Scar Revision

If you have been left with an unwanted scar, you may decide that scar revision is for you.  Scars can be caused from surgery, burns, an injury, acne or chickenpox.  The total removal of the scar can never be guaranteed but it can be made less obvious and any tightness felt can  be reduced with scar revision.  Your skin colour, age and the type of scarring will influence how much improvement you can expect.

The surgeon will establish whether you want scar revision to reduce the appearance of the scar, reduce the tightness of the scar or both. The size of the scar, location, character of the scar (raised or depressed) will determine what type of treatment you will have. Chemical peels or laser skin resurfacing can help soften rough or raised scars. Scar excision methods involve cutting the scar to reduce or reposition it.

Scar revision is done as a day case under local anaesthetic.

Chemical Peels
Chemical peels containing glycolic acid or lactic acid improve and smooth the texture of the facial skin by removing its damaged outer layers and may help reduce acne scarring. The procedure can take up to 30 minutes or longer, depending on the type of peel that you are having.

Laser Skin Resurfacing
Laser therapy uses heat to destroy the top layer of your skin. The procedure takes about 30 minutes and is often done under local anaesthesia.

Scar Excision
Scar excision is done to reduce the size of the scar or reposition it. Your surgeon may use the following techniques:

Excision and direct skin closure – the scar is cut out and the surrounding skin is drawn together and stitched to form a new, neater scar line. Excision and repositioning - the scar is cut out and the direction of the scar is changed to run along a natural relaxed skin-tension line. Excision and skin grafting - the scar is cut out and replaced with a skin graft from a healthy part of the body. Skin grafts can be partial or full thickness. Scar revision treatment is commonly performed and generally safe. However, you need to be aware of the possible side-effects and the risk of complications of this procedure.

Side-Effects
Chemical Peels - depending on the type of peel used, your skin may appear red and swollen, and may feel tight for a few hours to several weeks.

Laser Therapy  - your skin will be red and swollen. You may feel some tingling, burning and itching sensations. Your skin may blister, ooze clear fluid and crust over as it heals. It may take six months to a year for the skin pigment to return.

Scar Excision - the area around the scar may be tender, bruised and swollen. If a skin graft is used, the area from where the graft is taken will also be painful for several weeks.

Complications
The possible complications of any operation include an unexpected reaction to the anaesthetic, infection, excessive bleeding or developing a blood clot, usually in a vein in the leg (DVT). Specific complications of Laser therapy or dermabrasion are uncommon but can include changes in the skin pigment (such as darkening or lightening) of the treated area. If you are prone to acne, laser therapy may cause a flare-up.

It’s possible your scar may re-occur after treatment and be worse than before. It can take up to 2 years to see the full results. It is possible that you won’t be satisfied with the appearance of your revised scar.

Your surgeon will explain how to prepare for your procedure. If you smoke you will be asked to stop, as smoking reduces blood circulation in your skin and delays healing. 

Before surgery, your surgeon will ask you to sign a consent form. This confirms that you understand the risks, benefits and possible alternatives to the procedure and have given your permission for it to go ahead. You may  be asked to wear compression stockings to help prevent blood clots forming in the veins of your legs (deep vein thrombosis, DVT).

Photographs may be taken so that you and your surgeon can compare the scar area before and after treatment.

Before you go home, your nurse will give you advice about caring for the treatment area and give you a date for a follow-up appointment. Arrange for someone to drive you home after surgery.  You should have a friend or relative stay with you for the first 24 hours.  If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.

After a local anaesthetic it may take several hours before the feeling comes back into the treated area. Take special care not to bump or knock the area. After chemical peel or laser therapy, your skin will be red and very sensitive. The redness can last three to six months and you will need to protect your skin from the sun for up to a year.

After scar excision, don't put any stress on the treated area and protect it from the sun until it has completely healed. Once healed,  massage the area with a simple moisturiser to help the skin soften and improve circulation.