During scar revision, how can you remove tension and keep the scar from stretching?

Question

I have a horizontal scar on the top of my back towards the shoulder. The scar stretched when healing because of tension. When the incision was made there was no special technique and dissolving sutures were put in. The scar is also reddish even after a year. Are there techniques such as Z-plasty that would keep the scar from stretching from tension and therefore make it less noticeable?

Raffy Karamanoukian, MD, FACS · Answer

Our treatments use combination therapy to improve the epidermis and dermis for most deep scars. The options available for acne scars depend on the character of your scars, in terms of topography and contour. We see atrophic and hypertrophic acne scars, as well as scars that have hypo and hyperpigmentation. We begin each scar evaluation with an assessment of scar quality and subtype. Our main concern is rebuilding collagen and that is why we use a HIDEF protocol that includes combination therapy. Morpheus 8, scar subcision, fibrous release, fractional laser, CO2 laser, Thulium laser, PDL Vbeam laser, and fractional resurfacing can be used in addition to TCA Cross and chemical peels to further improve skin. Patients should start Melarase AM and Melarase PM for active hyperpigmentation. Always begin with a consultation to decide whether early subcision should be started.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best, 
Dr. Karamanoukian 
Realself100 Surgeon

Marc Polacco, MD · Answer

Thank you for your question. There are a variety of techniques used. One of the most important factors is repairing a wound without tension on the skin surface. Z-plasty is a technique that breaks up the scar and redistributes tension. There are also other treatments such as injection with steroids or 5-fluorouracil, or also laser treatments. There are pros and cons to each, so a conversation with your surgeon is important in making the choice that's right for you. I hope that helps!

Daniel Barrett, MD · Answer

Dear Driver1103,
scar prevention begins in the OR during the surgery when I meticulously close wounds in multiple layers in order to reduce tension and reduce scars width. I tape my incisions during the early postoperative period to reduce micromotions of the tissues so the incision can heal earlier. I also use compression garments and later Biocorneum gel.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Paul Mittermiller, MD · Answer

Scars over the shoulders are difficult to prevent from widening over time because there is usually a large amount of movement and tension in the area. Depending on how the scar appears, you could consider re-excising the scar and then trying to offload tension on the area afterwards with taping or silicone strips. You may still get widening over time though.

Reuel Aspacio, MD, FAAD - Account Suspended · Answer

Thank you for your question. Scarring outcomes often times vary on the back because the back is a high tension area. Layered closure with sutures can help minimize the tension, but even then, just daily bending over to tie your shoes can create enough tension to widen a scar. I highly recommend you consult with a board certified plastic surgeon regarding scar revision and to discuss your concerns about scarring on the back. Take care and good luck.

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