Scar removal surgery offers a promising solution for those looking to reduce the visibility of old scars. This procedure isn’t about erasing every trace of injury but rather improving the appearance of scars so they blend more seamlessly with the surrounding skin. The decision to opt for surgical intervention should be made after careful consideration of the type of scar you have, your overall skin health and your expectations from the procedure.
When exploring surgical options, it’s important to understand that the timing, technique, and outcome can vary widely depending on the individual case. Scar removal surgeries are tailored to address specific concerns—whether that’s flattening a raised scar, reducing the width of a scar, or altering its position for less visibility.
Before considering surgery, you might have tried other treatments with limited success. Surgery presents a more definitive approach, yet it’s not without its challenges. It requires a significant commitment to post-operative care and a realistic understanding of what the surgery can achieve.
In this blog, Chester Consultant Plastic Surgeon Anca Breahna shares her expert insights regarding scar treatment, drawing upon years of experience in the field of plastic and reconstructive surgery.
Scars tell the story of your skin’s response to injury, whether from accidents, surgeries, or conditions like acne. Recognising the type of scar you have is key to determining the most effective surgical approach.
Scars can be broadly categorised into keloid, hypertrophic, atrophic, and contracture types, each with distinct characteristics. Keloid scars are raised, extending beyond the original injury site, often requiring specific surgical techniques to address their growth. Hypertrophic scars, while also raised, stay within the injury boundaries and may become less noticeable over time. Atrophic scars leave a depression in the skin and are commonly associated with acne or chickenpox. Contracture scars, resulting from burns, can affect muscles and tendons, limiting movement.
A pre-surgical evaluation with Anca will involve examining the scar’s size, texture, and depth, as well as considering the skin’s overall quality and the impact on surrounding tissues. This evaluation is important for tailoring the surgical plan to your specific needs, aiming to improve the scar’s appearance while maintaining the skin’s function and reducing any discomfort.
Understanding that scar removal surgery might not completely eliminate the scar is important. The goal is to improve its appearance to the point where it’s less noticeable and more in harmony with the surrounding skin. This might involve making the scar flatter, lighter, or simply less conspicuous.
During your consultation, Anca also assess your skin’s healing capacity, which can affect the outcome of the surgery. Factors such as age, skin colour, and lifestyle can influence how well your skin heals and adapts post-surgery. A thorough understanding of these factors allows for a more accurate prediction of the surgical outcomes.
Scar revision involves modifying or reducing the scar tissue, using various surgical techniques based on the scar’s characteristics and location. The primary goal is to create a less noticeable scar, either by altering its position, reducing its size, or improving its texture.
Several techniques are available for scar revision and the choice depends on the specific needs of your scar:
The recovery period for scar revision surgery varies depending on the extent of the procedure and your healing process. Generally, you can expect some swelling, discomfort, and redness in the area, which usually subsides within a few weeks. It’s important to follow Anca’s aftercare instructions closely to ensure proper healing. This may include avoiding certain activities that could strain the healing scar, applying prescribed topical treatments, and attending follow-up appointments to monitor your progress.
Laser surgery has become a prominent method for treating various types of scars, offering a less invasive alternative to traditional surgical techniques. By using focused light, this procedure can reduce the appearance of scars, improving skin texture and tone.
Laser surgery utilises concentrated beams of light to remove or reshape scar tissue. Different types of lasers are used depending on the scar’s characteristics—some are designed to target the blood vessels in red scars, while others can remove the outer layer of skin or stimulate collagen production in the deeper layers. This process not only helps in blending the scar with the surrounding skin but also promotes healthier skin regeneration.
The laser surgery procedure usually involves a local anaesthetic to minimise discomfort, followed by the application of the laser to the targeted scar tissue. The duration of the treatment can vary from a few minutes to an hour, depending on the scar’s size and depth.
Recovery times also vary with the type of laser used. Ablative laser treatments might require a few weeks of downtime, with initial redness and swelling transitioning to gradual healing. Non-ablative and fractional lasers generally have a shorter recovery period, allowing you to return to your daily activities more quickly.
Cryosurgery represents an innovative approach to scar management, particularly effective for certain types of scars, such as keloid and hypertrophic scars. This technique uses extreme cold to selectively destroy abnormal scar tissue, encouraging the growth of new, healthier skin.
Cryosurgery involves the application of liquid nitrogen or argon gas to the scarred area, rapidly freezing the abnormal tissue. This sudden drop in temperature causes ice crystals to form within the cells, leading to cell death and subsequent reduction of the scar tissue. The procedure is typically quick, performed in Anca’s office, and can be adjusted in intensity depending on the scar’s characteristics and your skin type.
The advantages of cryosurgery include its minimal invasiveness, quick recovery times, and the ability to target specific areas without affecting the surrounding healthy skin. It’s especially beneficial for raised scars that have not responded to other treatments, as it can reduce their size and relieve symptoms like itchiness or discomfort.
However, cryosurgery is not without its drawbacks. The procedure can be uncomfortable, and there’s a risk of skin discolouration, particularly in darker skin tones. Additionally, multiple sessions may be necessary to achieve the desired outcome, and there’s always a risk of the scar not responding to the treatment as expected.
Recovery from cryosurgery is generally straightforward, with minimal downtime required. You may experience redness, swelling, and blistering in the treated area, which typically subsides within a few days to weeks. It’s important to follow post-procedure care instructions carefully, which may include keeping the area clean and dry, applying prescribed ointments, and avoiding direct sunlight.
For best results, cryosurgery may be combined with other treatments, such as steroid injections or pressure therapy, particularly in the management of keloid scars. This combination approach can help to further reduce the scar’s appearance and prevent recurrence.
Skin grafting is a surgical procedure used to treat extensive or deep scars, especially those that result from burns, injuries, or surgeries. This method involves transplanting skin from one area of the body (the donor site) to the scarred area (the recipient site), helping to restore skin appearance and function.
There are two main types of skin grafts:
The skin grafting procedure starts with the selection of the donor site, typically an area hidden by clothes, such as the inner thigh or buttock. Anca then carefully removes the skin from this area and transplants it to the scarred site, securing it in place with stitches or surgical glue.
The success of a skin graft largely depends on the body’s ability to integrate the transplanted skin into the surrounding tissue, a process that requires adequate blood supply. To promote healing, the treated area may be covered with a bandage or dressing that applies pressure and helps prevent movement.
The recovery process involves caring for both the donor and recipient sites. You may experience pain, which can be managed with medications prescribed by Anca. Keeping the graft area immobile and elevated can also help reduce swelling and promote healing.
The donor site typically heals within two to three weeks, while the grafted area may take longer. It’s important to follow Anca’s aftercare instructions, which will include how to clean and dress the wounds, signs of potential complications to watch for, and when to return for follow-up appointments.
Postoperative care is essential for the success of the skin graft. This may involve using moisturisers to keep the skin supple, sun protection to prevent damage to the new skin, and in some cases, physical therapy to maintain flexibility in the affected area.
Tissue expansion represents a unique approach for scar management, particularly suited for treating large areas of scarring where direct closure is not feasible, or the best aesthetic results cannot be achieved with simple excision. This technique leverages the body’s natural ability to grow extra skin by stretching surrounding tissue:
The initial placement of the expander is usually done under general anaesthesia, and the patient can usually return home the same day. The expansion process is gradual, with saline injections occurring every few weeks, causing minimal discomfort. This phase requires careful monitoring to avoid over-expansion or damage to the surrounding tissue.
Recovery from the final surgery, where the scar is removed, and the area is reconstructed, might involve more downtime and care than the initial expander placement. The success of this process depends heavily on following Anca’s advice for wound care, activity restrictions, and follow-up visits.
Tissue expansion is most suited for patients with healthy surrounding skin that can be stretched and have the patience for the multi-step process. It’s particularly beneficial for areas where a large amount of skin is needed, and there is enough adjacent skin to facilitate expansion, such as the scalp or back.
Benefits and Considerations
One of the main benefits of tissue expansion is that the new skin, being from the same person, matches perfectly in colour and texture. However, the process requires time and patience, with the full treatment spanning several months. There is also the temporary inconvenience of living with the expander and attending regular appointments for saline injections.
Tissue expansion offers an innovative solution for scar removal, particularly for those with extensive scarring where other methods might not provide satisfactory results. By utilising the body’s natural growth responses, you can achieve significant improvements in the appearance and functionality of scarred areas.
In the journey to improve the appearance and functionality of scars, a holistic approach that combines both surgical and non-surgical treatments often yields the best results. This integrated strategy allows for a complex management plan that addresses the scar’s physical characteristics, your aesthetic goals, and any associated symptoms or limitations.
Combining treatments may be considered in several scenarios: