Scar Revision

What are scars?

Scars are the marks that are left on the skin after an injury is healed. Scars can be caused by trauma, cuts, burns, acne, and skin related diseases like vitiligo or chickenpox. Scars are thicker, and shinier than normal skin and can appear anywhere on the body. They are usually red or pink in colour. Scars do not immediately disappear but fade in time. To make a scar as invisible as possible requires extra effort from both the patient and the surgeon.

What are the different types of scars?

  • Keloid scar: these are thick, raised, and are often red or dark in colour. They are caused by the over production of collagen that grows beyond the wound.
  • Hypertrophic scars: these are also thick, red, and are raised. But unlike keloid scars they do not grow over the wound but instead remain within their boundary.
  • Contractures: This occurs when the elastic nature of the skin is replaced with fibers which make the skin more rigid losing the ability to stretch and restricting movement. This can occur with burns or with the loss of a large area of skin from injury.

How are scars surgically treated?

  • Z-plasty: This surgery is performed for scar revision and is useful with contracted scars.   Z-plasty is a technique which redistributes tension on the wound by breaking up the scar into smaller units, making the scar less noticeable. In this technique, two flaps of the skin are replaced with a limb. These limbs arrange themselves to look like a ‘Z’. This may not be used to perform surgeries involving skin burns.
  • W-plasty: This is performed on scars that are triangular in shape. W-plasty does not add any extension or length to the scar, but decreases the lateral tension of the scar. This is performed only on scars with excess adjacent skin attached.

Z- and W- plasty surgical techniques give a geometrical impression of the scar on the skin making the scar less noticeable and more natural. 

What are acne scars?

Acne is a common skin condition that about 80% of people develop in their teenage years. Often, acne may resolve itself without leaving behind permanent marks on the skin; however certain individuals may get displeasing acne scars. If any skin defects remain even after 1 year, it is considered to be a permanent defect or scar.

What are the types of acne scars?

Acne scars can be classified into two major types based on the response of the tissues to the inflammation as follows:

  • Scars formed by increased tissue formation–Hypertrophic or Keloid scars
  • Scars formed by loss of tissue
    • Ice-pick scars
    • Boxcar scars
    • Rolling scars
    • Depressed fibrotic scars
    • Superficial and deep soft scars
    • Atrophic macules

How are acne scars treated?

Several surgical and non-surgical techniques are available for acne scar revision and your cosmetic surgeon will discuss the most suitable option for your particular situation.

Excisional surgery: Acne scar surgery is considered the most effective treatment method to treat depressed acne scars. It aims to convert a bigger, deep scar to a smaller, flat scar which can be treated with laser resurfacing. All these techniques are performed under anaesthesia.

  • Punch Excision – Punch excision is a technique used to correct ice-pick and deep boxcar scars. In this method a round, sharp and small sized (matched to the size of the scar) punch biopsy tool is used to remove the entire defect. The edges will be sutured
  • Punch Elevation – Punch elevation is a technique used for wide boxcar scars. A punch tool similar to a punch excision tool is used to excise the base of the scar but the walls of the scar remain intact. After the scar is removed, the remaining basal tissue is then raised to the surface of the skin and attached with sutures or steri-strips
  • Subcutaneous Incision – This technique is used to treat rolling and depressed scars. A special needle is inserted under the skin to separate the skin from the scarred surface. The scarred surface will then be flattened
  • Shave Excision – Shave excision is a technique to treat elevated and hypertrophic scars or keloids. The scar is removed with a flexible blade or scalpel to bring it in level with the surrounding skin
  • Fusiform (Elliptical) Excision – This commonly used technique is preferred for elevated and hypertrophic scars as well as depressed wide scars

It is important to remember when undergoing any treatment for acne scars that improvement is the goal. Several treatments may be necessary to achieve optimal correction, where your cosmetic surgeon may suggest combining different surgical and non-surgical techniques.