15 Nov Scar Revision Procedures
Every one heals differently, and the effects of a surgical scar or injury are always unique. Our plastic surgeons can improve the appearance of a scar on any part of the body using individualized scar revision procedures. While not all scars can be removed completely, proper treatment can drastically improve the scar’s appearance.
Fusiform Elliptical Excision
The fusiform/elliptical excision procedure is indicated for elevated scars, hypertrophic scars, depressed scars, and keloids. The scar is removed using a scalpel. The surgeon makes an elliptical incision with opposing angles of 30 degree or less. To produce a necessary incision when closed, adequate technique is required. The incision is then closed with epidermal sutures. The overlying epidermis and upper dermis that are not involved can be used as a flap in this procedure.
Serial Partial Excision
For large scars with little or no surrounding tissue laxity, a serial partial excision can be done. This technique is used when the location, size, and elasticity of the scar and surrounding skin prevent closure, or when closure of the incision will distort nearby structures. Using an excision technique, the scar is partially excised, and adjacent skin is advanced over the area. The incision is then closed using small sutures.
Z-plasty is used for long, linear scars, contracted scars, or webbed scars. With this technique, the surgeon makes a diagonal elliptical excision, and removes the main portion of the scar to create a central limb. The triangular flaps are cut to the same length as the central limb. The two free ends of the original Z are connected and closed with sutures.
For long, linear scars and contracted scars, the surgeon may use the W-plasty technique for removal. This does not lengthen the scar, but uses a series of small triangular skin flaps, which are positioned on either side of the original scar so the two sides connect after scar excision. Incisions are closed with sutures.
Geometric Broken Line Closure (GBLC)
Geometric broken line closure is used for long linear scars. This technique involves a series of varying geometric shapes designed to connect with their mirror images on the other side. The irregular pattern will camouflage the scar. All incisions are closed using suturing techniques.
For icepick scars and deep boxcar scars, a punch excision can be done. The surgeon uses a small pen-shaped tool to punch and remove the entire defect. The area is closed using sutures, but only a small, thin line remains.
Subcision is used for depressed scars and rolling scars. With this procedure, the subcutaneous fibrotic strands are released to create new connective tissue formation under the defect. The surgeon inserts a needle NoKor Admix needle, the blade is inserted at a shallow angle into the subcutaneous skin layer. The needle moves in a lancing and fanning motion to release the tissue strands.
Preparing for Scar Revision Surgery
The doctor will first meet with you to discuss your aesthetic goals and go over the choices for scar revision. If you take blood-thinning drugs, you may need to hold these for several days before surgery. You should stop smoking, as this causes vasoconstriction of blood vessels, which can interfere with the healing process.
After Scar Revision Surgery
Scar revision is usually done at the doctor’s office. After cleaning the site, a local anesthetic is administered using a sterile needle. Once numb, the surgeon revises the scar. After the scar revision procedure, the remaining incision will take 1-3 weeks to heal. This varies, depending on the type of procedure and extent of the scar removed. Sutures are removed after 5-10 days.