Scar formation follows wound healing from either a surgical or traumatising intervention without fail. The most crucial factor to consider when evaluating the success of surgery is the aesthetic appearance of a scar. Experience, thorough planning, and technique, combined with knowledge of anatomy and wound healing, can lessen difficulties and enhance the surgical result. Although scar revision cannot remove a scar, it can help make it less obvious and more socially acceptable. A scar can be revised using both surgical and non-surgical methods, either separately or in combination.
Image: Acne scars
What are acne scars?
Acne lesions get inflamed, leaving behind acne scars. Acne causes the pore wall to breakdown and enlarge. Some acne lesions are tiny, and the resulting scars are shallow and quick to heal. A blemish’s contents may occasionally leak into the tissue around it, leaving deeper scarring.
Acne scar types
These scars resemble tiny skin indentations.
Little scars that resemble pinpricks are called icepick scars.
Boxcar scars are more substantial indentations with definite edges.
Rolling scars have undefined edges.
They appear when the skin overproduces fibroblasts while an acne area is healing, leaving behind a raised scar.
Although they look like hypertrophic scars, these are usually thicker than the original acne spot. The hyperpigmentation that usually occurs on them causes them to be darker than the surrounding skin.
What is scar revision?
Patients who have scars from surgery or from an injury have the option of surgical scar correction. Revision of the damaged tissue may help with the restoration of both form and function, depending on how severe the scar is.
Scar revision is a medical or cosmetic procedure to lessen the pain or visual impact of a scar. Scar revision methods come in a wide range, from topical skin treatments to scar revision surgery.
Why is a scar revision required?
Scars can be unsightly and uncomfortable, whether they are the result of an accident, surgery, or burn. Itchy or unpleasant scar tissue is possible. Due to their protrusion or depression from the surrounding skin, lack of direction, pull on adjacent structures, and colour, scars might be more obvious. Some people are more prone to developing keloids, which are noticeable, elevated scars. This is especially true of those with deeper skin tones. Revision can help achieve a more natural appearance.
Types of Scar Revision
Depending on the kind, location, and size of a scar, plastic surgeons may choose from a variety of scar revision treatments.
Steroid Applications and Injections
Hypertrophic and keloid scars can benefit from the flattening and calming effects of steroids. Steroids are either topically or injected directly into the scar to dissolve the collagen in the skin. This works particularly well on scars that are hypertrophic or keloid, since they both continue to produce collagen after the lesion has healed. The discomfort or itching brought on by these scars may also be lessened with the use of these injections.
Another treatment option for keloid scars is laser surgery. Different lasers may be used to treat scars, depending on the underlying etiology of the scar. A scar may be flattened, have its abnormal colour removed, or smoothed with laser technology. For keloid scars, laser therapy is frequently combined with steroid injections, specialised dressings, and bandages.
There are numerous laser systems that can effectively treat different kinds of scars. The gold standard for laser therapy of keloids and hypertrophic scars continues to be the 585-nm Pulsed dye laser (PDL). Although ablative CO2 and Er:YAG lasers may be the most effective treatments for atrophic scars, nonablative laser operations have grown in popularity due to the intense interest in methods with low morbidity profiles.
MNRF Treatment-Micro Needling Radio Frequency
New collagen, elastin, and fibroblast production is initiated by MNRF to restart the healing process. Better skin tones, more natural-looking tissue, and more ordered collagen remodelling are the effects of this.
MNRF is a minimally invasive, non-ablative technique that delivers electrical currents carrying both mono- and bipolar radio frequency energy. The electrical resistance of dermal and subcutaneous tissue, which is inherent, causes the development of heat. Inducing neoelastogenesis and neocollagenosis, which result in dermal thickening, it produces radiofrequency thermal zones (RFTZ) without causing epidermal injury.
Dermabrasion smoothes out surface flaws like deep wrinkles or scars by removing the top layers of skin. Anesthetic will be given into the affected area before the required amount of skin is carefully “sanded” off using a rotating wire brush or diamond wheel.
Z-Plasty and Similar Tissue-Rearrangement Methods
Z-plasty is a method for reorienting scars. By creating tiny triangular flaps of skin surrounding the scar, the scar is orientated. The procedure your doctor uses will depend on the nature of the scar, but these flaps typically have a Z-shape (thus the name). To follow the wrinkles and features of the skin, the flaps are moved. Usually, the new scar is less apparent. Z-plasty, which is frequently used in reconstructive burn surgery, can also help in relieving the pressure on contracture scars.
Contracted scars can be lengthened and reoriented with a Z-plasty. Although this method can be applied almost anywhere, the canthi, oral commissures, and alar bases are the most often used sites. Z-plasties provide the advantages of extending scars, dispersing tension, and redirecting scars to be parallel to the resting skin tension lines (RSTLs). Also, some research indicates that the zigzag pattern may make the final scar less noticeable.
If nonsurgical therapeutic methods fail to effectively heal the keloid scar, surgery may be performed. In one kind of surgery, the scar is directly removed through an incision, and stitches are used to help seal the wound. Skin grafts may occasionally be applied to help close the wound. This requires reattaching or restoring the lost skin. When doing skin grafts, a healthy piece of skin is removed from the donor site and stitched to the place that needs it.
Skin grafts can be replaced by tissue expansion. An inflatable balloon known as a tissue expander is inserted under the skin close to the scar location during this surgery. The balloon is gradually filled with sterile solution over time to increase the area of healthy skin. The expander and scar are removed when the skin has been stretched sufficiently, and the stretched skin is then moved to cover the scar tissue. To get the desired results, this method may require several surgical steps.
How do I get ready to get my scars revised?
To promote wound healing, consume a diet that is rich in vitamins, minerals, and zinc, particularly zinc and vitamins A, C, and E.
Stop using anticoagulants.
Before scar revision, individuals with diabetes or those on immunosuppressants may need to adhere to certain guidelines.
Moreover, you might need to postpone treatment while undergoing scar revision if you’re using isotretinoin or another prescription for severe acne.
You can get more details on this from your healthcare provider.
What advantages can scar revision offer?
Scar revision can lessen the discomfort brought on by scars while also reducing their appearance.
Getting treatment may benefit a scar’s color, size, stiffness, texture and thickness.
Even though scar revision is a technique that is frequently performed and the risks are quite uncommon, it is crucial to be aware of these concerns and to discuss them with your surgeon before the procedure.
Like with other procedures, there is a chance for complications, some of which include bleeding, infection, and adverse anaesthetic reactions.
By adhering to your cosmetic surgeon’s advice both before and after surgery, you can reduce some risks.
Your surgeon will provide you with detailed instructions on how to be ready for surgery if you decide to have it, including recommendations on what to eat and drink, how much to take certain vitamins and drugs and whether or not to smoke. In the months following surgery, your surgeon will schedule frequent follow-up visits to assess your recovery.