Scar Revision

What are scars?

Scars are marks that remain on the skin after an injury or wound has healed. They form as part of the body’s natural healing process and can occur due to:

• Trauma or cuts
• Burns
• Acne
• Skin conditions such as vitiligo or chickenpox

Scars are often thicker and shinier than normal skin and may appear red, pink, or darker in colour. While most scars fade over time, they rarely disappear completely. Achieving the best cosmetic outcome requires active care from both the patient and the treating surgical practitioner.

Types of scars

1. Keloid scars
   • Thick, raised scars that extend beyond the original wound boundary.
   • Caused by excessive collagen production during healing.
   • May be red, dark, or uncomfortable.
2. Hypertrophic scars
   • Raised and thick like keloids but remain within the original wound area.
   • Tend to improve gradually over time but may still need treatment.
3. Contracture scars
   • Occur when the skin loses its elasticity and becomes rigid.
   • Common after burns or large injuries, and may restrict movement in the affected area.

Surgical treatments for scars

Z-Plasty

• Often used for contracture scars.
• Involves creating two triangular skin flaps that form a ‘Z’ shape.
• This redistributes tension, improves movement, and makes the scar less noticeable.
• Not usually performed on severe burn scars.

W-Plasty

• Best suited for scars with excess adjacent skin, such as triangular scars.
• Reduces lateral skin tension and blends the scar into the surrounding skin.
• Commonly used for facial scars.

Both Z- and W-Plasty techniques aim to break up the scar’s straight lines so they are less visible.

Acne scars

Acne is a very common skin condition, especially during adolescence. While many cases heal without lasting marks, some individuals develop permanent acne scars, especially if there was deep inflammation or improper healing.

If skin defects persist for more than one year, they are considered permanent acne scars.

Types of acne scars

Acne scars are broadly classified based on how the tissue responded to inflammation:

1. Scars caused by excess tissue (raised scars):
   • Hypertrophic scars
   • Keloid scars
2. Scars caused by tissue loss (depressed scars):
   • Ice-pick scars – deep and narrow.
   • Boxcar scars – wide with sharp edges.
   • Rolling scars – wave-like depressions.
   • Depressed fibrotic scars – deep, fibrous tissue involvement.
   • Superficial and deep soft scars – mild to moderate depth.
   • Atrophic macules – flat, thin, and discoloured areas.

Treatments for acne scars

Treatment depends on the type and severity of scars, and in many cases, a combination of surgical and non-surgical methods may be recommended.

Surgical options:

1. Punch Excision
   • Used for ice-pick and deep boxcar scars.
   • A small, circular tool removes the scar tissue.
   • The area is then sutured closed, leaving a smoother surface.
2. Punch Elevation
   • Ideal for wide boxcar scars.
   • The base of the scar is excised and lifted, while the sides remain intact.
   • The raised tissue is then secured at skin level with sutures or adhesive strips.
3. Subcutaneous Incision (Subcision)
   • Used for rolling or tethered scars.
   • A special needle releases the fibrous bands beneath the scar, allowing the skin to rise and flatten.
4. Shave Excision
   • For raised scars, such as hypertrophic scars or keloids.
   • A scalpel or flexible blade levels the scar with the surrounding skin.
5. Fusiform (Elliptical) Excision
   • Commonly used for wide depressed scars or raised scars.
   • Involves removing the scar tissue in an elliptical shape and closing it with fine sutures.

Post-treatment considerations

• Multiple sessions may be required to achieve optimal results.
• Your cosmetic surgery practitioner may recommend combining surgical techniques with non-surgical treatments, such as laser resurfacing or chemical peels, for best outcomes.
• The goal of treatment is improvement, not complete perfection. Patience and consistency are key.

Risks and complications

As with any procedure, scar revision surgery carries potential risks, including:

• Infection
• Bleeding
• Scarring at the incision site
• Changes in skin texture or pigmentation
• Need for revision surgery if optimal results are not achieved