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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.
Different scars require different treatments. A few common scars include:
- Burn scars. 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.
- Facial scars can be 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.
Is Facial Scar Treatment for You?
The goal of facial scar treatment is to disguise the scar, relocate it, or minimize its prominence.
Important factors to be discussed with your surgeon include:
- Skin type and color
- Ethnic background
- Individual healing rates
Different types of scars respond to different plastic surgery techniques. A person considering facial scar revision must understand that there is no way to remove scars completely.
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.
Making the Decision for Scar Treatment
What you should expect:
- 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.
- 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:
b. Surgical facility
c. Supportive surgery options
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. More than one technique may be employed.
Understanding Scar Revision Surgery
Following is a general description of the surgery. Remember, each patient’s individual needs and features are considered before surgery.
- 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. 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 hypertrophic 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.
What to Expect After the Surgery
Note: These are general guidelines. Please ask your doctor to fully explain what your expectations should be post-surgery.
- 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.
Follow-up care is vital for this procedure to monitor healing. Obviously, anything unusual should be reported to your surgeon immediately. It is essential that you keep your follow-up appointments with your surgeon.Read more about what you should do before and after your scar treatment.
Read more about what you should do before and after your scar treatment.
Request an Appointment
To request an appointment or to get more information about the Johns Hopkins Center for Facial Plastic and Reconstructive Surgery, please call 877-546-4530.