Dr. Edward Buckingham: Scarring can come in multiple forms. It can be from
injury where you suffer a laceration to the face. It can be from a burn. It
can be from a previous surgical procedure. So it's a very broad topic
that's going to prevent me from talking about the specifics of those
different things. So we're going to talk about it in a little bit more
broad terms related to that.

So scarring typically comes in two forms-either hypertrophic or atrophic.
Most scars are atrophic, and what that means is that the scars tend to be
flat, they tend to be white, and they tend to be widened. Hypertrophic
scars tend to be more acute scars and are scars that have a buildup around
them. Some people would call that a keloid, although a keloid is really a
separate entity where that hypertrophy or thickening extends beyond the
natural scar margins. That's a more rare condition. So hypertrophy just
means that the scar's been thickened.

In either case, when we're dealing with scars, we're really talking about
methods to correct them being skin resurfacing and surgical excision of the
scar. Oftentimes we combine skin resurfacing with surgical excision, where
we do the surgical excision first and then followed by the skin
resurfacing. The skin resurfacing that we use for scars is dermabrasion. So
surgical excision of a scar happens when again you have that atrophic scar
or hypertrophic scar and you need to remove that skin to get it into a
condition where you can then close the wound and then use dermabrasion to
improve it after the scar's been healed.

Removing the scar takes place in different methods depending upon the
orientation of the scar. So we all have natural wrinkle lines in our face.
We refer to those as the relaxed skin tension lines. When a scar's oriented
along those relaxed skin tension lines or the scar's oriented so that it
falls into the natural junctions of the face, so, say, the smile line or
just in front of the ear, those areas conceal scars very well. They can
still be visible if they're too wide or atrophic or hypertrophic, but you
can remove those scars and leave the orientation of the scar in the same
direction because it'll already be hidden in the natural facial units.

For scars that are running contrary to those natural facial units, we need
to do other things to improve those. The other things to improve those
typically either consist of using Z-plasties or using some sort of a broken
geometric shape to excise the scar. So if you think about a scar on a
person's face, your mind's eye is really drawn to the long linear nature of
the scar. And so if you can break up the linear nature of that scar into
smaller pieces, it creates the illusion that the scar is not there.

So, say, for example, you have a scar running on your cheek that's going in
this direction, which is contrary to the direction it should be going in
the relaxed skin tension lines. To treat that scar, we would excise that
scar, but in so doing, we would break it up into smaller pieces, typically
geometric shapes that alternate, say, circle, square, triangle, just for
example. Those triangles and squares are then excised on each side,
creating a lock and key pattern so the circle on one side is oriented with
the circle on the other. And as those fit together, you get this circular
shape, so you'd end up with, say, a scar that has a circle and then a
square and then a triangle that are broken down into little five millimeter
pieces that then make the scar not one linear configuration but a very
small bunch of different configurations running different directions that
then confuses the eye and allows the scar to be much more invisible.

Sometimes that's enough and you don't need to come back and do any surgical
resurfacing after that, but sometimes you need to come back after that and
do dermabrasion, which is literally again a sanding procedure where we take
a device that produces a rotation, and it has a bit or a burr with little
nodules on it that are made out of diamond actually. And you come along,
and you just sand that scar and the surrounding skin, which then allows the
skin to grow up from the edges and below, further concealing that geometric
broken line closure that we've already done. If the scar's oriented in
these linear areas, we just basically need to excise that scar in the
natural junction with or without dermabrasion. That's a much more easy
situation to deal with.

So that's kind of the basics of scar revision. So it very much depends upon
what type of scar it is, what location it is, what the orientation of it
is. And then we tailor a treatment to give the best possible results in the
individual case.

Scar Removal and Revision Methods

Dr. Edward Buckingham discusses revising hypertrophic and atrophic scars caused from injury or previous surgeries. Some options include skin resurfacing or surgical excision of the scar.