Scar revision is a common request and a frequently performed procedure in plastic surgery. Whatever it is scars from an accident from a surgical encounter, many patients have concerns about their scars. As a result, there is much interest in scar improvement whether it is immediately after the scar event has occurred or even years later. The sheer number of over-the-counter scar treatments attest to the public's interest in eradicating these unsightly and disfiguring marks.
Topical scar creams and ointments have little proven success, other than anectodal evidence, that they work. Topical scar treatments do have a role to play in early scars but not in older scars. Only the concept of some form of scar revision has any hope of improvement at this point. Scar revision can consist of a variety of treatments including excision and rearrangement (cutting out and recopying), laser therapies, and mechanical methods of dermbrasion or sanding. All are not equal, meaning that each has a specific role to play and can be beneficial if used in the right kind of scar.
There are several key points that anyone considering scar revision needs to appreciate. First and foremost, no method of scar revision can completely erase a scar's appearance. The skin that the scar has replaced will never be normal ….. ever. Scar revision is about improvement, not perfection or complete elimination of the scar. As a plastic surgeon, we are not magicians and have no magical wand. The important question before undergoing scar revision then is …. how much improvement can be had and is it worth the effort. That is where the value of a consultation with a plastic surgeon is ……. ascertaining how much scar improvement may be achieved.
Secondly, there is no single method of scar revision that will work for all scars. Much ballyhoo goes on about the use of lasers, but quite frankly, lasers are not the most common method of treating scars. They may seem like an 'eraser' but their use is restricted to treating early or persistent redness of scars and some light skin resurfacing of scars. Both of these laser effects produce mild degrees of improvement but it is not effective for many types sofar problems. By far, excision and primary closure (cutting the scar out and reclosing it) or excision and tissue rearrangement (cutting the scar out and realigning it through geometric rearrangements such as z- or w-plasties) is most common. Scar exclamation is probably the most effective method of scar improvement, if the scar problem permits, as it is removing the scar first and creating a fresh wound. Dermabrasion and deeper laser resurfacing may be helpful for wide scars that are raised that do not lend themselves to excision.
Lastly, it takes six months to a year to see the final results of scar revision. I tell patients that scar revision is a process that usually involves taking a step back (to allow healing) in the hope that in the long term you have jumped two steps forward and it looks better. Scar revision results are not always predictable and some leap of faith is necessary if one makes the effort. Scar revision results take time to see improvement often at least 6 months after the procedure.