10 Scar Revision Surgery Facts You Need to Know

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10 Scar Revision Surgery Facts You Need to Know

scarsEveryone has scars. Maybe it’s because of a thin scratch on your shin or a nick below your knee where you fell off that log when you were a kid. Some of you might have played a lot of sports, and have marks from gashes and grazes, or even surgery scars from a shoulder or knee reconstruction. Still others are affected by scars from serious accidents, illnesses, burns, or skin conditions, like acne and chicken pox.

Scars are often merely cosmetic. They don’t necessarily cause you any discomfort, and are easily kept out of sight or don’t detract from your appearance at all. Sometimes, however, scars can become an ongoing cause of soreness, irritation, embarrassment or decreased confidence and, occasionally, scars can even reduce natural movement over the affected area. Many people with disfiguring scars opt for revision surgery.

Considering scar revision procedure scan be intimidating, especially when surgery is involved. That’s why you should arm yourself with as much knowledge as possible before you go in – or under the knife. This article sets out all of the key concepts of the procedures: risks vs. rewards, average costs, key facts and statistics. You’ll even learn about all of the effective, natural ways you can treat and relieve your scars comfortably – and affordably – from your own home. 

1. What is a Scar?

A scar is a visible or textural mark on the skin or within body tissue where a sore, burn or wound has not completely healed, and fibrous connective tissue has developed.There are many different types, grouped loosely together by their physical characteristics and causes. In the following section you’ll read the terms you’re likely to hear from a doctor, dermatologist, or consulting surgeon.

2. Why Different Types of Scars Need Different Treatments

There are many types of scars, each needing a different type of treatment. They include, but are not limited to the following:

MinorScars

minor injuriesThese types of scars do not cause physical discomfort or impair physical function.Examples include acne scars, vaccination scars, scars from minor injuries and accidents, and even marks left by prior surgical incisions.Subtle scars are limited to surface irregularities and discoloration and can be soothed and often permanently improved by a range of natural remedies.

You can also seek over-the-counter treatments as recommended by your dermatologist, and cosmetic surgery or other minimally-invasive procedures recommended by your plastic surgeon.

Keloid Scars

Keloid scars are larger than hypertrophic scars. They extend beyond the boundaries of the original wound, and can be itchy or painful. Keloids happen when your body keeps making collagen after a cut has finished healing.

Keloid scars happen after injuries from:

  • Acne
  • Vaccinations
  • Burns
  • Wounds
  • Chicken Pox
  • Piercings

Sometimes you may not know what caused the keloid to form in the first place. In this case especially, your doctor may do a skin biopsy in order to rule out other types of skin growths, such as tumors.

Keloids are not usually harmful, and over time may become flatter, smaller and less noticeable. Whether or not you decide to seek medical treatment for keloids, it is recommended that you cover them up when under the sun: try a patch or plaster bandage, or at least sunscreen.

To prevent keloids from worsening – or even from occurring in the first place – you should take precautions with scars when out in the sun for six months after an injury or surgery, or 18 months for a child.

These treatments might be used to help to reduce the size of keloids:

  • Corticosteroid injections
  • Freezing (cryosurgery)
  • Laser treatments
  • Radiation
  • Silicone gel or patches
  • Surgical removal

Risks specific to keloids:

  • The above treatments may make keloids worse.
  • Keloids often recur at the site of scar revision.

Hypertrophic Scars

Hypertrophic scars are raised, thickened, and usually red, but form within the boundaries of the original incision or wound. They can be hyperpigmented, meaning they are darker than the surrounding skin tone, or hypopigmented, meaning they are lighter than the surrounding skin tone.

Hypertrophic scars usually improve as time goes by, without treatment or with non-surgical medical therapies like steroid creams or local steroid injections. If hypertrophic scars fail to improve with steroid treatments alone, your doctor may remove them surgically.

This involves cutting away the excess thickened tissue, and repositioning the edges of the original incision, aiming to get it to heal leaving less visible scar tissue. Your surgeon may advise anesthetic for the procedure.

To prevent the scar from reforming, your doctor might inject steroids into the site as part of your surgery. In some cases, a course of local steroid injections post-surgery might also be necessary.

Contracture Scars

Contracture scars happen when a large amount of tissue is damaged or lost – typically due to a burn – which causes the skin to pull together. These scars can restrict the movement of underlying or nearby tendons and muscles, especially when covering area across a joint such as a shoulder, elbow or knee.

Common treatments for contracture scars include: flap surgery, skin-grafts and Z-plasty:

  • Skin Grafting: Skin grafting is a complex surgical procedure that involves transferring skin from a healthy part of the body, called the donor site, in order to cover the injured area. Skin grafts are often taken from fatty areas, like a thigh; for more extensive scars, grafts may need to be taken from many areas and pieced together.

Skin grafting can greatly improve the function of a scarred area, but it is important to be aware that transferred skin will not alwaysexactly match the color and texture of the surrounding skin.

  • Flap Surgery: Flap surgery is complicated surgery which involves relocating underlying layers of blood vessels, fat and sometimes muscle along with the section of skin that overlays them.

Occasionally a skin flap can be chosen and repositioned over the injury site in such a way that blood vessels remain attached to the original site, improving blood flow, healing, and graft integration. In other cases, your surgeon can attach blood vessels in the flap to the new site directly, using micro-vascular surgery.

  • Z-Plasty: A hypertrophic or contractive scar can restrict the movement of muscles, joints, and tendons, as mentioned above. Z-plasty works by removing the extra scar tissue and making a series of small incisions on both sides of the scar site, which creates V-shaped skin flaps.

The resulting scar should be thinner, less noticeable, and allow a wider range of movement because the wound closure following a Z-plasty more closely follows the natural skin folds. As with the techniques of skin grafting and flap surgery, you may be awake or sedated, and undergo local or general anesthesia for Z-plasty.

Facial Scarring

Facial scarring can include any of the above types of scars, and your doctor may approach this type of scar in a variety of ways, including microdermabrasion and Z-plasty. If you have a single scar, then it may be possible to cut away the scar and reclose the incision with small stitches. The resulting scar will be thinner and less visible and your surgeon may disguise it, if feasible, within nearby natural wrinkles or folds of your face.

3. The Natural Way: Safe and Effective HomeRemedies

Aloe Vera

Aloe Vera is famous as an easily accessible anti-inflammatory substance. It is easy to buy as an after-sunburn gel or a lotion or ointment for general skin care. It’s an excellent idea to keep a living Aloe Vera plant at home and break off a leaf to use whenever you need – they’re one of the hardiest plants and can be revived from levels of neglect most plants wouldn’t survive.

To Use:

Apply some raw aloe vera gel or abought gel directly onto the scar several times a day. Aloe Vera is wonderful at soothing a fresh burn and preventing the burn from continuing to do tissue damage, which is why it’s at the top of this list.

Honey

HoneyDid you know that pure raw honey is sterile? Honey also contains natural antibacterial properties helpful when using it to treat fresh cuts and scrapes. Raw honey is a natural moisturizer, can stimulate new tissue generation, and helps create an antibacterial barrier between a healing wound and the dirt and germs that might cause extra inflammation, exacerbating the resulting scar.

To Use:

Massage honey directly onto the scar, or gently onto the wound that is in the process of scarring, and leave it there for as long as possible before wiping off gently with a warm cloth.

Lemon Juice

Fresh lemon juice contains alpha-hydroxy acid, which assists in the removal of dead skin cells, helps new cells to grow, and can improve the elasticity of your skin.

lemon juiceTo Use:

  • Clean the scar and surrounding area thoroughly.
  • Put about a teaspoon of lemon juice onto a cotton ball or a clean square of linen cloth folded up a few times.
  • Rub the cotton or linen on the scarred area and let it sit for about 10-30 minutes.
  • You might want to tape it up with somecello-tape so that you can get on with your day while it’s doing its job.
  • Rinse it off afterwards.
  • Remember that lemon juice can make skin sensitive to sunlight: your scar is already vulnerable to ultraviolet rays so consider covering it up when going outside.

Arnica

Arnica ointment is effective at reducing swelling, pain and inflammation in skin conditions like dermatitis. Arnica ointment is an excellent choice to discourage the skin irritations that develop into lesions – and eventually into scars – while treating existing scars in the same area.

You can find recipes to prepare your own or buy arnica creams from health food stores and alternative medicine practitioners.

Vitamin E

Vitamin E comes in capsule formVitamin E comes in capsule form. It is reported to stimulate the formation of collagen, which gives skin its strength and flexibility, but should be avoided as a remedy for keloids. Vitamin E should also only be used once a scar has fully healed, preferably for several months.

To Use:

Use a vitamin E rich lotion or pure vitamin E oil broken out of a capsule onto the skin. Let sit on skin for a while and repeat once a day. Consider combining the topical use of vitamin E with the addition of more vitamin E-rich foods to your diet – almonds, hazelnuts, olives and sunflower seeds – for an even better result.

Rosehip Oil

Rosehip seed oil has long been used for stretch marks, acne, rosacea, arthritis, burns, sun damage and other skin-related conditions, but also can be used as a scar treatment. This oil is fairly safe, but to avoid a possible reaction, test on a small patch of unaffected skin before trying this remedy.

You can apply pure rosehip oil directly to the affected area with little to no dilution: it is most often bought in a retail package that may or may not be diluted with other oils and moisturizers, and with instructions on how to apply for best results.

To Use:

As rule, a few drops of plain rosehip oil will cover a small scar, and you should let it dry naturally.

You don’t have to wash it off, but if you feel the need to wipe off excess oil before pulling on a pair of stockings or something, wait about 30 to 40 minutes beforehand to let the oil absorb as much as possible. Apply this oil once or twice a day.

Positive results should show within a few weeks after consistent application. Like other nutrient-packed oils such as flaxseed oil, rosehip oil is volatile in the sense that it doesn’t keep well for long at room temperature. Only open bottles you can finish within three months, and you should refrigerate it to keep it fresh.

Olive Oil

Olive OilOlive oil is full of vitamins E and K, which are great for your skin and make this a highly effective treatment for scars. Virgin olive oil is particularly high in antioxidants and has a higher acidity level, which makes it better at helping your scars to fade quickly.

To Use:

Massage into skin. Leave on as long as possible, and wipe off any oil that is still in excess after 10 minutes with a damp cloth.

Onion Extract

Onion extract is anti-inflammatory and can help inhibit the production of collagen, which as you read above makes up the fibrous excess scar tissue. Be warned that results can take months to appear.

In the case of keloids, what you’re looking for is to prevent new collagen growth. It may also be hard to know how successful the treatment is, since you can’t know how much the keloid would have grown if left untreated for the same period.

You can find onion extract in a gel, which can be directly applied to scars.

Make Your Own Cooling Cucumber Cream

CucumberCucumbers are common, affordable, and often used on skin for their cooling, moisturizing effect. They are low in acid and allergens so are suitable for using on the most sensitive skin, which might be easily irritated by more active or acidic ingredients.

Making your own cucumber cream at home is easy:

  • Peel a cucumber, remove its seeds, and blend for a few minutes with a handful of washed mint leaves.
  • Beat an egg white separately and then add this to your mix.
  • Smooth the combined paste onto the scar and leave it for about 20 minutes, before washing off with cool water.
  • Keep your cucumber cream in a clean jar in the fridge and reapply regularly.

Tea Tree Oil

Tea Tree OilTea tree oil is an irritant and highly poisonous if ingested. Having said that, it has well-known antimicrobial properties and in a safe dilution can help skin to heal and reduce the appearance of scar tissue.

To Use:

Add a few drops of tea tree oil to 20 to 30ml of olive oil, mix well, and massage into the area a few times a day. Wash your hands afterward, and make sure it doesn’t get on anything you’re going to eat.

4The Next Step: Home-CareMedical Remedies

There are many effective home treatments you can try, such as:

Ask Your Doctor or Dermatologist About Topical Steroid Creams

Steroid cream is prescribed for a range of skin complaints such as dermatitis. It may help reduce minor scars from forming in the first place if prescribed as a treatment for on-going skin conditions, but may be helpful in treating larger scars before resorting to steroid injections or scar revision surgery.

Apply An Alpha-Hydroxy Cream

creamsThese are derived from the natural fruit acids mentioned earlier, and help by removing dead skin cells. Alpha-hydroxy creams will come in different strengths and be aware that since you’re dealing with acids, they can cause irritations. Don’t get something recommended for a specific scar on your leg and assume that it will be safe and comfortable to use on your face. Consult with a dermatologist to find the best choice for you before trying this option.

Try a Prescription Scar Remover

Over-the-counter scar removers can come in the form of creams, salves, ointments, gels, lotions, and poultices and will usually contain as their active ingredient one or a combination of the ingredients listed above. They often contain silicone.

5. Surgical Techniques For Treating Scars

More and more surgical techniques are emerging for treating scars. They include:

Look Into Laser Treatment

In laser scar revision, treatment, a narrow beam of high-energy light is focused on the treatment area to burn away excess skin. This can reduce redness and help to smooth out raised or uneven scars.

Enquire About Dermabrasion And Microdermabrasion

Both types of dermabrasion are usually applied to give skin a smoother appearance. Your doctor will use a motorized wire brush to remove part of the outer layer of skin on a scarred area. This technique is typically quick, but you will be awake and may experience serious discomfort.

Ask About Soft Tissue Fillers

your doctor will inject into your skinSoft tissue fillers are substances, typically calcium hydroxyapatiteor collagen, which your doctor will inject into your skin. Collagen for this purpose is most often sourced from pigs, cows or human tissue. Soft tissue fillers are used to treat soft, indented scars. Approximately two million soft tissue injections were given in America in 2014.

Check Out Cryosurgery

Cryosurgery is a procedure in which the upper skin layers of a scar are frozen, typically with liquid nitrogen, to induce blistering. This will help by removing excess tissue from the scar. At least one recent study has shown this to be effective in treating keloid scars.

  • Talk to your doctor about cortisone injections: Cortisone injections are used to shrink and flatten scars. These injections are useful against scars that result from an over-aggressive healing process, such as keloids and some hypertrophic scars.
  • Learn about steroid injections: Your consulting doctor may recommend a course of steroid injections, given over a period of weeks or months or years, to gradually improve the condition and appearance of scarred tissue. This method may be used in conjunction with scar revision surgery.
  • Get scar revision surgery: In scar revision surgery, a doctor will remove the scar tissue completely, and reattach the surrounding healthy skin, taking care to do this in a way that avoids the recurrence of excess scar tissue, discoloration, or constricted movement when the new incision heals.

6. Risks 

RisksKeep in mind that no persistent scar can be removed completely, and that the speed and degree of improvement depend on the individual nature of the scar and how well you care for it before, during and after medical treatment. Potential risks include:

  • Scars fail to improve at all.
  • Scars recur.
  • Scars get worse.

In the case of scars that don’t cause physical discomfort or constrict your range of movement: you might be focusing on perfecting a probably small aspect of your physical self, giving your time and money to someone else, instead of investingtime in becoming at peace withsomething as simple as your appearance, and spending your time, energy and talents making the world around you the one you want to live in

7. Rewards

The rewards of scar revision surgery include the following:

  • A vast improvement in the physical appearance of the scar and smoothness of that area of your skin.
  • Improved flexibility and movement.
  • Less irritation, less surface area of scar tissue.
  • Preventing the scar from continuing to form or worsen it may have if left untreated.

8. Average Costs Of Scar Revision Surgery

Average CostsMost people worry about the costs of scar revision surgery, and rightly so. The prices vary from surgeon to surgeon; however, you can shop around to find a clinic closer to you that offers reasonable rates. The generally range in the following prices:

In the United States

According to the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS), the average cost for scar revision surgery on the face is $1,135, compared to $3,260 for laser skin resurfacing and $238 for microdermabrasion.

Average Costs Of Scar Revision Surgery In The United Kingdom

A consultation with a dermatologist in London can cost in excess of £200. Prices for scar revision depend on the type and number of treatments required: steroid injections start at £240; skin tag removal at £400; and pixel laser scar removal for the full face around £500 for each treatment, with an average course of three treatments coming to £1,200. Smaller areas of skin may cost less.

Surgical scar revision – including for keloid scars – can be done with local anesthetic and an outpatient visit for under £1,000. Flap scar surgery will normally cost no less than £1,500 if performed using local anesthesia – significantly more if general anesthesia is required, up to £2,500. Aftercare supplies like medical tape and silicone gel will incur extra costs.

The cost of a steroid injection is around £100 if administered in the private sector, and steroid cream around £15 for a 45g tube.

Average Costs Of Scar Revision Surgery In Australia

Scar revision surgery options in Australia average between $350 and $1,000 for simpler procedures and go up from there.

9. Scar Revision Surgery Statistics

StatisticsIn 2014 in the United States, 177,000 scar revision surgeries were performed, not including dermabrasion, microdermabrasion, soft tissue fillers, and scar revision surgeries classified as ‘laceration repairs.’ These statistics are taken from the 2014 report published by the American Society of Plastic Surgeons.

10. After-Care When You Come Home

Your aftercare is just as important, if not more so than the surgery itself and includes doing the following:

  • Remember to carefullyfollow the instructions your doctor gives to you
  • Keep the scarred area elevated when lying down
  • Use cold compresses on the scar
  • Keep your scar out of the sun

surgeryFor those who need it, scar revision surgery is life-changing, but before you opt for this type of scar treatment, talk to your doctor. You want to make sure you are a good candidate for the surgery, as well as understand what to expect as your outcome. When it comes to scars and scar treatments, knowledge is power.

 

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