What is Scar Revision?
They are traces on the skin that attract attention and can be distinguished from the natural appearance. This may be vague, or it may be so severe that it restricts movements. Some areas of the body may be more sensitive to scarring. All kinds of surgical interventions, accidents, infections, various skin diseases and burns can leave scars on the skin at different rates.
Which Variables Are Important in the Development of Scars?
1- Your body’s healing potential
2- Original trauma type
3- Your Surgeon’s Skill
4- The size and depth of the wound
5- Degree of blood supply of the region
6- Thickness and color of your skin
7- The direction of the scar etc.
Are Scars Completely Erased After Scar Treatment?
No matter how the scars are formed; It is impossible to know in advance how it will develop. How a scar will develop depends on the combined effect of different factors,
How much the appearance of a scar bothers you is, of course, a personal matter. Although a scar can never be completely removed, plastic surgeons can improve its appearance by injection or administration of certain steroid-containing drugs, or by surgical procedures called scar revision.
Preoperative Evaluation:
Many scars that are large and bad-looking early on may become less noticeable over time. Some symptoms such as tenderness and itching can be treated with steroids. For this reason, many plastic surgeons will recommend waiting a year or more after any trauma or surgery before making the decision for scar revision.
If you have trouble with a bad scar, the first thing you should do is consult a plastic surgeon. After examining you, your doctor will tell you about possible methods of treatment and will reveal the risks and benefits. When talking to your doctor, you should express your expectations; You should clearly put forward the questions or doubts in your mind.
How Many Types of Scars Are There?
Keloid Scars:
Keloids are rough, itchy clusters of scar tissue that protrude from the edges of the incision or wound. It is usually darker than the surrounding skin or red in colour. It occurs when the body continues to produce a fibrous protein called collagen after a keloid scar has healed.
Keloid can develop in any part of the body, but most commonly (the sternum) develops in the earlobe and shoulders. It mostly occurs in dark-skinned people and the tendency to develop keloid decreases with age.
In the treatment of keloid, redness, itching and burning sensation can be reduced by injecting steroids directly into the scar tissue. Sometimes the scar tissue may also shrink as a mass and decrease.
If steroid therapy is insufficient, the scar tissue can be excised and closed with one or more layers of stitches. This is an “out patient” (outpatient surgery) procedure that is usually performed with local anesthesia. You can go back to work in a few days and the stitches can be removed in a few days. Rarely, a skin patch (graft) may also be used, but it is possible to develop keloid from the area where the patch was taken.
Regardless of the type of treatment adopted, keloids have a tendency to recur and sometimes even develop larger than the previous one. In order to prevent this, the removal of scar tissue can be combined with steroid injection, steroid injection during surgery or radiation therapy, or you may be asked to wear a compression garment for a period of one year and silicone application for nine months. Even in such a case, keloid may recur and repeat procedures may be required every few years.
Hypertrophic Scars:
Often, keloid and hypertrophic scars are confused with each other, as both are thick, red, and raised from the skin. However, the hypertrophic scar remains within the boundaries of the original incision or wound and heals over time, although it usually lasts for a year or more with the aid of steroid applications or injections.
If a conservative approach is not effective, surgery may provide recovery. The plastic surgeon removes excess scar tissue and can place the incision less visibly. In this procedure, it can be performed under local or general anesthesia, depending on the decision of you and your doctor, instead of the scar. A minimum of nine months of silicone application is required. Steroid injections may be given intermittently during surgery and up to two years after surgery to prevent coarse scarring.
Contractures:
Burns or traumas that cause major skin loss will contract and contract as they heal. This event, called contracture, can affect adjacent muscles and tendons, leading to limitation of movement. To correct a contracture, the scar tissue must be cut and replaced with a skin graft or flap. In some cases, a procedure called z plasty can be applied. In some cases, techniques such as tissue expansion may also be used. If the contracture has been present for a long time, post-surgical physiotherapy may be required to achieve full function.
Facial Scars:
Whether hypertrophic or not, facial scars are seen as a cosmetic problem due to its location. There are several ways they can be less noticeable. Re-closing it with fine stitches after cutting it out often creates a thinner and less noticeable scar.
If the scar crosses the natural skin lines (lines of relaxation), the direction of the scar can be made less obvious by making them parallel to these lines.
With Which Methods Can Scar Treatment Be Done?
Z – Plasti Method:
With the Z plasty technique, a scar direction is made less noticeable by conforming more to the natural lines. In addition, the tension (tension) formed as a result of the contracture is also reduced. However, z plasty may not be suitable for all scars and an experienced plastic surgeon is required to make such decisions.
In the Z plasty procedure, the old scar is removed and new incisions are made on both sides to form small triangular flaps. These flaps close the wound at different angles to form a “z” shape to the scar, and the wound is closed with thin sutures to be removed within a few days. Z plasty is usually performed under local anesthesia.
Even if the scars are made less obvious with Z plasty, they should not be expected to disappear completely. A portion of the scar will also remain outside the relaxation lines.
Skin Grafting and Flap Surgery Method:
Skin grafts and flaps have a more serious place in scar surgery. It can be done under general anesthesia. It may take several weeks or months for the treated area to heal, and a supportive bandage accessory may be required for up to a year.
Grafting is a skin transplant from a healthy part of the body (donor site) to the traumatized area. Graft retention means the formation of new blood vessels and scar tissue in the traumatized area. Although the use of one’s own skin as a graft is usually successful, sometimes the graft may not hold. In addition, some scarring occurs in the donor and recipient areas in all grafting operations.
In flap surgery, it is a complex procedure in which the skin and subcutaneous region of the body (sometimes including the muscle) are transferred to the traumatized area. Since this piece of skin has a vascular stem, it is fed by its own circulation.
The function of skin grafting and flap surgery in a scarred area can be greatly improved. However, cosmetic results may be less satisfactory as the color and softness of the transferred skin will not fully match the surrounding skin. In general, flap surgery gives better cosmetic results than grafting. However, your doctor will decide what kind of treatment you need.
What Kinds of Risks Are Encountered in Scar Treatment?
All Surgical procedures carry some risk and uncertainty. Normally a scar revision is usually a safe procedure. However, the possibility of complications exists as in any surgery. These complications include infection, bleeding, or recurrence of an unsightly scar. These risks can be reduced by choosing the right plastic surgeon and following their pre- and post-operative recommendations.
How Does Healing Happen After Scar Revision?
It is very important to follow your doctor’s recommendations after scar revision for the wound to heal properly. Even if you think you are recovering very quickly, your doctor will suggest that you start your normal activities gradually.
The degree of recovery varies depending on the factors mentioned above. If your scar looks bad in the early period, do not panic; The result may become clear after a year, sometimes even longer.
