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Scar Revision

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Overview

Scars can occur from surgery or from injury.  A scar is the result of the normal healing of the body, and it is inevitable that scars will occur when there has been either surgery or injury.  However, it may be possible to try to reduce the appearance of your scars.

HOW scars occur

When we do plastic surgery, we know that scars will result.  There are a number of factors that contribute to the development of more-noticeable scars, including how the injury or incision was made (how much damage was done to the surrounding tissues), how the injury or incision was closed (if it was closed), how the healing injury or incision was treated after it had been closed, and the genes of the patient.

Unfortunately, some people just develop thicker and more noticeable scars than others.  A good way to get an idea of the kind of scars that your body forms is to look at the scars you have already formed.  For example, a woman who has had a Caesarian Section and who is thinking about a Tummy Tuck could look to the C-Section scar to get an idea.

However, local factors are likely to play an issue.  One of the most important of these is wound tension.  We often see thicker scars when the wound is under tension after repair.  In some cases, such as Tummy Tuck, tension is a desired result of surgery.  In other cases, such as when larger tattoos are removed, tension may be a by-product of the primary goal of surgery.

what can be done about scars

Unfortunately, there is nothing that will eliminate scars, and when a scar has occurred, the goal is to try to minimize its appearance and any interference with function caused by the scar.  There are a great number of interventions that may be appropriate for a given scar.

For example, we can remove the scar with surgical excision, and then close the resulting wound, with the hope that the new scar will be better than the old scar.  This is more likely to be successful when something about the closure is different the second time, such as more careful technique (especially if a plastic surgeon did not do the initial closure), or less tension the second time (because the skin has relaxed somewhat since the first closure.

A variation of scar excision and closure is a modification in the design of the scar with one of a wide variety of techniques.  One of these is the "Z-Plasty," which allows us to break up a tight scar, but there are many more revision designs available.

Other treatments of an existing scar can include injections, such as steroid injections, which can make a thick scar less thick, but which can result in a somewhat wider scar.  Laser treatments have been used, which can reduce the redness of a scar somewhat more quickly (although the redness tends to fade on its own over time anyway).  Microneedling is another treatment that has been used for scars.

Treatments you can do yourself include massage and silicone sheeting. 

Massage is often done with a lubricant, such as Mederma or Vitamin E oil (cut open a Vitamin E capsule to get the oil).  For this to work, the massage should be fairly firm, and preferably for fifteen minutes three times daily.  This is more likely to be effective in the weeks and months following healing, but can be tried with scars of any age.

Silicone sheeting can also be effective, by applying continuous pressure.  This sheeting is available at drug stores or online, and ideally is left on for 23 hours a day (i.e., except when you are taking a shower).

A preventive measure that can be used in the first few months following healing is a specialized silicone sheet with two lines of adhesive, designed to take tension off of the scar as it is healing, since we know that scars that heal under less tension tend to heal with less thickness and width.  An example of this is the Embrace® dressing, which is available online in different sizes.  This works best when started about four weeks after surgery, and kept on for about 60 days.  Each dressing can generally be left on for 10 days before being changed.  The dressing is applied with a special applicator so that the sheet is under tension when the adhesive is applied, and then pulls the two sides closer, so that they are under less tenion.

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Because there are so many possible interventions for thickened or noticeable scars, and because there is no treatment that eliminates visible scars, please make an appointment for a complementary consultation, so we can discuss your situation and what treatments might help.

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*Individual results are not guaranteed and may vary from person to person. Images may contain models.