Milwaukee Scar Removal doctors

Scar treatment or revision is a very individualized procedure that depends upon the appearance, characteristics, size, and location of the scar. Scars are visible because of color and texture changes; different treatments may be required to address these different characteristics. The history surrounding the injury or surgery is also helpful in trying to determine why unsatisfactory scarring occurred; the approach may be different for a post-traumatic scar compared with a post-surgical scar.

Scars may be difficult and frustrating for both patients and physicians because individuals want them to disappear following treatment.  Unfortunately, there are no medical or surgical treatments to remove scars completely. Surgical scar revision of any kind does involve certain risks.  These risks include changes in pigmentation (hyperpigmentation or hypopigmentation), possible red coloration or occasionally fine visible capillaries within a scar, infection, and surface texture changes (hypertrophy or atrophy). It is important to consider these risks when evaluating a scar for possible treatment, and these should be explained in relationship to the scarring you have, your skin type, and the procedure(s) recommended.

Scar revision by excision involves an actual surgical procedure to cut out the scar and then close the skin, followed by months of care to try to optimize the healing and maturation of the closure. Often times we will recommend certain skin care products and sunscreens be used before and after scar revision surgery.

Scars located in regions of significant motion, or that experience tension, often become less desirable because of widening, and the atrophy or hypertrophy that accompanies it. Areas on the upper back, shoulders, and upper/mid chest often develop raised (hypertrophic) scars that may be pink or red in color.  Areas near joints such as the shoulders, elbows, and knees often produce scars that are widened and thinned (atrophic) because of tension that exists across the scar line. Scars on the neck have the potential to heal nicely but may widen as a result of recurrent tension associated with neck movements.

Steroids, 5-fluorouracil, and colchicine have all been used to treat scar hypertrophy or keloids. These compounds can soften and flatten scars, and can improve symptoms such as itching or pain; they will not improve scar width.

If the scar is pink in color, Intense Pulsed Light (IPL™) may help to lighten that coloration; but it does nothing for the surface texture. We frequently use IPL to treat dilated capillaries and rosacea on the face with good results; but similar appearances in scars do not always respond as consistently. IPL can only be used on lighter skin types (I-III). Laser Genesis is another light-based treatment that may reduce scar redness, and sometimes even the thickness of a scar.

Laser resurfacing with a fractionated system such as the Fraxel laser or Pearl Fractional laser may be helpful as an additional modality to improve scars. Lasers are used more commonly to address textural issues and provide smoothing and blending. Depending upon the laser modality, resurfacing may be more risky in individuals who have dark skin colors. Laser resurfacing may provide better results if used while scar maturation is still occurring.

Patients with darker skin pigmentation may provide additional challenges. In the presence of increased skin pigmentation, scars or the surrounding tissue may be more likely to darken as well. Inflammation that occurs as a result of the initial injury and subsequent healing stimulates increased pigment production in the skin, a process known as post-inflammatory hyperpigmentation (PIH). In many instances once scar hyperpigmentation occurs, the only way to effectively remove the pigment from that scar is to excise the entire scar; and there are certain situations where that is impractical. Even treatments aimed at improving scar appearance can result in PIH. For this reason, sun avoidance and proper use of sunscreen remains critical in reducing the risk of PIH, even months after healing. Pre- and post-treatment with skin care products (bleachers, retinol, etc.) may help to reduce recurrent hyperpigmentation following scar treatments.

In general, most physicians will evaluate a scar and determine if some reasonable improvement can be obtained. Scar revision is better undertaken if there is good probability for at least moderate improvement. It is important that patients understand the risk and estimated outcomes so they can make a decision they will be happy with.

Best wishes. Ken Dembny

Scar treatment or revision is a very individualized procedure that depends upon the appearance, characteristics, and size of the scar. Consult a plastic surgeon regarding your scar; he or she will be able to discuss your treatment options so you can decide what is best for you.

Unfortunately, there are no medical or surgical treatments to remove scars completely. Options for scar treatment (where there is surface texture irregularity) may include fillers, laser resurfacing, and/or excision. From your description of a “deep” scar I would suspect that excision of the scar is probably your best option; but the only way to know is to evaluate the scar and surrounding skin. Scar excision involves an actual surgical procedure to cut out the scar and then close the skin. This may then be followed by weeks to months of care to try to optimize the healing and maturation of the skin closure.

Surgical scar revision of any kind does involve certain risks.  These risks include changes in pigmentation (hyper- or hypopigmentation), possible red coloration or occasionally fine visible capillaries within a scar, infection, and surface texture changes (hypertrophy or atrophy). These would be explained in relationship to the scarring you have and your skin type. It is important to consider these risks when evaluating a scar for possible treatment for improvement.

In general, a plastic surgeon would evaluate a scar and determine if some reasonable improvement could be obtained. Scar revision is best performed when there is good probability of at least moderate improvement.

Best wishes. Ken Dembny

Small scars can result at the site where a staple end pokes the skin, or where an external suture travels through the skin. For this reason, a buried suture is used for the final layer of the skin closure to minimize scarring.

Despite our best efforts, scar widening can occur following a tummy tuck, even when buried skin sutures are used. So I do not think that you can definitively say that your widened scar is the result of a skin closure with staples. There is no doubt, however, that the small circular scars have been caused by the staples.

Individual physicians handle re-operative costs differently.  The type of complication/adverse event, the causes or circumstances surrounding such an event, the time frame in which it occurred post-operatively, the setting in which the revision occurs, and any specific written policies the physician has would be some of the considerations affecting what costs are passed on to the patient for re-operations. I would agree that $3500 seems expensive for a scar revision of this nature. You should discuss the specific details with your surgeon.

Your scar also looks hyperpigmented (darkened). Any scar revision will carry similar risks. Sun protection, and the use of a skin bleacher, may help to reduce post-inflammatory hyperpigmentation. Best wishes.