Scars and wound healing are unpredictable. The way a scar develops depends on many factors including how your body heals, the type of the original injury, and on the surgeon's skills who initially treated the wound.
Many variables can affect the severity of scarring, including the size and depth of the wound, the blood supply to the area, the thickness and color of your skin, and the direction of the scar. Whether the appearance of a scar bothers you is a highly personal matter.
While no scar can be removed completely, a skilled Facial Plastic Surgeon can often improve the appearance of a scar, making it less obvious.
Many scars that appear large and unattractive at first may become less noticeable with time. Some can be treated with steroid injections to relieve symptoms such as tenderness and itching. For these reasons, it is recommended to wait as long as a year after an injury or surgery before you decide to have scar revision.
Depending on the scar, Dr. Zimm may initially suggest less invasive treatments to minimize the appearance of your scar. These minimally invasive treatments can include laser resurfacing, pressure treatments, steroid, 5FU, or botox injections. If after your examination, he determines that your scar will require scar revision surgery, he will discuss this in depth with you. For many scars, scar revision can be preformed in the office with local anesthesia alone; however, depending on their location and size, some scars will require scar revision surgery at the hospital as an outpatient procedure.
Many patients combine scar revision with another cosmetic procedure they wish to have.
There are several ways to make a facial scar less noticeable. Often it is simply cut out and closed with tiny stitches, leaving a thinner, less noticeable scar.
If the scar lies across the natural skin creases Dr. Zimm may be able to make it appear less conspicuous by repositioning it to run parallel to these lines with a variety of surgical techniques.
Some facial scars can be softened using laser skin resurfacing which can level an elevated scar, but it won't completely erase the scar.
Keloids represent scar tissue that grow beyond the edges of the wound or incision. They are often red or darker in color than the surrounding skin. Keloids occur when the body continues to produce the tough, fibrous protein known as collagen after a wound has healed.
Keloids can appear anywhere on the body, but they're most common over the breastbone, on the earlobes, and on the shoulders. They occur more often in dark skinned people than in those who are fair. The tendency to develop keloid scars lessens with age.
Keloid scars are often treated by injecting a steroid medication directly into the scar tissue to reduce redness, itching, and burning. In some cases, this will also shrink the scar.
If steroid treatment is inadequate, the scar tissue can be removed and the wound closed with one or more layers of stitches. This is generally an outpatient procedure, performed under local anesthesia. You should be back at work in a day, and the stitches will be removed in a few days.
No matter what approach is taken, keloid scars have a stubborn tendency to recur, sometimes even larger than before. To discourage this, Dr. Zimm will combine scar removal with steroid injections, direct application of steroids during surgery and pressure therapy over the scar. Even so, a keloid scar may return, requiring a repeat procedures in a few years.
Hypertrophic scars are often confused with keloid scars since both tend to be thick, red, and raised. Hypertrophic scars, however, remain within the boundaries of the original incision or wound. They often improve on their own, though it may take a year or more. Hypertrophic scars may improve with the help of steroid applications or injections.
If a conservative approach doesn't appear to be effective, hypertrophic scars can often be improved surgically. The plastic surgeon will remove excess scar tissue, and may reposition the incision so that it heals in a less visible pattern. This surgery may be done under local or general anesthesia, depending on the scar's location and what you and your surgeon decide. You may receive steroid injections during surgery and at intervals for up to two years afterward to prevent the thick scar from reforming.
Burns or other injuries resulting in the loss of a large area of skin may form a scar that pulls the edges of the skin together, a process called contraction. The resulting contracture may affect the adjacent muscles and tendons, restricting normal movement.
Correcting a contracture usually involves cutting out the scar and replacing it with a skin graft or a flap. In some cases a procedure known as Z-plasty may be used. New techniques, such as tissue expansion, are playing an increasingly important role. If the contracture has existed for some time, you may need physical therapy after surgery to restore full function.
Z-plasty is a surgical technique that can be used to reposition a scar so that it more closely conforms to the natural lines and creases of the skin, where it will be less noticeable. It can also relieve the tension caused by scar contracture. However, not all scars can be repaired with a Z-plasty. While Z-plasty can make some scars less obvious, it won't make them disappear completely. A portion of the scar will still remain outside the lines of relaxation.
In the Z-plasty procedure, the old scar is removed and new incisions are made on each side, creating small triangular flaps of skin. These flaps are then rearranged to cover the wound at a different angle, giving the scar a "Z"pattern. The wound is closed with fine stitches, which are removed a few days later.
As you heal, remember that no scar can be removed completely; the degree of improvement depends on the size and direction of your scar, the nature and quality of your skin, and how well you care for the wound after the operation. It is quite normal for your scar to look worse initially. It's important to remember that the final results of your surgery may not be apparent for some time.