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Scar Revision
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| Surgical Scar Revision 3 years after |
Overview
One of the most common procedures Dr. Cruise is asked to perform is scar revision. Some people believe
that a plastic surgeon has the ability to completely remove
scars as if the injury never occurred. Obviously, this is
not possible. Once the skin is cut it can only heal by scar
tissue. The key to scar revision is to make the scar as unnoticeable
as possible. This is the art of plastic surgery.
Before performing a scar revision, Dr. Cruise carefully examines all the characteristics regarding
the scar and where it is located. Typically, a scar revision
requires excision of the old scar and precise repair. Also,
important is changing the direction of the scar so that it
falls into a natural skin crease where it is much less noticeable. For example, a 2 inch scar on the forehead is much more noticeable
if it is positioned vertically as oppose to a horizontal scar. This is because the natural skin creases of the forehead run
horizontally.
Another trick at Dr. Cruise's disposal
is to turn a scar that is either elevated or depressed into
a flat scar. This is important because scars that do not lay
flat will cast shadows which draw everyone's attention.
There are other techniques that Dr. Cruise
will elaborate on in Dr. Cruises philosophy section.
Another important aspect of scar revision
is understanding the differences between the types of scars
and the different ways people heal. Scars can be classified
into 3 different types. The first and most common type is
the unfavorable scar. This type of scar can
usually be dramatically improved if the precise plastic surgery
planning and repair are performed. This type of scar is caused
by either poor original repair or no repair at all leaving
the wound to heal on its own. The second type is the hypertrophic
scar. This type is widened and is usually hard. It
too is amenable to scar revision. The third and most difficult
scar to revise is the keloid.
A keloid is a scar that does not know when to stop growing. The scar keeps forming. It gets bigger and bigger until eventually
it is bigger that the original injury. This type of scar is
prone to return.
In addition to surgical techniques, there
are medications and injections that can be used to make scars
heal better as well as making them softer and less itchy.
Dr. Cruise has a large armamentarium
and tremendous experience at his disposal to fight scar formation. He has obtained his expertise by treating burn victims at
the Grossman Burn Unit of Western Medical Regional Hospital. Take comfort in the fact that no matter what type of scar
you have, Dr. Cruise has vast experience with similar scars
and knows exactly what needs to be done to produce the best
result possible.
 Benefits
The main benefit of scar revision is
that it brings you back as close to normal as possible. You
become less self-conscious about people noticing your scar. You do not have to spend as much time applying the right makeup
or wearing the right clothes to conceal the scar. Here is
a summary of the benefits.
- Improvement in self confidence.
- An inconspicuous scar is less painful
and less itchy.
- You do not have to worry about concealing
the scar with makeup or clothes.
- Helps with poor scars especially on
the face or hands, which can cause significant problems
with movement and function.
- Scar revision surgery is relatively
quick, low cost and with little down time.
- It is the only hope for large scars
such as burn or serious injury.
Are
you a good candidate?
Most noticeable scars are amenable to
scar revision. People with the following benefit the most
from scar revision surgery:
- A widen scar.
- A scar that is either elevated or
depressed compared to the normal skin around it.
- Scars that distort the face especially
when smiling or moving forehead.
- Discolored scars.
- Most scars of the face.
- Keloid scars are often amenable but
the patient must understand that a recurrence is possible.
Dr. Cruise's philosophy regarding Scar Revision
 My
time spent with burn victims as a director at the Grossman
Burn Unit has made me understand the devastation associated
with scar deformity. I realize that most people reading through
this web site have scars that are minor compared to a burn
scar but the effect can be similar. It can significantly diminish
one's confidence.
Within the burn unit we have developed
the optimal treatment for scar reduction. Of course, the average
scar is much simpler to treat but many of the burn techniques
are useful on even small scars.
If you have a large scar it is often
useful to do serial excisions to try and remove as much of
it as possible. If your scar is sunken, it is useful to elevate
it using various techniques such as fat transplantation, and
local tissue rearrangement.
After revision, I have my patients apply
topical steroids, Vitamin E, and silicone to minimize the
redness and excess scar formation. Sometimes, steroid injection
is necessary.
Possible
complications
The most common complication after scar
revision is inadequate scar improvement. This is minimized
by making sure the patient understands what can and can not
be done. Other complications are those that are possible with
any operation. These include infection and wound healing problems,
unfavorable scarring, fluid or blood collection, numbness,
asymmetry, and contour irregularities.
Prior to surgery
BEFORE SURGERY
- Avoid sunbathing for 2 weeks prior to surgery.
- Quit smoking at least 2 weeks prior to surgery as nicotine can impair and delay healing.
- Stop all aspirin containing products, medications that contains blood thinners (Motrin, Advil etc.) vitamin E and herbal supplements 2 weeks prior to surgery. You can take 1 multivitamin a day.
- Let the doctor know of all medications taken daily.
THINGS TO PURCHASE BEFORE SURGERY
- Medications.
- ScarLess®. ScarLess® is a prescription strength cream with vitamin E, silicone and Hydrocortisone to help minimize redness and elevation of the scars. You can purchase ScarLess at our office.
- Silicone Sheets. Silicone sheets minimize scarring and are a must postoperatively. Go to www.neosporen.com or a drug store and buy one box - 12- week supply.
THE DAY OF SURGERY
- Do not bring any jewelry or valuables with you on the day of surgery.
- Wear comfortable, loose-fitting clothes. Wear flat, comfortable shoes.
Anesthesia
Scar revision is typically done under
local anesthesia. If you would like, sedation can be added
to make you more comfortable.
If more anesthesia is necessary, Cruise Plastic Surgery
uses only board certified anesthesiologists to make sure you
have the best anesthesia possible. The anesthesiologist will
discuss with you what type of anesthesia is best for you. He/she will take into consideration your medical history,
the procedure, and your personal wishes.
After
the procedure
The procedure itself will take 30 to 1
hour - depending of the size of the scar.
AFTER SURGERY
- You may take a cool shower the day after surgery.
- At 2-3 weeks after surgery take your steri-strips off. Apply ScarLess®, allow it to dry and then apply silicone sheet twice a day for two months.
- Sutures will dissolve on their own.
- Avoid direct exposure of incision to sunlight for at least 6 weeks. After 6 weeks, apply sunscreen (at least SPF 15) to the area of the incision, if you will be in the sun for extended periods of time.
- Do not smoke for at least 1 week after surgery.
- Be sure to use all you medications as directed.
WHAT TO EXPECT AS YOU RECOVER
- Pink scars will eventually fade to an unnoticeable color. It may take up to a year for the scar to fade to its minimal color.
- Some firmness may develop.
WHEN TO CALL US
Post surgical complications are rare and are often easily solved by the doctor if you notify us. Call us if you experience any of the following:
A temperature of 101 F or higher, increased local redness or warmth, chest pain, shortness of breath, legs swelling, calf pain, or if you feel that anything might be wrong. Please call the office during regular business hours @ 949-644-4808 after page Dr. Cruise @ 714-304-8050. In addition, call if you have continuous discharge from the incision line.
Recovery
time
Some people with sedentary jobs go back
to work right after the revision. If your job, however, requires
strenuous activity it may take as long as 2 weeks to return
to work. Most people return to work in about 2 to 3 days.
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