Scar Revision

Improve the appearance of a scar through scar revision

Scars can be caused by various situations, including physical trauma, accidents, or the results of previous surgery. A scar will be developed depending on how your body heals in response to the original surgery or the experience of the surgeon.

There are a number of variables that can affect how severe scarring can be, including the size and depth of the wound, thickness and color of your skin, blood supply in the area, and direction of the scar. The extent that a scar affects your self-esteem is a personal matter.

No scar can be completely removed, however, Dr. Lesavoy is a skilled scar revision surgeon in Los Angeles who can improve the appearance of a scar. This can make the scar appear less obvious through the injection or application of various steroid medications or scar revisions.

More serious forms of scar surgery are skin grafts and skin flaps. These are more likely to be performed in a hospital as inpatient procedures, under the use of general anesthesia. The treated area may take several weeks or months to heal, and a support garment or bandage may be necessary for up to a year.

The process of grafting involves the transfer of skin from a healthy part of the body (the donor site) to cover the injured area. The graft is said to “take” when new blood vessels and scar tissue form in the injured area. While most grafts from a person’s own skin are successful, there are times that the graft doesn’t take. In addition, all grafts leave some scarring at both the donor and recipient sites.

Skin flap surgery is a complex procedure in which skin, the underlying fat, blood vessels, and sometimes the muscle, is moved from a healthy part of the body to the injured site. In some flaps, the blood supply remains attached at one end to the donor site, while in other, blood vessels in the flap are reattached to vessels at the new site using microvascular surgery.

Skin grafting and flap surgery can greatly improve the function of a scarred area. The cosmetic results may be less satisfactory, since the transferred skin may not match the color and texture of the surrounding skin. Generally, flap surgery produces better cosmetic results than skin grafts.

CONTRACTURE: Burns or other injuries that result in the loss of a large area of skin may form a scar that pulls the edges of the skin together, a process that is called contraction. The resulting contracture may affect the adjacent muscles and tendons, restricting normal movement.

Correcting a contracture generally involves cutting out the scar and replacing it with either a skin graft or a flap. In some cases Z-plasty may be used. Several new techniques, such as tissue expansion, are also playing an increasingly important role. Ask Dr. Lesavoy for more information about correcting a contracture. If the contracture has existed for some time, you may need physical therapy after surgery to restore full function.

KELOID SCARS
KELOID SCARS
Keloids are thick, itchy, puckered clusters of scar tissue that grow beyond the edges of a wound or incision. Often they are red or darker in color than the surrounding skin. Keloids occur when the body continues to produce the tough, fibrous protein known as collagen after a wound has healed.

In the illustration, this thick, over-grown cluster of scar tissue on the earlobe is a keloid. It has been removed and the incision closed with stitches, leaving a thin scar.

Keloids can appear anywhere on the body, but the most common areas are over the breastbone, on the shoulders and on the earlobes. They occur more often in dark-skinned people than in fair-skinned people. The tendency to develop keloids lessens with age.

Keloids are often treated by injecting a steroid medication directly into the scar tissue to reduce redness, itching, and burning. In some cases, these steroids will also shrink the scar.

If steroid treatment is inadequate, the scar tissue can be cut out and the wound closed with one or more layers of stitches. Generally, this is an outpatient procedure, performed under local anesthesia. You should be back at work in a day or two, and the stitches removed in a few days. A skin graft is occasionally used, although a keloid may develop at the site from which the graft was taken.

No matter what approach is taken, keloids have a stubborn tendency to recur, sometimes even larger than before. To discourage this, Dr. Lesavoy may combine the scar removal with steroid injections, direct application of steroids during surgery, or radiation therapy. Or you may be asked to wear a pressure garment over the area for as long as a year. Even so, the keloid may return, requiring repeated procedures every few years.

If you believe a scar revision can work for you, we can provide additional information to help you understand the types of scars, procedures that can treat them, and results you can expect. Your treatment experience will depend on your unique circumstances and severity of the scar. Please call our office to schedule an appointment and meet with Dr. Lesavoy. You may reach us at 310-248-5451.

BEST CANDIDATES FOR SCAR REVISION
Many scars that appear large and unattractive at first may become less noticeable in time. Some scars can be treated with steroids to relieve symptoms such as tenderness and itching. Because of this, many plastic surgeons recommend waiting as long as a year or more after an injury or surgery before you decide to have scar revision.

If you’re bothered by the appearance of a scar, your first step should be to consult a board-certified plastic surgeon such as Dr. Lesavoy. The surgeon will examine you and discuss possible methods of treating your scar, risks and benefits involved and possible outcomes. Be frank in discussing your expectations with Dr. Lesavoy, and make sure they’re realistic. Don’t hesitate to ask any questions or express any concerns you may have.

Insurance generally doesn’t cover cosmetic procedures. However, if scar revision surgery is performed to minimize scarring from an injury or to improve your ability to function, it may be at least partially covered by your insurance. Check your policy or call your carrier in order to be sure.

DOES SCAR REVISION WORK?
Scar revision is successful as long as the patient understands that once there is a cut or incision on the skin, either surgical or traumatic, there will always be a scar. The object of a plastic surgeon to revise a heavy or thick or wide scar is to improve it, but it will never remove the scar.
HOW LONG DOES SCAR REVISION TAKE TO HEAL?
The initial healing phase of a surgical scar revision may include localized swelling, discoloration or discomfort and may take up to 2 weeks. Healing will continue for several weeks and has a new scar heals it will slowly refine and fade up to approximately 6 months.
WHEN SHOULD YOU REVISE A SCAR?
One must wait at least 6 months for the old scar to heal and then revision can be done.
WHAT TYPE OF ANASTHESIA IS USED FOR SCAR REVISION?
Scar revision traditionally is performed under local anesthesia as an outpatient.
UNCERTAINTY AND RISK WITH SCAR REVISION
While generally safe, there is always the possibility of complications with scar revision. These may include infection, bleeding, a reaction to the anesthesia, or the recurrence of an unsightly scar.

You can reduce your risks by choosing a qualified plastic surgeon such as Dr. Lesavoy and closely following his advice, both before surgery and in follow-up care.

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