Scar Revision Surgery – Part 1

Jun 6, 2022 | Skin resurfacing

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Scars on skin are very common. When the naturally formed skin is broken for whatever reason, be it a pimple eruption, a boil, burnt injury, trauma injury or a scratch, our body tries to heal and close the skin by regrowing new skin on the area. However, the scar tissue that develops is never the same as the one that we had before. That leaves a scar and how deep the scar is, depends on how big and deep the injury is. If an infection develops during healing or after injury, then the scar may not look smooth or any lighter.

Scar can form anywhere on the body but most often the scars on the face is what we are very conscious about and worried too. Many people try to get the scar lightened with creams or lotions that can lighten the scars but those creams and ointments may or may not be effective. When the scar doesn’t get lighter with superficial application of creams, the next option one has is to undergo scar revision surgery. 

Types of plastic surgery for scar removal

The procedures can be either minimally invasive or surgical.  

Minimally invasive procedures include:

  1. Corticosteroid injections
  2. Bleomycin injections
  3. Laser treatment
  4. Chemical peeling, microdermabrasion etc
  5. Micro needling
  6. Cryosurgery

 

Corticosteroid injections

Corticosteroids are man-made versions of cortisol, a hormone that’s usually made by the adrenal glands. They help the body respond to injuries, reduce the immune system’s activity and inflammation. Corticosteroid injections are usually given for hypertrophic and keloid scars. Hypertrophic scars are those that are thick and little raised during the wound healing process. Usually they look like a smudge on the skin after they heal. Keloid scars are raised scars that are most often dark in colour.

Bleomycin injections

Bleomycin injections are considered a better approach for hypertrophic and keloid scars treatment. However, a resurgence of keloid scar even after treatment with bleomycin injection can happen.

Laser treatment for scars

A very popular treatment currently where controlled laser energy is focused on the scar that can help smoothen out the scar.  Laser energy also helps in production of collagen under the skin.

Chemical peeling, microdermabrasion etc

Usually, chemical peeling and microdermabrasion like procedures are used to reduce or lighten acne scars or whitening the darker areas of the skin (like underarms or inner thighs etc). These procedures peel off the top most layers of the skin letting the body generate new skin. When multiple sessions are done, all the scarred layers of the skin would have gone leaving spotless skin. Again, if the injury or scar is deep, this procedure can only lighten it.

Here is one of our articles on pimple scars – How to get rid of pimple scars at home?

Micro needling

Micro needling is also used to treat small scars like those made by acne. A device is rolled on the skin and it has very tiny needles that pierce the skin when rolling. The pricks help the body produce collagen in the area that in turn helps in growing a smoother and lighter skin. A little advancement in micro needling for scar removal procedure is that, instead of needles, radiofrequency energy is used to signal the body to generate collage in the area.

Cryosurgery

The procedure involves freezing the skin to death. The frozen skin falls off and the body starts making new skin in the area. This procedure is not used for all types of scars. 

 

Surgical scar removal procedure

Skin graft or skin flapping is the most common procedure used by plastic surgeons to remove scars on the skin. The scarred tissue is removed and new skin (from a different part of the body) is taken and put on top of the scar site. 

In some cases, the muscles or tissues under the skin need to be repaired (sutured) and then the skin grafting may have to be done. Such a multilayer repair can be more effective in removing scars on the skin.

What type of scars can be treated with plastic surgery?

  1. Surgical scars that form after fixing an injured site or after a c-section (for women). Acne scars that are too dark and refuse to fade with time can also be fixed with cosmetic surgery to the face or any other part of the body.
  2. Hypertrophic scars – as mentioned, these are little raised, discoloured parts of the skin after an injury or wound heals.
  3. Keloid scars – Similar to hypertrophic scars but these are raised and much darker.
  4. Contractures – Skin stretches in some parts of the body such as knees, elbows, joints etc. When the skin in such places is gone or injured, the new skin that forms, may not be that elastic in nature. Such non-elastic tissue that grows under the skin is called a ‘contracture’. A surgery to such areas to restore the fibrous tissue and the skin on it may be needed to bring back the previous functionality. 

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