Scar Revision

Do you, or someone you know, have a facial or body scar?

Scarring can effect your self perceptions, and the perception others have of you. This can effect your self esteem,motivation and success in many aspects of your life. Scarring on the skin can have far reaching psychosocial implications, much deeper than the skin they appear on.

Today, there are many modalities of treatment available to help minimize, and limit the effect of scarring on your skin. You do not have to live with scarring. Each and every person is different and will benefit from different treatment modalities. Treatment methods and final results will vary, depending on many factors including your skin type, the mechanism of the scarring, the location of the scar, the age of the scar, the size of the scar, and what previous if any treatment has been attempted. All these factors play an important role in determining the best treatment option for you.

Types Of Scars:

Hypertrophic Scar

A hypertrophic scar is a thick red raised worm like scar that occurs in an area of injury. The red raised scar tissue generally keeps the shape and size of the original injury.

Keloid Scar

A keloid scar is very similar to a hypertrophic scar in appearance except that it spreads beyond the margins of the original injury and can extend to areas where there was no scarring previously.

Spread Scar

This is the most common form of scar and is generally a flat wide scarred area of skin. It usually results from a poorly supported wound that has spread apart from tension.

Factors That Effect Scarring

1. Skin type- there is a large amount of variability in the character of different peoples skin. Some skin tends to heal very well from incisions while other skin can heal with hypertrophic or even keloid scars. Dr. Kaila would be able to help determine your skin type, but even he may not be able to completely predict the results of your healing.
2. Mechanism of injury-generally sharp clean cuts will heal with a nicer scar than wide crushing injuries with significant tissue damage.
3. Location- some areas of the body heal with better scar results than others. For example, scars on the center of the chest and shoulders heal much worse than scars on the upper eyelid on the same person. Scars in areas with high tension and continuous stretching such as knees and elbows also tend to heal poorly.
4. Age of scars- scars naturally undergo a maturation process as they heal. During this process the scars will often start out very thin then become more thick, red and inflamed and then eventually fade and flatten again. The timing of this complete process may take up to 1 year and sometimes even 2 years to complete.
5. Size of scars- Obviously the larger the wound, the larger and more conspicuous the scar will be. Generally wounds that are larger and require more tension to approximate will also cause wider, more noticeable scars.
6. Previous treatment- As treatment of a scar will affect the wound healing results, previous treatment of a scar is something that should be considered when analyzing a scar and determining the best option to improve it's results. Scars that have suboptimal treatment and healing will lend themselves to improvement by the use of plastic surgery. Scars that have already had the optimum treatment and have not healed well may have little available options for improvement.

Different Treatment Options to Optimize Scar Healing

1. Silicone sheeting gel- a liquid or solid silicone gel with properties to aid in scar healing and improve final scar outcome. Must be in contact with the wound for at least 18 hours a day to have clinical effect.
2. Cryrotherapy- Using liquid nitrogen to freeze portions of the scar and reduce it's size.
3. Laser Scar Resurfacing- using a laser to control and burn down layers of scar tissue to help reshape scars and flatten them.
4. Surgical Scar Revision- removing a scar completely and redoing the scar using plastic surgery to maximize the wound healing and scar result.
5. Steroids- a form of medication used to delay the wound healing process and reduce the thickness of active scars.
6. Pressure Therapy- some thick hypertrophic scars respond well to pressure to help reduce their thickness and redness. Different pressure applying prosthetics can be made by your plastic surgeon.
   

How Do I Get My Scar Treated?

Initially most patients are seen and treated in the emergency department by their family physician or emergency room physician. If the emergency physician feels it is warranted they may ask for the assistance of a plastic surgeon to help primarily deal with your injury. However, most emergency physicians can do an excellent job of primarily dealing with your injury and will refer you to see a plastic surgeon to follow up. It is a good idea at this point to ask for a referral to a plastic surgeon. A plastic surgeon should see you within 2-3 weeks of your initial injury to have a thorough scar evaluation done. At this point diiferent options for treatment will be outlined for you. The cost of the assessment and treatment will be outlined for you. The cost of the assessment and treatments may be covered by OHIP, your extended health plan or insurance companies in the case of motor vehicle accidents. The sooner the assessment can be done, the more likely the results will be improved sooner and less revisionary surgery will be required. At Bluewater Surgical Centre you will likely be seen within three weeks. At the first meeting you will get a consult determining the cause and nature of your scarring and a full scar assessment will be performed. You may or may not have photographs taken at this time. Different treatment options will then be offered to you at this time and advice and assistance to help choose the right option for you will be provided. If an insurance company or legal action is involved, and in many instances they are, a medical report will first be generated and then a treatment plan. Approval will be granted by the insurance company. Assistance in legal and insurance claims for this process is also provided if required. If you have any questions or would like further assistance please do not hesitate to call the Bluewater Surgical Centre @ (519) 336-1555 or visit us at www.bluewatersurgery.com.