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Scar revision basics

Throughout life, most people tend to accumulate scars.  They can be surgical scars, or scars from accidents or other injuries.  Some of these scars can be easily covered up, either with clothing or makeup.  However, that is not always desirable or even feasible.

Likewise, some scars also cause more problems than just being unappealing to the eye.  For instance, some scars affect function, such as a scar on the nostril may affect breathing, or a scar on the eyelid may make it difficult to fully close the eye.

If you have scar that bothers you, either aesthetically or functionally, a scar revision may be in order for you.  Scar revisions are not always performed ‘surgically’.  Steroid injections and dermabrasion can often times camouflage a scar quite successfully.  In the case of surgical revision, several techniques can be employed to blend in a scar with the surrounding tissue.  Dr. Ashbach will assess your scar and advise you on the best course of action.

Scar revision involves substituting your current scar for a new scar.  At face value, this concept may seem a bit ridiculous.  However, please appreciate that most scars are first generated in a ‘less-than-cosmetically-ideal’ situation.  Maybe you got cut on a dirty piece of metal or broken glass.  Maybe you waited for five hours in an ER to be hastily stitched up by an overextended doctor.  Or maybe you just put on a bandage and let it heal on its own.  We can help with all those situations.

Although some people are ‘good’ or ‘bad’ healers, many things can be done to help optimize a cosmetic and functional result.  The bottom line is that a good scar result is not a random event. 

Preparing for scar revision


Post-operative care for scar revision

The two most important things to do are:

  1. Keep the scar moist.  A moist scar is a happy scar. Many products are available to keep the scar moist.  Most cheaply, this could be done via the application of Vaseline several times per day.  Aquaphor is another option, but keep in mind that 10% of people are allergic to lanolin (one of the additives) and get additional redness as a result.  Silicone gels can also be used (our office has Kelocote available) that stays in place much better than Vaseline or Aquaphor, but are a bit more expensive.
  1. Keep the scar out of the sun. The UV rays of the sun lead to unwanted scarring by stimulating fibrosis and widening.  Given that a scar can take up to a year to fully mature, you need to keep the sun off your scar that whole time! 

Other things to optimize healing:

  • Ice the area for the first 24-48 hours.
  • Keep incisions clean and inspect daily for signs of infection.
  • Keep area clean and dry first 24 hours.
  • No tub soaking while sutures or drains are in plac.e
  • Sutures will be removed in 5-14 days.

When to call:

Increasing redness or warmth of the surrounding tissue after a few days

Continuous bleeding despite 15 minutes of holding gentle pressure

An oral temperature over 101 degrees.

Any yellowish or greenish drainage from the incisions or notice a foul odor .In many situations, a “tape” dressing is used to cover the suture line to protect it. This will be removed at your first post operative visit. Try not to get the tape wet. In general, we use a dissolvable suture to close the incision line. When the tape dressing is place over the sutures, the suture material ordinarily comes off when the tape comes off. When tape is not applied over the incision line, the following procedure should be followed:

Using a Q-tip moistened with peroxide, gently swab the suture line. Follow each peroxide treatment with a thin layer of Polysporin® or Bacitracin® This should be done three times per day until the sutures completely dissolve, are removed or until we instruct you to discontinue it. We will usually recommend that you continue this treatment as long as there is ANY crusting along the suture line.

In most patients, make-up may be applied to the areas involved within 2 – 3 days after the tape or sutures are removed. Apply and remove carefully.

Remember: it takes time (6-12 months) for the scarto mature. It will get red and lumpy before it begins to flatten and become lighter in color. Not until it is white and flat is it mature, so be patient. In most scar revision cases, more than one operation will be necessary in order to obtain the best possible result.

Please notify us if you have any problems such as undue swelling or redness or if you are unsureof any of the instructions you are to follow