Every time the skin is cut, be it from an accident or as a planned incision for surgery, it heals with a scar. For various reasons scars may become very obvious or unsightly. Scar revision is a common plastic surgery procedure, where these scars can be hidden or improved.
Specialist Plastic Surgeons are highly trained to minimise the visibility of scars or make an existing scar less visible and is one of Dr Safvat’s areas of expertise. However no one can promise to operate and cut the skin without getting a scar or make a scar disappear altogether.
To simplify the picture there are 4 common reasons for bad scars
Keloid scars
People often call all bad scars Keloids. In fact individuals who get Keloid scars have a genetic predisposition to this. They usually get keloids wherever they are cut. This is more common in the darker skin individual, but can happen even in people with paler skins. Keloid scars are not limited to the site of injury and can spread beyond the limits of the cut. They can also occur any time after the injury.
Hypertrophic scar
Hypertrophic scars occur when somewhere along the healing process something delays the healing and causes a raised and thicker scar. For example, this can be infection, excess tension on the wound, severe friction or loss of significant tissue, etc… It is limited to the site of injury and does not spread beyond the wound. Individuals with hypertrophic scar usually heal normally and have normal scar elsewhere. Hypertrophic scars will eventually settle, become slightly less raised and more pale, provided the aggravating event is resolved. Also certain areas of the body are more prone to poorer scarring for example earlobes, middle of the chest and shoulders.
Poorly executed scars
Poorly executed scars are closed either under too much tension, or put in directions or at sites, that are more obvious. Plastic surgeons are highly trained to put scars in natural skin creases or shadow lines, and close wounds in layers and without tension. The location and orientation of a scar has a significant impact on how noticeable a scar is.
Traumatic scars
Traumatic scars are not uniform. Some are clean lacerations from a sharp object. Others have variable amount of shearing or crushing component to them. By enlarge the former will heal better and the latter will result in a poorer scar. Scars take up to a year to mature and can be improved in this time. This can be done by sun protection, scar massage and applying silicone to the scar. It is also imperative to stop smoking as it impairs all wound healing and causes poorer scarring.
To correct bad and unsightly scars
To perform scar revision surgery and make a scar less unsightly, Dr Safvat initially investigates what has gone wrong to cause the bad scar and then plan to rectify them if possible.
He will assess each scar and discuss with you what the best treatment is. There are various approaches and techniques to improve the appearance of scars.
At times a series of steroid injections and other non-surgical management is all that is needed. Other times scars can be surgically realigned, broken up, set within a wrinkle fold or shadow line so that they are less obvious. Yet for some patients, their hypertrophic or stretched scar can just be cut out and redone without tension. Occasionally Dr Safvat even uses fat grafting (transferring some fat from one part of the body to under the scar) to enhance the quality and appearance of the scar.
True Keloid scars are difficult to treat and have a success rate of about 60%. Often the more different modalities that are tried the better the chance of success. These include surgically cutting part of the scar (called intra-lesional excision), post-operative Radiotherapy, Steroid injection and Silicone sheeting.
Most scar revision procedures are performed as a day surgery procedure. But some scars require more complicated surgery and an over-night stay at the hospital may be required.