Scar Revision - Cosmetic Surgery

How Do You Prepare Before Scar Revision?

A plastic surgeon would be consulted for a scar revision procedure.

The surgeon should be provided with information like

• A detailed medical history of the patient
• Past and present health problems
• Presence of any known allergies
• Prior surgeries
• Regular medications being taken

Before scar revision surgery, the individual would be asked to:

• Undergo medical tests to ensure fitness for surgery
• Avoid consuming aspirin, blood thinners such as warfarin and other medications which can increase bleeding during surgery
• Advised certain medications
• Stop smoking before the surgery as it affects the healing process

The surgeon would examine the scar tissue and note its location and type. It could be of burn type or due to some injury or surgery. Based on the evaluation, the surgeon can recommend the treatment technique to minimize the appearance of scar or relocating it.

One must be aware of the cost and risks associated with the surgery.

What Happens During the Scar Revision?

The scar revision process involves

• Pre-operative check-up - Routine tests would be recommended to be done before the surgery. The patient maybe admitted one or two days prior to surgery
• Fasting before surgery - If required, the surgeon may recommend overnight fasting
• Shifting from waiting area or ward to waiting area in operating room - The patient would be shifted to the operation room, one- two hours before the surgery
• Shift to operating room- The patient may feel slightly anxious in the operating room looking at the ambience and lights overhead. There would also be monitors to check ECG, oxygen level and other vital parameters.
• Administering anesthetic medications - Depending on the procedure a local anesthetic which means the patient is awake during surgery or general anesthesia maybe used to make the patient sleep
• Performing the surgery - As soon as the patient goes into deep sleep due to anesthetic effect, the surgery is initiated

How is it Performed?

The scar revision surgery procedure varies with the type of scar.

• Surgery for contracture scars- These scars maybe treated with Z-Plasty, Flap surgery or Skin grafting.
• Z-Plasty - a surgical method that makes a scar less prominent by changing its direction or position, into a fold or crease of skin. During the procedure, the old scar is removed and incisions are made on side of the wound to create flaps. The flaps are then rearranged to get a "Z" pattern. Wound is then closed with thin stitches. This procedure is usually performed under local anesthesia as outpatient procedure.
• Skin Grafting - This is a complex surgical procedure used to treat scars associated with burns. The skin from a healthy part of the body like thighs or other fatty areas is used to cover the injured area. Grafting procedure may show a difference in color and texture as against the surrounding tissue.
• Flap surgery. This too is a complex surgical procedure in which the skin along with the underlying fat and blood vessels is moved from healthy part of body to the site of injury. The blood vessels are then re-attached to vessels at new site, with the help of microvascular surgery.
• Removal of facial scars - These can be treated using Z-Plasty procedure or Dermabrasion. Dermabrasion or Laser resurfacing involves use of an abrading tool or laser to make the scars less visible and smoother.
  Microdermabrasion - this is a newer less invasive technology that targets the dermis layer of skin without damaging the upper layers of skin.
• Keloid or hypertrophic scars - These can be treated using steroid injections to reduce the size. If the scars do not respond to injections, further appearance can be improved by removing the tissue surgically and closing the incisions. It is an outpatient procedure, under local anesthesia. The stitches can be removed in few days' time and person can get back to work in a day or two.

What Happens After Scar Revision?

After surgery, the individual would wake up from sleep, feeling a bit groggy. The voice of anesthetist maybe faint, as patient would not be fully conscious.

Depending on the type of surgery, a light dressing or an elastic dressing maybe placed over the area of operation.

The individual may feel some discomfort after scar revision surgery. The person would then be shifted to the recovery room.

What is the Recovery Process after Scar Revision?

In the recovery room, nurse would monitor all vital parameters and observe for an hour or two. If stitches are involved, these are removed after 3-4 days of surgery.

For post-operative recovery, the person may be asked to stay in hospital for one or two days or maybe discharged on same day depending on the type of surgical procedure.

It is important to follow surgeon's recommendations on post-operative care.

Localized swelling, discoloration or discomfort can be experienced after scar revision.

Sunscreen creams must be applied to keep away sunlight which can tan the healing tissue.

Recovery differs for every patient and depends on type of surgery. Healing process can take several weeks.

The surgeon may schedule frequent follow-ups after surgery, to check the progress.