Scars, whether from an injury or a previous surgery, can never be removed completely. They can, however, be minimized so that only a portion of a scar remains, sometimes one that is so faint it will not be noticeable aside from close examination. Plastic surgery to limit scars is called scar reduction or revision. This type of procedure is not always successful, in that some scars reappear. Also, the ease in reducing a scar is dependent on the individual’s skin color or texture, their general health, the nature and location of the scar, and any corresponding scar tissue or other damage. Plastic surgeons usually advise persons with scars wait at least a year before having surgery because many scars will fade with time. The benefits of scar reduction may not be readily apparent after surgery, due to inflammation and other temporary changes caused by the procedure. Success is best assessed after a least a year. The procedure used varies greatly depending on the type of scar and its cause. Below are some major categories of scars and the techniques used.
Keloid Scars
Keloids are clusters of scar tissue that grow beyond the initial edges of a scar. They are thick, reddish or dark fibrous masses of collagen, which the body produces as part of the healing process. Initially, steroid injections will probably be used to reduce the scar without surgery. If that is unsuccessful, the scar will be surgically removed and a skin graft used to cover the open area. Keloids may return or can appear at the site where the grafted skin was removed. Often steroids are used in conjunction with surgery and the patient may wear a pressure bandage of some kind for as long as a year.
Hypertrophic Scars
These are sometimes confused with keloids, as they appear similar in color and texture, but hypertrophic scars don’t spread beyond the original wound site. Steroids may help here again, but if not, surgery and fine stitches can be used to reduce the scar. Steroids may be used at the site for up to two years to keep the scar from returning.
Contracture
Contractures do just what their name implies. They are scars – usually from burns or injury – that cause the skin to contract, sometimes limiting the flexibility of the area. For example, a contracture on the hand may keep someone from effectively playing the piano. Because of the area of scarring that is removed, the procedure usually involves a skin graft or skin flap. Due to previous limited mobility and the possible involvement of muscle, physical therapy may follow surgery.
Facial Scars
Here surgery with very fine stitches is common, as are attempts to disguise the reduction using natural creases and lines of the face. Again, a scar can be cut out and the skin reconnected to form a faint, less noticeable scar. Some facial scars can also be reduced by dermabrasion.
Z-plasty
Z-plasty is a procedure in which a z-shaped piece of skin is removed that includes the scar. The incision will leave a new scar, but one that is closed with fine stitches and that tends to be less visible due to the skin’s contours or natural “relaxation lines."
Skin grafting and flap surgery
Grafting and flaps are more serious techniques and are used when a scar is larger or excess skin and sometimes additional tissue or muscle is removed as well. These procedures are usually to reduce scars from injury. A graft is taken from a healthy part of the body and applied after the scar is removed. This is actually two surgeries, increasing the risk of complications and requiring a much longer healing period. Since the graft is taken from another part of the body, it is more difficult to match up textures and skin tone. Sometimes skin grafts do not “take” and another surgery is required. Flap surgery is more complex. It may include moving blood vessels, fat, and even muscles along with the skin to the new site. This procedure can be lengthy and may involve microsurgery to reattach the blood vessels.
