Scar RemovalTreatment

Scars can be distressing, whether the result of an injury or previous surgery.  They may appear elevated, depressed, widened, or discoloured.  Scar reduction is a surgical procedure that may reduce the appearance of a scar.  Every scar and patient are unique.  The best option for you will be discussed in consultation with a board-certified plastic surgeon.

What is Scar Reduction?

Plastic surgery cannot eliminate scarring, but may be performed to reduce the final scar appearance.  There are various techniques of scar reduction that may achieve less prominent scarring.  Before considering scar reduction, it is important to wait until your scar is fully mature.  It generally takes a full year for a scar to reach its final appearance.  Immature scars may improve over time and respond to non-surgical treatments, including scar massage and silicone gel or sheeting.  Steroid injections may be an option for more problematic scars to soften and flatten them over time.  Sun protection is critical, particularly over the first year, to lower the risk of developing discoloration of the scar, whether hypo- or hyperpigmentation.  These colour changes may be permanent so it is recommended to wear at least SPF30 as your scar matures.  If you are still concerned and self-conscious about a scar after it has fully matured, a board-certified plastic surgeon can discuss surgical options during consultation and help you understand what to expect from your surgical outcome.

Problematic scars that become more elevated and thicker over time are divided into hypertrophic vs. keloid scars.  The difference between them is that a hypertrophic scar becomes elevated but stays contained within the boundaries of the original injury.  A keloid scar becomes thicker and more elevated over time and extends beyond these boundaries.  Treatment options are similar, including scar massage, pressure earring if it resulted from a piercing, topical silicone, and steroid injections.  De-bulking is a surgical technique that may be performed in certain cases – removing most of the keloid while leaving a narrow cuff to minimize trauma to surrounding healthy tissue.  A series of steroid injections is critical post-operatively to lower the risk of recurrence, generally performed every 6-8 weeks until the scar is stable.  Conservative treatment is recommended for many keloids given the high risk of recurrence, which may be larger and more symptomatic than the current keloid.  Dr. Gupta will discuss the best options for you regarding keloid improvement and create a customized treatment plan.

How is Scar Revision Performed?

Depending on the extent and technique of scar revision, it may be performed under local or general anaesthetic.  It is performed in either an office-based setting or operating room using meticulous techniques that may result in a less prominent scar than one created traumatically.  A scar may be excised and closed in a layered fashion to reduce skin tension and lower the risk of recurrent scar widening.  Depending on the orientation of a scar, it may be possible to reorient a scar through scar revision to follow natural crease lines.  A tethered scar may also be released through a technique called subcision. You will receive detailed instructions regarding appropriate wound care, showering, and bandaging after surgery.  If deeper stitches are required, they generally resorb over the first few months.  If skin stitches are placed, they are removed at approximately one week post-operatively following facial surgery and at 10-14 days for other body sites.

Scar Revision Recovery

Dr. Ashit Gupta will provide detailed instructions to follow post-operatively to reduce further scarring and minimize scar appearance as healing progresses.  You will generally be able to resume exercise within a week or two, potentially a little longer if more extensive surgery is performed.  It is important to wash the incision with soap and water daily to lower risk of infection.   Following suture removal, you will be given recommendations regarding scar management, including scar massage, sunscreen, and silicone gel or sheeting depending whether your scar is on your face or body, respectively.

Managing expectations is very important following scar revision.  Dr. Gupta wishes for patients to understand that a scar will still be present, however may appear less prominent following plastic surgery techniques and appropriate aftercare as it matures.  Your scar will reach its final appearance by one year post-operatively.

A main advantage of scar revision is that it converts a mature scar into an immature one, which is then responsive to ongoing non-surgical treatments as it matures. Sometimes old scars may not have been managed appropriately following traumatic injuries. It is not uncommon that patients present with discoloured scars following sun exposure as they were not aware of the importance of UV protection during early healing.

Scars result when the skin repairs wounds caused by trauma, diseases, or surgery. They are a natural part of the healing process. The more the skin is damaged and the longer it takes to heal, the greater the chance of a noticeable scar.

Typically, a scar may appear red and thick at first, and then gradually fade. Many actively healing scars that seem unsightly at three months may heal nicely if given more time since scars take a full year to mature.

The way a scar forms is affected by an individual’s age and the location on the body or face. Younger skin makes strong repairs and tends to over-heal resulting in larger, thicker scars. Skin over a jawbone is tighter than skin on the cheek and will make a scar easier to see. If a scar is indented or raised, irregular shadows will be seen, giving the skin an uneven appearance.

Types of Scars

Atrophic Treatment

These scars appear sunken, as indentations in the skin. Common causes of atrophic scars are chicken pox, injuries, surgery, and acne, although these can sometimes also develop as hypertrophic scars. Once formed, the size and shape of atrophic scars do not usually change.

Hypertrophic Treatment

These scars appear raised, and are usually the result of acne, burns, piercings, or cuts, which means surgical scars are often hypertrophic. Over time, hypertrophic scars become smaller and less noticeable.

Keloid Treatment

These scars are also raised, but continue to expand over time. This is because keloid scars are actually a type of non-malignant tumour created by an overgrowth of scar tissue. Some ethnicities are more prone to keloid scars, particularly those with darker skin.

What Can and Cannot Be Done for Scars?

Surgical scar revision can improve the way scars look by changing the size, depth, or colour. However, no scar can ever be completely erased, and no technique will return the scar to its normal uninjured appearance. Surgical scar removal typically results in a less obvious mark. Because each scar is different, each will require a different approach.

Scar Treatment

Topical creams are useful for hyperpigmentation. These include vitamin A/tretinoin creams (by prescription), and also alpha hydroxy acids such as glycolic acid.

Cortisone (steroid) injections are effective in softening very firm scars (or keloids) causing them to shrink and flatten. This scar treatment is popular for hypertrophic scars and keloids. Less commonly, intralesional bleomycin may be used.

Cryosurgery involves freezing of the upper skin layers that causes blistering of the skin to remove the excess tissue of the scar.

Silicone-containing gels and sheets have shown modest benefit in reducing scar thickness and pain. They must also be used regularly and results are variable.

Surgical Scar Revision Treatment

Based on the ability of the skin to stretch with time, surgical scar revision is a method of removing a scar and re-joining the normal skin in a less obvious fashion. The surgical removal of scars is best suited for wide or long scars, those in prominent places, or scars that have healed in a particular pattern or shape. Wide scars can often be cut out and closed, resulting in a thinner scar, and long scars can be made shorter.

Laser Resurfacing and Pulsed Dye Laser Treatment

Another method of improving surgical, acne, chicken pox, and other scars is laser scar revision. High-energy light is used to remove or remodel unwanted, damaged skin. Patients can usually return to work or regular activity within one week, but skin may stay pink for several weeks or months, particularly after skin resurfacing with a carbon dioxide laser. Several different lasers are available depending on the skin defect requiring improvement. A pulsed dye laser, for example removes scar redness and flattens raised scars (hypertrophic scars or keloids). This laser can also improve itching and burning sensations in the scar. Acne scars or other indented (atrophic) scars can be improved with laser skin resurfacing.

Soft Tissue Fillers (eg. hyaluronic acid) Treatment

Various injectable substances are available to elevate indented soft scars. The amount of material injected will vary with the size and firmness of the scar. Improvement is immediate but is not permanent and treatments often need to be repeated.

Punch Grafts and Punch Excisions Treatment

Punch grafts are small pieces of normal skin used to replace scarred skin. A tiny circular “cookie cutter” is used to cut a hole in the skin and remove the scar.

The area is then filled in with a matching piece of unscarred skin, usually taken from the skin behind the ear. The “plugs” are taped into place for five to seven days as they heal. Punch excisions, on the other hand, involve the use of stitches to close the holes produced by the tiny skin punch.

The stitches are removed in five to seven days. Even though the punch grafts and excisions form scars of their own, they provide a smoother skin surface which is less visible than depressed scars. Deep or “pitted” acne scars can be best treated by punch grafts or excisions, and also by laser resurfacing (e.g. Profractional laser), and trichloroacetic acid (CROSS) treatment; subcision (below) can also be beneficial as an adjunctive treatment.

It is best to have an assessment by a dermatologist to determine the type of scars that you have, and based on your skin type, type of scarring, amount of downtime you can take, and budget, Surgeon at Delight Clinic can figure out a treatment plan for you.

Subcision Treatment

This is a process used to treat deep rolling acne scars by separating the skin tissue from deeper scar tissue using physical (needle movement under the skin) and sometimes chemical (saline injection) means. This allows blood to pool under the affected area as well as to break up tethered scar cords, eventually causing the skin to elevate. Several sessions are often required and there is often bruising for 7-10 days.

Chemical Peels Treatment

This procedure involves the use of a chemical to remove the top layer of the skin in order to smooth depressed scars and give the skin a more even colour. It is most helpful for shallow superficial scars. Different chemicals can be used for different depth peels. Light peels require no healing time while deeper peels can require up to two weeks to heal.

Dermabrasion or Microdermabrasion Treatment

This is a method of treating acne scars, pockmarks, some surgical scars, or minor irregularities of the skin’s surface. A machine is used by the physician to remove the top layers of skin to give a more even contour to the surface of the skin. Silk Peel Dermal infusion is a stronger medical grade microdermabrasion offered at our Toronto Dermatology Centre. While it can offer improvement for certain scars, it cannot get rid of the scar entirely. Patients can usually return to work within a week.

Scar Removal Treatment – Frequently Asked Questions

Are there any risks?

A doctor should discuss potential side effects and risks with the individual before performing laser procedures. The side effects may depend on the type of laser, the severity of the scar, and the person’s skin tone. Some of the more common side effects include: • minor bleeding • discomfort • skin infection • skin crusting • skin discoloration • swelling

How many sessions does it take to remove a scar?

Again, depending on the severity of your skin condition, you may need to undergo about one to three sessions. These treatments can be done at four to six-weekly intervals.

Can you reduce the appearance of scars?

Methods for improving the appearance of scars include: Topical treatments, such as vitamin E, cocoa butter cream, and several commercial skin care products like Vaseline and Aquaphor that are sold over the counter may be somewhat effective in helping to heal scars.

What is the recovery time of scar surgery?

Scar revision is an outpatient surgery performed under local anaesthesia. Unless the scar is on a part of the body that would interfere with daily activities, patients can usually return to work the day after the surgery.

Who are the candidates for Scar reduction?

Candidates for scar revision are individuals who are in overall good health and have one or more scars that they find visually unappealing. Every scar is different, but candidates for scar revision usually have one of the following: • A scar that is excessively wide. • A scar that is irregularly shaped. • A scar that notably protrudes or is indented from the surrounding skin. • A scar that is significantly lighter or darker in colour than the surrounding skin.

Will I Have A Scar After My Procedure?

Yes. Even plastic surgery results in scars. Scar revision may reduce the appearance of your scar or correct factors such as scar widening, discoloration, elevation, or depression. Aftercare is equally important as the scar revision procedure itself. It is important to follow recommendations regarding scar massage, sunscreen, and other topical treatments as your scar matures to optimize healing.

How Can My Scar Be Changed?

Each scar is unique and there are just as many ways that scars can be made less prominent. For example, if your scar appears irregular or widened, it may be converted to a narrower linear scar. Other scars may be reoriented to follow natural crease lines. A scar on the forehead, for example, is often more subtle when it follows the natural transverse wrinkle lines vs. one that is oriented obliquely. There are many options for scar revision and a customized plan will be made based on your scar and any risk factors for increased scarring.

Does Scar Reduction Really Work?

Scar reduction may work for many scars to reduce the final appearance. It will not completely remove a scar and may not be an option in certain cases. Understanding your goals and determining whether they may be achieved through scar reduction is a main focus of your plastic surgery consultation and may increase the likelihood of a successful surgical outcome.

Can Scar Reduction Change Breast Surgery Scars?

Scar reduction may be an option for breast surgery scars depending on your presentation and concerns. It is recommended to wait a full year to ensure that your scars are fully mature. It may be possible to improve areas of scar widening or elevation through scar reduction.