. 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.
It should be noted that there is no ideal technique or way to remove the scar completely. 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 visual exposure, 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, and muscles and tendons located under the skin are affected by the healing process and contraction (contraction).
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 IN SCAR REVISION
There are several surgical techniques suitable for different types of scars (scar revision).
- The most common way to remove a scar is to cut it out completely or serially (in several acts) and reattach the edges of the skin using a gentle surgical technique using microsurgical instruments and suturing the skin with thin sutures. In a scar that is completely compressed (contracture), surgery generally consists of removing the scar completely. After excision (removal), a skin flap is formed consisting of surrounding healthy skin and this flap is lifted from the substrate to move toward 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 a scar from one area of the skin to another, usually into natural furrows and lines of the skin, to reduce its visibility. With Z – plasty we do not remove the scar but make it less noticeable.
- Dermabrasion and laser scar revision are methods used by the operator to make scars of rough surfaces or those above skin level less visible, removing the upper layers of the skin 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 peels . These products reduce the intensity and number of granules in the skin, reducing the color contrast.
- Sometimes keloids begin to be treated with injections of corticosteroids or some other agent (silicone cream) that 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.
It is important to remember that scar tissue after surgery requires at least 1 year for complete healing to complete and maximum appearance improvement effect. 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.
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.