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 Beverly Hills 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.

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.