Scar Revision

Scars can be unsightly and do serious harm to your confidence, but Dr. Leonard has years of experience with scar revision. Dr. Leonard can significantly reduce the appearance of scars by applying or injecting steroids or, for deeper scars, through surgical procedures referred to as scar revision.

If You're Considering Scar Revision

Nobody expects to find themselves with a seemingly permanent scar. Even when an incision is expected, like through surgery, the severity of the scar will largely depend on how your body heals itself and how the surgeon performed the procedure.

The variables that can affect the severity of a scar include:

 How deep and wide the cut was
 How much blood travels through the scarred area
 How thick your skin is, as well as the color.
 The direction of the cut, e.g. with or against the grain

While all of these factors influence how severe your scar will be, the deciding factor in pursuing scar revision is an entirely personal one: How much does it bother you?

No scar can be completely removed, but through steroid application or surgical scar revision, Dr. Leonard is more than qualified to drastically reduce the appearance of your scars. If you’re considering whether scar revision is right for you, this will explain which types of scars are the most common, how Dr. Leonard is likely to treat them and what results you can reasonably expect. That said, unique situations often influence what can and cannot be done, so it’s best to personally ask Dr. Leonard any lingering questions before your scar revision procedure.

Making the Decision

Time is a large factor in a scar’s healing process. Many scars will become near invisible with time, and common symptoms like sensitivity or persistent itching can be treated with steroid application. Dr. Leonard recommends waiting at least one year before considering scar revision, since it’s difficult to determine what your scar will look like before then.

That said, you should consult Dr. Leonard about your options after your scar has had time to heal. He will look at your unique case history and scar to determine what treatment option will best suit you, explain the risks and rewards of any possible procedures and explain what results you can expect. While consulting Dr. Leonard, keep your expectations based in reality and inform him of any concerns you have about minimizing the appearance of your scar.

Insurance will typically not cover scar reduction procedures, but there are exceptions. For example, your insurance may cover all or part of the procedure if the scar hinders your ability to move freely. The only way to know for sure is to contact your insurance provider.

All Surgery Carries Some Uncertainty and Risk

Scar revision is certainly a low risk procedure, but nothing is entirely risk-free. Complications sometimes include post-surgical infection, poor reaction to anesthesia, bleeding, or the reformation of scar tissue. The best way to reduce your risk of complications is to follow Dr. Leonard’s instructions both before and after your procedure.

Keloid Scars

Keloids are usually raised, thick and itchy scars that have grown beyond the initial cut. They will usually appear darker than the rest of your skin, and are formed when your body continuously produces collagen after your scar has healed itself. Keloids can form anywhere, but are most commonly seen above your breastbone, near your shoulders and on earlobes. You are more at-risk for keloids if your skin is darker, and older people are less likely to develop keloids.

Keloid treatment often consists of steroid injections to reduce the itching and redness of the area, and this procedure will sometimes reduce the keloid’s size as well.

If steroids seem ineffective, Dr. Leonard may surgically remove the tissue and stitch the wound closed. This is a minor outpatient procedure and thus only requires local anesthesia, which means a short recovery time of a few days and much lower risk for surgical complications. Occasionally a skin graft is required, but the area where the skin is taken from is then at risk of developing a keloid.

Regardless of your personal treatment, keloids have a nasty habit of coming back. To prevent this, Dr. Leonard may use steroid injections in combination with removing the scar tissue. Alternatively, you may be instructed to wear a compression garment for a year to discourage keloid development. In the most severe cases, keloids may return indefinitely and require repeated treatment.

Hypertrophic Scars

Hypertrophic scars share many similarities with keloids, such as redness and swelling. Hypertrophic scars, however, will not swell beyond the boundaries of the initial wound. Additionally, these scars are more likely to fade on their own or through steroid injections.

In instances where steroids are not enough, surgical scar revision becomes an option. Dr. Leonard may remove the scar tissue and re-align the cut so that it heals in a less noticeable way. This procedure is performed under local or general anesthesia, depending on the location and the decision that you and Dr. Leonard reach.

Dr. Leonard may advise you to receive occasional steroid injections for up to two years post-surgery in hopes of preventing the hypertrophic scar from reforming.

Contractures

Contractures are most often caused by burns and are categorized by the loss of a portion of skin. This leads to a process called contraction, where a scar forms to pull the existing skin back together. Not only is this often unsightly, but it may affect nearby muscles and hinder regular movement.

The most common treatment method is for Dr. Leonard to surgically remove the scar tissue and replace it with a skin graft. In some situations, Z-plasty may be recommended. If the contracture has been around for many years and impaired movement, you may require physical therapy to regain control over the nearby muscles.

Facial Scars

Facial scars are often considered cosmetic issues by insurance agencies, even when the scar is hypertrophic. One of Dr. Leonard’s most common facial scar treatments is to simply remove the scar tissue and close it with small stitches, which will then leave a drastically smaller scar.

If the scar travels across natural lines in the face, known as “lines of relaxation” Dr. Leonard may alter the scar’s position to disguise it as one of these lines.

In some cases, facial scars may be treated via dermabrasion, a procedure where the outermost layer of skin is scraped with a controlled rotary wheel. This treatment leaves skin smoother than before, but will not entirely remove a facial scar.

Z-Plasty

Z-Plasty allows scars to be re-aligned and hidden within your skin’s natural lines. Additionally, it relieves the pressure on muscles caused by contractures. If you and Dr. Leonard decide that this procedure is right for you, he will remove the scar tissue and create new incisions on each side of the old scar, which creates three small triangles of skin. These three flaps are then positioned to cover parts of the old scar, creating the shape of a “Z”.

The procedure is finished with small, temporary stitches and is an outpatient procedure using local anesthesia. As with any procedure, Z-plasty will only reduce the appearance of scarring rather than remove it entirely.

Skin Grafting and Flap Surgery

Skin grafting surgery is a more serious form of scar revision. Grafts and flaps are typically performed in hospitals as inpatient treatments utilizing general anesthesia. The treated area can take several months to heal, and in some cases a bandage is recommended for up to a year.

Grafting is when skin is moved from one area of a body onto the treatment area and is considered “set” when blood and scar tissue have connected the new skin to the treatment area. Odds of success are highest using your own skin for a graft, but there is never a guarantee. Additionally, any graft will leave scarring around the treatment area.

Flap surgery is more serious, and involves transporting things like skin, blood and muscle to a new area and covering a scar. The blood supply may remain attached to the skin flap or the local blood vessels may be activated via a microvascular procedure.

Skin grafts are often successful, but may not be aesthetically perfect due to the new skin not matching its location. As a rule, flap surgery is generally more successful than grafting.

After Scar Revision

After your scar revision procedure, it’s vital that you follow Dr. Leonard’s instructions to make sure you heal properly. You may feel normal soon after the surgery, but return to your daily tasks at the pace you and Dr. Leonard deem appropriate.

As your treatment area heals, remember that no scar can be 100% removed, but the overall improvement will depend on the size and direction of the wound, your body’s natural healing processes and how you care for the wound post-treatment. If you are dissatisfied with your scar revision results, remember that the treatment area may not heal completely for at least one year.

Contact Leonard Plastic Surgery

Leonard Plastic Surgery

Water Place │ 500 Liberty Street S.E., Suite 400 │ Salem, OR 97301

(503) 391-2760 │leonardplasticsurgery@gmail.com