Scar Revision

Scar Revision in Sydney

Are you considering scar revision in Sydney?

Not everyone scars the same. Some lucky individuals can sustain tremendous injuries to their skin and barely have anything to show for it after everything has healed. Other individuals can have minor trauma such as an insect bite, or ear piercing, and generate scars that can be seen across the room.

Damage to the deeper layers of the skin (dermis) will always result in a scar. Therefore, any surgical incision will create a scar. A scar cannot be removed, but scar revision is possible. Specialist Plastic Surgeons are trained to minimise the visibility of a scar. Appreciating what is achievable requires an understanding of what causes bad scars, how we try to avoid them, how we treat problem scars, and the types of scar revision in Sydney.

What causes bad scars?

The main determinant of how good, or poor, your scars will be is your genetics. It is well known that the darker your skin, the greater your chance of problem scars. People from African descent will have worse scarring than people from Northern Europe. Mediterranean and Asian patients also often have problem scars, although their risk of a true keloid scar is lower than darker skinned races. If you have had operations, or injuries, that have healed well in the past then you are likely to heal well again. If you are unlucky enough to have poor scarring after simple, uncomplicated surgery, then your genes are working against you.

We also know that certain areas of the body are more prone to problem scarring than others. Particularly bad areas include earlobes, sternum, back and shoulders. People that have scarred well in the past should not presume that other operations will have the same results, especially in these areas.

The cause of the scar has a strong determination on the final outcome. An injury caused by a car accident, with multiple cuts and crushing of the tissues will cause much more damage to the skin and underlying tissues than a surgical incision. Similarly, careful tissue handling during a procedure is likely to result in less damage than rough operating. These all impact on the health of the cells that are trying to heal your wounds, resulting in changes to your scar.

The orientation on any scars has an important impact on how visible a scar is. A scar that hides in a natural skin crease or shadow line will be less visible than one that crosses skin folds or natural areas that the eye skips over.

Incidents that occur during the healing process, such as infection, can also contribute into changing a scar from acceptable to noticeable, causing the patient to seek scar revision later.

What are the types of bad scars that are common?

In normal practice, there are three types of scars that cause patients to be unhappy and to seek a scar revision in Sydney after minor trauma or an operation.

1.    Hypertrophic scars

Hypertrophic scars are red raised scars that occur along lines of injury or incision. They can be caused by any of the above factors, but can also be worsened by changes in the healing environment such as stretch, sunburn or infection. Children with traumatic injuries often heal well, but have a high rate of hypertrophic scars. These scars have the potential to be improved by scar revision if the mitigating problems are managed.

2.    Keloid scars

Keloid scars are scars that heap up and overgrow the area of initial injury or incision. They have strong genetic correlation, and people that tend to form keloid scars will tend to form them everywhere. These are common on the sternum (breast bone), shoulders and earlobes, especially in dark skinned people. Revising these scars has only a 50% success rate, even with all the usual tricks thrown at them. Scar revision in Sydney to remove a keloid may simply result in the formation of a new keloid at the incision site. They occasionally require drastic steps to dampen down the healing process.

3.    Stretched scars

These scars have often had some stretch during the healing process. These are very common on the back, although most patients do not worry about these scars in that part of their body. Surgical scar revision in Sydney may be successful with enough physical scar support.

What can I do to make my scars as good as possible?

As you can see from above, a lot of the final outcome of your scars is pre-determined for you. However, there are things that you can do to make your scars as good as possible, so that you do not later need a scar revision in Sydney.

Providing the healing tissues with good nutrition and oxygen is very important. This involves ensuring that your iron (haemoglobin) level in your blood is within normal range, even a little high if possible. Important nutrients are folate, Vitamin B12, Vitamin C and Zinc.

Avoiding nicotine (in all forms, not just cigarette smoke) is important in the critical first 6-8 weeks. Nicotine is a vasoconstrictor – it causes blood vessels to shrink in size. It is the same as shutting down a lane on a highway – cars (nutrients) take much longer to get to where they need to be. This results in a slower healing, weaker wound in most instances. In extreme cases, the presence of nicotine can prevent a wound from healing.

As the wound matures through different stages, the methods of helping your scars change. Initially physical support and a moist (not wet) healing environment are important. During later healing stages, assisting the breakdown of scar tissue and discouraging excessive healing is important. Finally, avoiding ultraviolet radiation helps the scars mature as well as possible, which may prevent the need for a scar revision later.

How long should I wait before thinking about a scar revision?

Scars mature for about a year before plateauing. A scar is most of the way towards maturation by 6 months, and this is a reasonable time to consider scar revision in Sydney, if there are no ongoing signs of scar activity.

If there are obvious problems with contour, a scar revision may be reasonable earlier than 6 months. Problem scars, such as hypertrophic or keloid scars, often benefit from a series of steroid injections and other non surgical management until the scar settles down.

What can be changed in a scar revision procedure?

1.    Contour

A scar that has a step in it can be surgically revised to be flatter. Alternative methods such as dermabrasion and laser ablation may help.

2.    Alignment

Scars that are crossing natural skin folds (wrinkles) can be sometimes be realigned to sit within a wrinkle fold. If this is not possible, then the scar can be broken up so that it is less obvious. Scar revision in Sydney may include repositioning scars so that they are placed in better locations.

3.    Thickness or width

A thick or wide scar (such as a hypertrophic scar) can be surgically revised once the scarring process has settled down. The success rate of this varies widely. Dermabrasion and some laser treatments have reasonable success at helping scars with these problems.

4.    Colour

A normal mature surgical scar is white – there are no melanocytes or pigment cells. Some scars from chemical peels, laser and dermabrasion can be over-pigmented. Surgery is unlikely to help scars with abnormal colour, except if the new scar can be given a better healing environment than the original scar after scar revision in Sydney.

Are there any options other than scar revision surgery for treating my scar?

Yes. Many scars benefit from non surgical management, especially in the first year of healing. Many of these techniques are often employed pre-emptively by Specialist Plastic Surgeons to assist their patient’s scars after a procedure.

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