Scar Revision

Scar revision is used to enhance the appearance of scars resulting from injuries, surgeries, or other traumas. While surgical treatment can certainly improve your scar aesthetically, it cannot recover your skin to its pre-injury status. Scar revision basically replaces a scar with a smaller one. It is important to remember that your plastic surgeon will work with you during what can be an emotionally-charged process so that your needs and expectations can be met.

Who Can Undergo Scar Revision Surgery?

Individuals who have experienced significant loss of regional tissue, injury that crosses aesthetically distinct areas of the face, function limitation, unsatisfactory wound closure, and poor post-injury wound management may want to consider scar revision surgery. You may want to consider scar revision surgery if your scars:

  • Span across anatomic regions
  • Are constantly subjected to wrinkling of the skin
  • Are deeply traumatic

The types of scars that may respond to revision are keloid scars, hypertrophic scars, and contractures. Keloid scars are an abnormal proliferation of scar tissue that grows beyond the boundaries of the original wound. Hypotrophic scars, like keloids, are raised scars, but they don't grow beyond the boundaries of the injury, and they may reduce in size over time. Contractures occur when scar tissue pulls the edges of skin together, possibly restricting movement.

Scar Revision Procedures

During scar revision surgery, skin tissue is removed in a specific shape or pattern that aids in diminishing the size of the original scar. Partial or serial excisions are common approaches to scars too large to be excised in one sitting, and that have insufficient available skin for a local skin flap closure. In this procedure, an ellipse is excised from the scar's center, and the sides of wound are undermined for closure.

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This hypertrophic scar has formed a contracture, restricting finger motion. Using Z-plasty, the scar is removed and incisions are made on each side, creating small triangular skin flaps, which are rearranged and interlocked to cover the affected area.

Contractures respond well to the Z-plasty and W-plasty techniques because they minimize the visibility of scars by repositioning them along the natural lines and creases of your skin. In Z-plasty scar revision, the surgeon makes a Z-shaped incision so that the middle line of the Z runs along the scar tissue. The flaps of skin formed by the other lines of the Z are rotated and sewn into a new position that reorients the scar about 90 degrees, minimizing that the appearance of the scar by breaking up the straight line of the scar into smaller units.

Like the Z-plasty, the W-plasty diminishes the visibility of a scar by turning a straight line into an irregular one, but it does not entail the formation and repositioning of skin flaps. During W-plasty surgery, a series of short incisions are made to form a zigzag pattern that replaces the straight line of the scar.

Other surgical techniques used in scar revision include flaps, grafts, fusiform and shave excisions, laser skin surfacing, and dermabrasion. Your plastic surgeon will recommend the course of action best suited to the nature of your scar and your goals for surgery.

What to Expect After Scar Revision

Excision approaches like the Z and W-plasty typically necessitate pain medication, rest, and wound and bandage care. If skin grafts or flaps are used, postoperative care will begin in the hospital. Patients receiving skin grafts are typically expected to return to Dr. Sattler's office at regular intervals so that the graft sites can be monitored.

Please contact our plastic surgery practice in Glendora nearby Arcadia and Azusa if you are interested in learning more about the benefits, costs or possible side effects of scar revision surgery in LA County and the San Gabriel Valley.