Scar Revision, Excision, Dermabrasion and Injection

Whenever the skin has been broken, whether by an injury, infections such as acne, or even surgery, there always will be a scar.

Common Problems
Many individuals develop facial scars that warrant special attention from a facial plastic surgeon in Detroit, MI.

Scar tissue is a normal result of the healing process. Whenever the skin has been broken, whether by an injury, infections such as acne, or even surgery, there always will be a scar.

Scars are permanent in nature and cannot be removed totally. The appearance of scars, however, often can be improved so they are less unsightly, less noticeable, and altogether more readily camouflaged with cosmetics.

This change in appearance is the goal of facial plastic surgeons when they perform "scar revision" procedures. Their success depends on many factors -- the scar's size, shape and location, and the patient's age, heredity, and general skin condition.

The three most common types of scars are:

1. Hypertrophic scar. An excessive amount of scar tissue in an incision or wound characterizes this type of scar. The scar itself appears redder in color and firmer in texture than the surrounding skin, and rises above it.
2. Keloid scar. This type of scar exhibits the same characteristics as the hypertrophic scar, plus one more. It continues to grow and enlarge with time. Areas most likely to develop keloid scars are the earlobes, chin and neck.
3. Acne scar. The most common type of facial scarring comes from acne infections.

Common Solutions
Since scar revision procedures may affect patients differently, each scar and each patient require careful study by the facial plastic surgeon before he selects a procedure to improve the scar. The most frequently used procedures are these:

Excision. Although scars cannot be totally eliminated, scar tissue can be removed and wound edges carefully sutured to create an even, narrow scar. Very wide scars or scars in areas of severe tension sometimes may be narrowed in stages, excising only a portion of the scar at a time so that the surrounding skin can accommodate the change.

The term "excision" also includes surgical techniques whereby the facial plastic surgeon repositions or irregularizes the scar so that its appearance may be more easily camouflaged. The surgeon will try to reposition the scar if he can bring it to fall within natural skin lines or creases. If that is not possible, he can irregularize it by breaking up the straight, unnatural line of the scar into small geometric patterns that blend better with the skin texture.

Collagen injections. Scars that lie in appropriate directions and are adequately narrow, but are depressed, can be filled with collagen.

Collagen, a natural bovine product, has the advantage of blending well with the deep skin's own tissue makeup. Its disadvantage is that it is not permanent and may need periodic augmentation.

Steroid injection. Some scars - particularly the hypertrophic and keloid scars - are improved by injection of steroid medication. This medication does not narrow the scar but often will flatten and soften it, achieving a degree of blend with surrounding skin.

Dermabrasion. Some scars may be smoothed or "sanded" to blend with surrounding skin through dermabrasion. This sanding or abrasive technique usually is done with a rotary abrasive instrument. Often, dermabrasion is combined with other scar revision techniques to gain the best final result.

Deciding On An Operation
Most scars will improve with time and should be allowed to mature and completely heal prior to initiating surgical treatment. Usually treatment will not be instituted until several months following a wound; sometimes a year or more is recommended.

Anyone interested in scar revision should consult a competent facial plastic surgeon. During the initial visit, the surgeon makes a thorough evaluation of the facial features to determine whether surgery is indicated. The surgeon then will discuss any questions and concerns related to the surgery.

In addition to the skill of the surgeon, the patient's realistic expectations about the results of the surgery and his general emotional state are important considerations. Mental attitude is as important as the ability to heal in evaluating candidates for facial plastic surgery in Detroit, MI.

Once surgery is agreed upon, pre-operative photographs are taken to help the surgeon plan the operation. These photographs usually are compared with similar ones taken sometime after surgery and serve as a permanent before-and-after record of the results.

The Immediate After-Effects
Most patients experience minimal pain or discomfort following scar revision. Neither is it painful when sutures are removed, usually within a few days of surgery and, typically, right in the surgeon's office.

The Results To Expect
Again, scars cannot be removed, only improved, and these improvements can take months. The scar revision patient must be willing to accept this long-term commitment. Once scar treatment has begun, it will require multiple steps, including dermabrasion and other touch-up procedures, plus prolonged use of special facial tape that takes the tension off of the wound edge to prevent scar widening.

Often the scar can be improved to the point that cosmetics can do the rest.

The Risks
The risks are minimal. There are inherent risks in any surgical undertaking, however, and these should be discussed thoroughly with your Detroit facial plastic surgeon. Many thousands of scar revision procedures are performed each year with excellent benefit to the patient.