Scars are visible because of color and/or surface texture changes compared to the surrounding skin. Scar treatment or revision is a very individualized procedure that depends upon the appearance, characteristics, and size of the scar. Scars resulting from brachioplasty can be very difficult to manage, and of all the scars resulting from plastic surgical procedures these are often more of a struggle, and tend to be more visible. Arm lift scars can also take 18 months, or more, to completely mature.
Below are some general comments about ways some scars can be managed. Treatments that are appropriate for you can only be recommended after an examination.
Scar excision/revision 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. Sometimes this is the best option, if the non-surgical treatments will not provide substantial benefit. Generally, we would evaluate a scar and determine if some reasonable improvement could be obtained with surgery. Surgical scar revision is better undertaken if there is good probability for at least moderate improvement. Some physicians may recommend that certain skin care products be used topically before and after surgery to improve the results. Surgical scar revision does involve certain risks: changes in pigmentation (hyperpigmentation or hypopigmentation), possible red/pink coloration, fine visible capillaries within a scar, infection, and surface texture changes (hypertrophy or atrophy). Your surgeon would explain these in relationship to the scarring you have and your skin type. It is important to consider all these risks when evaluating a scar for possible surgical treatment.
Scars located in regions of significant motion, or that experience tension, often widen; atrophy (thinning) or hypertrophy (thickening) can occur along with this widening in some situations. Areas on the upper back, shoulders, upper/mid chest, elbows, and knees often produce scars that are raised or thinned, and widened. Medial arm scars can widen, and can show areas of thinning and thickening, sometimes within the same scar.
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. A vascular laser, such as the Nd:YAG could be used to achieve a similar result; and can be used on darker skin types.
Steroids can be injected in to the scar to improve itching, pain, and to try to soften and flatten raised scars. Steroids are more effective if used while the scar is healing, as opposed to after maturation is complete. Steroids may flatten raised scars but they do not make scars narrower.
Laser resurfacing (Fraxel laser, Pearl Fractional, fractionated or broad based CO2) may be helpful as an additional modality to improve scars. Lasers are used more commonly to address textural issues and provide smoothing and blending. Some lasers may not be used in all skin types - laser resurfacing may be more risky, or not possible, in individuals who have dark skin colors. The details of laser resurfacing are best discussed during a consultation, after the scar’s appearance, consistency, and location have been evaluated.
Pigmentation of the scar, or skin around the scar, can occur in almost anyone; but is more common in those patients with darker skin colors. Many times the only way to effectively remove the pigment from a scar is to excise the entire scar. In individuals with darker skin types there will be a risk that the pigmentation may occur again in the new scar. Pre-surgical and post-surgical treatment with skin care products (bleachers, retinol, etc.) may help to reduce recurrent hyperpigmentation. In patients with darker skin types, the fibrotic tissue in the scar may appear paler/whiter than the surrounding skin color. This is difficult to address, because there is no guarantee that scar excision will result in a scar that matches the skin color.
Often times the best way to optimize the appearance is to spend the time and effort while the scar is healing the first time. This is best achieved with attentive surgeons and patients. Scar massage, taping, silicone gel sheeting, skin bleaching agents, topical silicone or steroid creams, injected steroids, sunscreen, and sun protection methods may all play an important role in the final appearance.
Your surgeon should be able to provide recommendations and treatment options.
Best wishes, Ken Dembny