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Scar Revision Surgery
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SCAR REVISION SURGERY

A scar may be common, but it is still an unsightly presence for many. For those affected, hope comes in the form of Scar Revision Surgery. It is a standard procedure that improves the appearance and condition of a scar on any body part.

What is a scar?

Our body has a natural way of dealing with trauma, and a scar is a way that it heals and replaces damaged and lost skin. Composed of fibrous tissues, scars formed due to many reasons. They could result from injuries, infections, surgery or tissue inflammation and can appear anywhere on the body. Scars vary in appearance - some are flat, sunken, bumpy or coloured. They may also be itchy and/or painful.

The final appearance of a scar is dependent on several factors that include skin type, injury type, location, the direction of the wound, age of the person and their nutritional status (the level of nutrients in their body).

What are the different types of scars?

Scars come in different types, including keloids, hypertrophic scars, contractures and adhesions. Sometimes, abnormal scars are formed after the healing of a wound.

What is a keloid scar?

Keloids can develop after minor skin damage such as acne spots or piercings and can spread beyond where the skin was originally damaged. It usually appears as a raised, enlarged scar and is pink, red, skin-coloured or darker than the surrounding skin.

What is a hypertrophic scar?

Another type of raised scar is the hypertrophic scar. It is classified as an abnormal response where different forms within the wound result in a lifted appearance.

Ordinarily, a small wound to the skin's top layer heals normally, with new skin forming as the wounds heal. In deeper wounds that occur in the dermis layer and lower, the body responds by producing collagen to help in repair works. As collagen is thicker than the skin, it results in a scar. Sometimes, the body produces extra collagen during the process, resulting in a raised scar. The raised scar can either be a keloid or a hypertrophic scar.

Hypertrophic scar versus a keloid scar

Hypertrophic scars

Keloids

Appearance

Typically stays within the wound area

Extends beyond the wound area and can grow very large

Colour

Pink to Red

Red to Purple

Location

Commonly occurs in areas where the skin is taut

Occurs in both areas where the skin is taut or less taut

Collagen arrangement (microscopically)

Fibres are parallel to the epidermis (upper skin layer)

Fibres are random and disorganised, with more blood vessels present

Time to develop

One to two months after injury

It can take months or years to develop after an injury

Treatment needs

Generally becomes less noticeable over time

Does not go away without treatment

Scar changing to cancer

Lesser seen and lower risk

Increased risk

Treatment success and ease

Easier to treat

Harder to treat with a high return rate

What is a Contracture scar?

Contracture scars are formed when a large skin area is damaged or lost. This type of scar pulls the skin's edges together, causing tightness. This, in turn, affects the joints, muscles and tendons, typically causing a decrease in movement.

What is an Adhesion scar?

Adhesion scars form between unconnected internal organs and can cause complications during certain surgeries.

When does a scar form?

Scars are formed due to the body's natural healing response to wounds. This process, however, does not restore the skin's appearance to its original state.

How long does it take for scars to improve?

Over time, scars improve in appearance. Depending on the type, it can take ONE to TWO years, and in the case of thickened hypertrophic scars, improvements may take THREE to FIVE years. Keloids may not go away without treatment and may also grow larger.

How can a scar be minimised?

Some scars can be camouflaged with makeup, while others can be minimised with a dermatological approach. This will be determined by the doctor after taking into account the following:

• The patient's age, overall health and medical history.
• The type, severity, symptoms and location of the scar.
• The patient's tolerance and allergic reaction (if any) to certain medications, therapies and procedures.

The patient's preferences and expectations will also be taken into consideration. It is to note that treatments can only improve the appearance of a scar but not eliminate it completely.

Scar-minimising procedures

The list of scar-minimising procedures, include:

‍Dermabrasion
‍It involves removing the top layers of skin. As the skin heals, its surface appears smoother. Dermabrasion is often used to address small scars, minor skin surface inconsistencies, and, surgical and acne scars.

‍Chemical peels
‍Sun-damaged skin, irregular pigmentation (colour) and superficial scars can be treated with chemical peels. The skin's top layer is removed with a chemical application, which improves its appearance as the skin regenerates.

‍Collagen and/or Cortisone injections
‍Injectable collagen is often used to treat scars, wrinkles and facial lines. It replaces the loss of the body's natural collagen. Cortisone injections are generally used to soften and shrink hard scars.

‍Cryosurgery
‍As the name suggests, it involves freezing and this instance, that of the skin's top layer. This causes the area to blister.

‍Laser resurfacing
‍Aside from wrinkles, laser resurfacing may also be used to treat hypertrophic scars. The procedure uses high-energy light to burn away damaged skin.

‍Punch grafts
‍Punch grafts can be used to treat deep acne scars. During the procedure, the hole is punched in the skin to remove the scar, and it is then replaced with skin, commonly from the back of the earlobe. It is considered a small skin grafting procedure.

‍Surgical scar revision
‍This procedure aims to create a less noticeable scar. The original scar is surgically removed, and the skin is rejoined. The procedure is done on scars that are wide and long or those that heal in an unusual way. It is also used on scars that appear in highly visibly places.

How long does scar revision surgery take?

Scar revision surgery takes about one to two hours in most cases. Depending on their size and location, some types of scars may take longer as they require extensive revision and tissue repositioning.

When should you get a scar revision?

Over time scars shrink and become less noticeable, so ideally, an individual can wait until it lightens in colour before opting for the procedure. This can take anywhere between months to a year after the wound has healed. Some scars may require a scar revision surgery after 60 to 90 days they have healed. It is best to seek a doctor's advice in regards.

Can a scar be removed completely?

Scars cannot be removed completely. The available procedures are to help in lessening its appearance. Discussing with a doctor will help alleviate concerns and form a realistic expectation.

Is scar revision surgery safe?

In general, all surgeries do include the risk of bleeding, infection and, in the case of scars - a recurrence. However, scar revision surgery is typically safe. A patient must do their part by following the pre and post-surgery instructions. It is also important that a patient raises concerns with their doctor during recovery.

Does scar revision leave a scar?

Although the procedure will not eradicate the scar, it will improve its appearance by making it look less noticeable.

What should a scar look like after 6 months?

The scar will be slightly elevated than the surrounding skin. Its colour and volume will also decrease during the healing process, typically lasting between three and six months. Afterwhich, the scar will gradually become paler and softer.

When can I go back to work after scar revision?

A patient can expect to return to work in ONE or TWO after the procedure, depending on the extent. The doctor will be in a better position to advise.

Recovery from scar revision surgery

Do follow all advice the doctor gives and remember to avoid sun exposure for at least 12 months. Many factors contribute to the healing rate, and the doctor will advise a patient regarding this.

Is Scar Revision Surgery worth it?

Patients who had a bad experience with the previous surgery or were involved in an accident are traumatised; we got your back.

We recommend you come for a consultation and assessment to understand whether or not you are suited to the treatment.

We welcome you to call us and schedule a consultation with Dr Ivan Puah to understand how we can help you achieve improved self-confidence.

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