Surgical Scar Treatment

Scars are areas of fibrous tissue that replace normal skin after an injury or surgery, forming as part of the body’s natural healing process. Surgical scars typically undergo a lengthy course of healing; it can take one to two years for them to reach their final appearance. Poor healing of scars can cause aesthetic concerns as well functional issues such as restricted movement, pain, and sensitivity in the affected area.

In most cases, scar tissue gradually matures, becoming less noticeable as it softens and fades. The formation of scars can be minimized from the surgical stage with precise techniques, optimal incision placement, and using the finest suturing materials, including deeper sutures. Even with meticulous surgical execution, however, poor scar formation is possible.

Avoiding direct sun is also critical in preventing poor scar formation. Exposure to sunlight can activate melanocytes, the cells responsible for pigment production, leading to hyperpigmentation in the scar area. This increased melanin production can result in darker, more noticeable scars and interfere with the normal healing process, causing scar tissue to become more pronounced and uneven. Additionally, UV radiation can break down collagen and elastin fibers, further compromising the integrity and appearance of the scar.

In many cases, treatments to minimize scars may not require surgical intervention. Often the issue can be managed non-invasively with topical creams, silicone sheets, laser therapy, corticosteroid injections, fillers to contour depressions, or dermabrasion.

If non-surgical scar treatments have not achieved optimal outcomes, surgical treatments should be considered. Surgical options for poor scars include techniques such as excision with primary closure, Z-plasty, W-plasty, and skin grafting, which aim to remove or reposition scar tissue to improve your appearance and function. These procedures are often tailored to the specific type and location of the scar to achieve the best outcomes. (Read more in Procedure Details.)

Finally, radiation therapy is sometimes used for severe and recurrent keloid scarring by targeting and reducing the activity of fibroblasts, the cells responsible for excessive scar tissue formation. However, this treatment carries risks such as skin irritation, potential changes in skin texture and color, and a small increased risk of radiation-induced cancer with repeated exposures.

To determine which methods are best for you, seek out an experienced physician who can help develop an appropriate treatment plan. Be sure to discuss the benefits and risks of various procedures.

When non-invasive treatments prove ineffective in minimizing problematic scarring, you can consider several surgical options.

Subcision uses a needle or specialized tool to break up and release the fibrous bands tethering down a scar. This is particularly useful for acne scarring. Using this technique may require multiple sessions to achieve optimal results. Sometimes, subcision is combined with fillers to balance and smooth out the skin’s contours.

Surgical scar revision is a procedure aimed at improving the appearance or functionality of a scar by modifying its size, depth, or color. This can involve excising, or cutting out, the scar and closing the area with fine sutures to create a less noticeable scar. Reducing the tension on the new incision is critical in these cases. Techniques like Z-plasty or W-plasty may be used in this procedure; they involve reorienting the scar into a more natural alignment with the skin’s lines and contours, thereby making it less conspicuous.

To determine which approaches are best for you, seek an experienced surgeon who has extensive experience in non-invasive and surgical scar revision and reconstruction.

Before you go

During a scar revision consultation, you can expect a thorough evaluation of your scar by your physician. Non-invasive management of scars can be handled by a dermatologist, plastic surgeon, or facial plastic surgeon. Surgical scars are typically addressed by plastic surgeons or facial plastic surgeons.

Your physician will review your medical history, discuss your concerns, and examine the scar’s location, size, and texture. They will explain various treatment options, such as surgical revision, laser therapy, or steroid injections, and recommend the most suitable approach for your case.

Questions to ask include the expected outcome, risks, recovery time, and cost. The physician may take photographs for comparison, discuss anesthesia options, and outline a personalized treatment plan to improve the scar’s appearance and functionality.

During the procedure

On the day of scar management, non-invasive procedures like steroid injections, dermabrasion, fillers, or laser treatments can be performed during a “lunchtime” appointment, allowing for minimal downtime. These methods are quick and typically require no anesthesia.

In contrast, surgical scar revision involves local anesthesia. Your surgeon will excise the scar tissue and meticulously repair the area using techniques such as linear closure, W-plasty, or Z-plasty to minimize scar appearance and enhance healing. The surgical approach is more involved, requiring sutures and a longer recovery period, but it is often necessary if non-invasive methods have already been attempted or if the scar is significant.

Surgical Scar Treatment Aftercare

Following surgical scar revision surgery, post-operative skin care is crucial.

Topical therapies play an important role in optimizing wound healing and minimizing scar visibility after surgery. Silicone-based creams, gels or taping are commonly recommended as they create a protective barrier, hydrate the skin, and help regulate collagen production, promoting a smoother scar appearance. Vitamin E oil or creams containing vitamin E may be suggested for their antioxidant properties, aiding skin regeneration and reducing scar tissue.

Sunscreen application is paramount to prevent hyperpigmentation and protect the newly healed skin from harmful UV rays, particularly in the early stages of scar management.

It’s important to note that if you are prone to keloid scars, you are at a higher risk for future keloid formation, even with an optimally executed scar revision. To ensure the best outcome, arrange for close follow-up care with your surgeon, who can monitor your healing process and implement preventive measures. These measures may include corticosteroid injections to reduce inflammation and the likelihood of keloid formation or prolonged treatment with silicone gels and sheets to minimize scar tissue development and improve overall scar appearance.