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Facial Plastic and Reconstructive Surgery Handbook |
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Scar Revision
Scars are ubiquitous in our society, and may be caused by accidents or by various operations. All scars should initially be allowed to heal for a period of six to twelve months, and then if their appearance is not acceptable, should be seen by a facial plastic surgeon skilled in scar revision. Almost any facial scar can be improved to some degree. No scar can be totally removed. There will never be a perfect result in scar revision, but almost always there will be some degree of improvement. Every scar is different, and the techniques necessary for improvement will vary from scar to scar, and from patient to patient. Some scars can merely be excised and resutured, but most scars will require an excision in some sort of irregular pattern. Excising the scar with an irregular pattern camouflages the scar.
Most scar revisions are performed under local anesthesia and most of these are done in the office. Normally, a light dressing is placed over the operated area, and this is removed three to four days after surgery. If sutures need to be removed, they too are removed around the third or fourth postoperative day. You will be encouraged to wear antitension taping across the incision, for this will greatly improve the final result. Somewhere between three and twelve months after surgery when things are healed, an additional procedure needs to be performed. This is called dermabrasion, and this sands the area of the scar smooth, so that it sits at the same level as does the surrounding normal tissue. This too causes some reddening; the reddening and the healing will now progress over the next six to twelve months, and somewhere between twelve and twenty-four months after the dermabrasion, the scar will finally be improved. One must be patient with scar revisions, for improvements do not occur rapidly, and with many scars, multiple procedures are necessary to obtain the best final result.
The major risk with scar revision is that the patient is not pleased with the final result, and this is most commonly caused by expectations far greater than are reasonably possible. Other complications include bleeding, infection, changes in pigmentation and numbness or tingling.
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| Figure 15 |
Figure 16 |
Figure 17 |
Figure 15 shows a woman who has been involved in a serious automobile accident. She has many cuts, abrasion and even some tissue loss. Figures 16 and 17 show her appearance several years later after multiple scar revisions.
Terence Davidson, M.D., F.A.C.S.
UCSD Otolaryngology Division
200 West Arbor Drive
San Diego, CA 92103-8895
(619) 543-6631 |