Scar Revision / Repair
Facial or neck scars can be problematic for several reasons. These problems can be divided into two major categories: 1) aesthetically unpleasing, or 2) causing functional problems, like limiting lip motion or neck motion. For this discussion, we will focus upon the aesthetically unpleasing scars, and discuss these by subtype below with their treatment. Scars for the most part can not be erased, but are instead camouflaged and minimized using specialized techniques.
These scars can be very visible due to their contour, or the shadows they create. Frequently, these are the result of an infected or broken-down wound. Typically, these can be removed and re-closed under more favorable conditions.
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Uneven edged scars
These scars are typically due to retained swelling on one side of a wound, or due to suboptimal technique. They also can be corrected with removal and re-closure. Another simple option is dermabrasion of the wound. This gentle sanding technique can be minimally invasive and very effective.
Similar to depressed scars, and commonly occurring in association, these scars are typically due to excessive tension on a wound, infection, or, to powerful muscle action upon a wound. Typically these are treated using a variety of techniques including removal and reclosure, and using techniques like “undermining” or z-plasty to correct tension problems.
Poorly oriented scars
Wounds heal best when they are parallel to the fine and deep lines and wrinkles of our face for both camouflage purposes, and tension minimization. Poorly oriented scars cross these lines, and are more noticeable specifically for this reason. Scars can be re-oriented to an improved orientation, using a technique known as flap rotation, or z-plasty.
Hypertropic / Raised scars
More than technical wound problems, these scars are raised above the normal skin level due to over-healing. This is typically due to a genetic disposition in individuals with darker skin. Unlike the other scar categories, because of the high recurrence rate, these are typically managed with local steroid injections, or silicone sheeting.
Many scars can involve several of these sub-categories, and treatments can be tailored to individual patients. One scar, for example may require steroid injection, dermabrasion, removal and reclosure, and z-plasty all to maximize results.