Scar Revisions
When the skin is in the
process of recovering from an injury, whether the result
of an accident, surgery, a burn, or acne, scarring will
occur wherever multiple layers of the skin have been
affected. Once a scar forms, it is permanent but may be
made less visible or relocated surgically.
With very few exceptions
most people are self-conscious about facial scars. Some
people may also experience diminished functioning of the
eyes, mouth, or nose due to scarring. If you've wondered
how facial scar revision could improve your appearance,
your self-confidence, or your level of facial
functioning, you need to know how scar revision works
and what you can expect from this procedure. This
pamphlet can address many of your and provide you the
information to begin considering facial scar revision
surgery.
Successful facial plastic
surgery is a result of good rapport between patient and
surgeon. Trust, based on realistic expectations and
exacting medical expertise, develops in the consulting
stages before surgery is performed. Your surgeon can
answer specific questions about your specific needs.
The most basic requirement for all surgery is good
health. Other requirements are more subtle and should be
carefully considered in discussion with your surgeon.
Expectations of the surgery and of the surgeon must be
realistic. A person considering facial scar revision
must understand that there is no way to remove scars
completely. The goal is to improve the appearance of the
scar either by disguising it, relocating it, or
minimizing its prominence. Skin color and type, age, and
the type of scarring, are all important factors that
must be part of the discussion prior to surgery.
Different types of scars
respond to different plastic surgery techniques. Timing
of surgery is another important choice. Some surgeons
advise against any scar revision in cases of injury for
a period that might extend up to a year after the
injury. This interval allows the body enough time to
heal fully.
Whether the surgery is desired for functional or
cosmetic reasons, your choice of a facial plastic
surgeon is of paramount importance. Your surgeon will
examine the scar in order to decide upon the proper
treatment and inform you of outcomes that can be
expected from facial scar revision surgery.
Different scars require
different treatments. For example, severe burns that
destroy large sections of skin cause the skin to heal in
a puckered way. As the skin heals, muscles and tendons
may be affected in this "contracting" movement. Keloid
scars are a result of the skin's overproduction of
collagen after a wound has healed. These scars generally
appear as growths in the scar site. Hypertrophic scars,
unlike keloids, do not grow out of the boundaries of the
scar area, but because of their thick, raised texture,
can be unsightly and may also restrict the natural
movement of muscles and tendons.
Some facial scars are
unattractive simply because of where they appear on the
face, while others affect facial expressions. All
surgical possibilities will be discussed in the initial
consultation along with risks involved for each type of
scarring. The agreement between you and your surgeon on
how to proceed is a prerequisite for successful surgery.
After you both decide to proceed with scar revision,
your surgeon will inform you about the anesthesia, the
surgical facility, any supportive surgery options, and
costs.
Because scars are highly
individualistic and the patient's attitude toward scars
is so personal, maximum improvement in facial scars may
require more than one procedure, and more than one
technique may be employed.
When a scar is of the contracture type, surgery
generally involves removing the scar tissue entirely.
Skin flaps, composed of adjacent healthy, unscarred
skin, are then lifted and moved to form a new incision
line. Where a flap is not possible, a skin graft may be
used. A graft involves taking a section of skin tissue
from one area and attaching it to another, and time must
be allowed following surgery for new blood vessels and
soft tissue to form. Z-plasty is a method to move a scar
from one area to another, usually into a natural fold or
crease in the skin to minimize its visibility. While Z-plasty
does not remove all signs of a scar, it does make it
less noticeable.
Dermabrasion and laser
resurfacing are methods a surgeon uses to make "rough or
elevated" scars less prominent, by removing part of the
upper layers of skin with an abrading tool or laser
light. Clearly, the scar will remain, but it will be
smoother and less visible.
Keloid or hypertropic
scars are often treated first with injections of
steroids to reduce size. If this is not satisfactory,
the scars can be removed surgically, and the incisions
closed with fine stitches, often resulting in less
prominent scars.
You can expect to feel some discomfort after facial scar
revision surgery. Some swelling, bruising and redness
are generally unavoidable. It is important for you to
follow your surgeon's after care recommendations to the
letter. Though the sutures will be removed within days
after the surgery, your skin needs time to heal.
Surgeons generally insist on decreased activity after
surgery and instruct the patient to keep the head
elevated when lying down, to use cold compresses to
reduce swelling, and to avoid any activity that places
undue stress on the area of the incision. Depending on
the surgery performed and the site of the scar, the
facial plastic surgeon will explain the types of
activities to avoid. No medication should be taken
without first consulting the surgeon. It is important to
remember that scar tissues require a year or more to
fully heal and achieve maximum improved appearance.
Facial plastic surgery
makes it possible to correct facial flaws that can
undermine self-confidence. Changing how your scar looks
can help change how you feel about yourself.
Insurance does not
generally cover surgery that is purely for cosmetic
reasons. Surgery to correct or improve scars caused by
injury may be reimbursable in whole or in part. It is
the patient's responsibility to check with the insurance
carrier for information on the degree of coverage.
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