I had a botched surgery that left me with horrible scars around my face and ears. Is scar revision surgery my only option for improving the scars? Are scar revisions usually successful surgeries?
What Results Can I Expect from Scar Revision Surgery?
Doctor Answers (9)
Many factors influence how your skin heals including how the initial injury happened, whether or not there was any infection, the amount of tension on the skin as it healed, and nutritional/genetic factors. Scar removal/revision is done in 2 fashions:
- Removal of the scar surgically
- Partial removal via dermabrasion/peels/lasers
When you remove a scar surgically, you are simply trading in for a new scar. The obvious goal is to control as many of the factors which led to a poor scar in the first place. By making a sharp incision, releasing tension on the wound, possibly reorienting the scar pattern, and performing a meticulous closure, many scars can be drastically improved. The risk is a scar which is larger and possibly worse than the original.
Partial removal of scars work well for heaped up or hypertrophic scars. By planing down the scar, you can often make it less noticeable.
A key differential in scarring are keloids versus hypertrophic scar. A keloid is an actual tumor of scar tissue - a massive amount of collagen abnormally produced in a scar. A true keloid extends well beyond the original injury. A hypertrophic scar is more common which is simply a wide, thick scar which is often quite disfiguring. A consultation with your plastic surgeon should reveal which type you have as the treatments can vary significantly.
There are many options to improve your scars
It always depends on what your scars look like. Options include:
1. excision and reexcision: straight closure, running w plasty, multiple z plasties, geometric closure.
2. skin resurfacing: including laser, dermabrasion, chemical peels
3. tissue expanders to recruit more skin
4. local flap surgery whereby skin and tissue are recruited to reline the areas of scars
5. free flap surgery where tissue from some other part of the body is transferred to the areas of the scars and connected with blood vessels.
Many scars are excised and reclosed. There are many options with this approach. You can cut the scars out and close them as a straight line. Your eye however usually notices anything that is longer than 7mm. So many times, it helps to close the new incision not in a straight line but broken up into "w's", "z's", or multiple patterns (geometric line closures). This is done in attempts to trick the mind by not having any line longer than 7mm.
Resurfacing is always an option to improve the scar by taking the scars away on the surface and allowing new skin to grow over to improve the appearance. This can be done with lasers, dermabrasion, chemical peels, and dermasanding.
Usually scars can be made better
You do not indicate what surgery you had but it sounds like it may have been face-lift surgery that caused your scars. In my experience poor face-lift scars can be improved after enough time has gone by to allow the skin to be lifted and re-attached without tension. This is basically a revision face-lift. Your case may be simpler than that but I would need to see photos to know. I hope this helps you.
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Scar Revision Surgery
Poor scarring on the face is generally related to excessive wound tension, infection, poor technique, and/or exposure to nicotine in the perioperative period. Since blood supply to the face is exceptional, facial scars generally heal very nicely. Any revision surgery performed would have to be performed in a fashion that placed tension on deeper soft tissues (SMAS), and minimized tension on the skin. The ability to do this depends partially on the size and location of the scar. An evaluation by a Board Certified Facial Plastic Surgeon or Plastic Surgeon wold be very helpful in doing this
Fixing bad surgical scars
It sounds like you have bad scars that perhaps spread after a facelift procedure. Although there are many techniques depending on what the scars look like, if you have bad scars after a facelift, you probably have spread scars or displaced scars, or maybe a pixie ear deformity. These problems will need surgical revision to fix. A spread scar is not going to get narrower by lasering it or injecting steroids (which could make it worse). A scar that has migrated forward from the ear will not be moved back to where it is supposed to be with anything other than a surgical procedure. A pixie ear deformity needs a surgical procedure to fix it. The other thing I sometimes see is railroad track scars from stitiches in front of the ear. This will also need surgical revision and placement of buried stitches only.
Scar revision surgery for scars can be helpful
However, every case is different and this is definitely a situation where you want a board certified plastic surgeon to look at you and examine you. There are numerous factors such as skin tension, skin color, age of the patient, how old the scar is, how old the patient is (this is one of those rare occasions where is actually better to be older!) etc.
Sometimes, one cannot be sure that a scar revision will help and you just have to take a bit of a chance.
It is important to realize that no one can make the scar truly disappear--sometimes we can make is less obvious.
Scar revision surgery
There are generally three outcomes when considering revising a scar. The scar could be better, worse, or the same. The type of scar (surgical, burn,etc.) and the location of the scar (face, abdomen,etc.)plays a role in whether your result will be favorable or not. Typically, raised, thickened scars (hypertrophic scars) can be surgically excised and reclosed under minimal tension to create a thinner, flat scar. These types or scars generally have better outcomes than keloids, which are raised thickened scars which grow beyond the borders of the original incision or scar. Keloids can be very difficult to treat and ofter require multiple excisions, steroid injections, topical silicone, and radiation-as a last resort.
Other types of scars which are more superficial can be treated with laser resurfacing, chemical peels and other less invasive techniques.
It is difficult to recommend scar treatment without actually seeing the scar.
I recommend consulting with a board certified plastic surgeon or dermatologist to determine the best approach to your particular scar.
Scar revision can be great
The real question is how was your original injury managed. If there is a technical component to your problem, then improving the technique via scar revision can frequently improve the result. In the right circumstances, scar revision can work quite well, but you are trading one scar for another so there is some variability to the outcome. You need a proper examination by a qualified surgeon to figure your potential benefit here.
John Di Saia MD
Scar revisions can be very successful IF they are expertly evaluated and managed. This means :
1) Follow up with your surgeon; ask him/her their opinion on the scarring. Remember your "genes" play a significant role in your wound healing/scarring. But you can ask, "Why were scars placed in a particular area or region? Do you think my healing is completed (if not, what can be done to maximize healing potential (steroid injections, silicone sheeting, massage, sun-avoidance, etc.)). Why do you think my scars are visibile or have not healed to my satisfaction? What can you do to improve their appearance?"
2) If what you hear is not satisfactory, or you would like to hear it from another expert, a second opinion can give you a lot of information. Identify a Board Certified Plastic Surgeon in your area that performs a significant number of the proceedures that you have had and schedule an appointment.