Explore Plastic Surgery

Scar revision is a common request and a frequently performed procedure in plastic surgery. Whether it is scars from an accident from a surgical encounter, many patients have concerns about their scars. As a result, there is much interest in scar improvement whether it is immediately after the scar event has occurred or even years later. The sheer number of over-the-counter scar treatments attest to the public’s interest in eradicating these unsightly and disfiguring marks.
As a general rule, there are no specific scar creams or ointments that will make any significant improvement in an established scar. Topical scar treatments do have a role to play in early scars but not in older scars. Only the concept of some form of scar revision has any hope of improvement at this point. Scar revision can consist of a variety of treatments including excision and rearrangement (cutting out and reclosing), laser therapies, and mechanical methods of dermbrasion or sanding. All are not equal, meaning that each has a specific role to play and can be beneficial if used in the right kind of scar.
There are several extremely important points that one needs to understand about scar revision. First and foremost, no method of scar revision can completely erase a scar’s appearance. The skin were the scar lies is never going to be normal…..ever. Scar revision is about lessening its appearance, not completely eliminating it. As a plastic surgron, I have no magical wand or an eraser at most disposal The critical question before contemplating scar revision then is….how much improvemennt can be had and is it worth the effort. That is where the value of a consultation with a plastic surgeon is…….determining what degree of improvement may be possible.
Secondly, there is no single method of scar revision that will work for all scars. Much ballyhoo goes on about the use of lasers, but quite frankly, lasers are not the most common method of treating scars. They may seem like an ‘eraser’ but their use is restricted to treating early or persistent redness of scars and some light skin resurfacing of scars. Both of these laser effects produce mild degrees of improvement but it is not effective for many types sof scar problems. By far, excision and primary closure (cutting the scar out and reclosing it) or excision and tissue rearrangement (cutting the scar out and realigning it through geometric rearrangements such as z- or w-plasties) is most common. Scar excision is probably the most effective method of scar improvement, if the scar problem permits, as it is removing the scar first and creating a fresh wound. Dermabrasion and deeper laser resurfacing may be helpful for wide scars that are raised that do not lend themselves to excision.
Lastly, scar revision, no matter what method is used, takes time. I tell patients that scar revision is a process that usually involves takes a step back (to allow healing) in the hope that in the long term you have jumped two steps forward and it looks better. It requires a commitment of time and a leap of faith that the ‘effort’ will be worth the result.
Dr. Barry Eppley
http://www.scarscription.com/
http://www.eppleyplasticsurgery.com/
http://www.ologyspa.com/
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis

Scars from most plastic surgery procedures are an inevitable outcome. Most plastic surgery operations require an incision, and when this is necessary as it almost always is, a scar will result. While many incisions (and subsequent scars) can be relatively ‘hidden’ dependent upon the procedure (e.g., facelift, blepharoplasty), many plastic surgery procedures on the body can not. (e.g., breast reduction, arm lift) As a result, many procedures require the acceptance of a scar for the procedure’s other benefits. Or to put it another way….make sure the scars are a more acceptable ‘problem’ than the originial deformity.
For some procedures, the acceptance of a scar is relatively easy as it lays in a relatively non-visible location. Procedures such as facelifts, tummy tucks, or thigh lifts place scars in favorable locations that are very tolerable and patients do not usually have a problem with their presence. In other operations such as breast lifts and arm lifts, the scars are anything but hidden and the decision for that procedure can be a more delicate quandry. In the spirit of trading off one problem for another, I advise patients to be sure that the creation of a scar will be viewed as less of a problem than their original concern. In the end, cosmetic plastic surgery is about making the patient feel better about themselves and their areas for which they are self-conscious. It does the patient no good, for example, if the arm from an armlift is much smaller around but the patient hates the scar. In this example, the patient is still is not comfortable with their arm and nothing has been achieved but a surgical exercise.
There are certain plastic surgery procedures to which scarring is of an utmost concern. I find that the breast lift or mastopexy is the #1 plastic surgery procedure to which this scar concern applies. Which is better…a breast that sags with no scar or a better shaped breast with visible scars? That can be a tough call for some patients and obviously depends upon how severe the initial problem is. While a patient must make the final call about a scar vs. improvement trade-off, I have found a simple way to make this decision. If when talking about the scar, the patient quickly says and indicates that…..what do I care about that scar, who would want to live with this? (or some variation thereof) Then this is a safe scar bet. Conversely, if the patient slowly starts shaking their head, looks concerned, or says they are not sure or have to think about it, then I will not do the procedure. A scar is not something you should have to think very much about. If you have to talk yourself into thinking the scar will be fine, it will likely not be. Furthermore, once a scar is on the patient, I have no magic eraser to get it off. There will always be another day or sometime later in life in which the concept of a scar may be more appealing.
The other issue about a scar is that not all scars, no matter how visible or well placed, will always turn out well. Even in routinue procedures, a patient’s scar can turn out poorly no matter how well the operation is performed. Scar hypertrophy and the possible new for scar revision later is always a possibility. Patients have to be informed of this possibility and have to be willing to accept this poor outcome. Whiel scar revision is always possible, there is no guarantee that scar revision will always be successful.
Dr. Barry Eppley
http://www.eppleyplasticsurgery.com
http://www.ologyspa.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis

Scar revision is both a frequently performed and a common consultation in plastic surgery. Scars can occur from trauma or surgery and can be very distressing for some patients. While time makes many scar better, some scars go on to be raised, wide, or stay very red without improving. On the face, scars can be quite conspicuous if their orientation does not parallel the relaxed skin tension lines of the face. While many scars can be improved by plastic surgery techniques, there are some fundamental principles of scar revision that every patient must understans and be willing to accept.
First and foremost, no scar can be completely removed, there will always be some telltale signs of its existence. In plastic surgery, we don’t have any erasers that can completely make it go away. I don’t care what you see on the internet or on any doctor’s website. (the overexposed or picture with bright lights can make it look washed out and absent) Or to put it another way, we are physicians not magicians! Scar revision, no matter how it is done, is about lessening its appearance, not complete elimination. Whether a scar revision procedure is worth it depends on if the patient can accept some degree of improvement only. I usually think it is worthwhile if the scar can be improved by 50%, anything over that is a bonus and a fortunate development. Secondly, getting the final result in scar revision takes time. Usually much more time than one would prefer to spend, but this fact is inescapable. I always tell patients, think of stepping back a step to eventually move forward two steps. One step back…six to 9 months to step forward…and in children this will usually be longer. I have no celebration about scar revision results until we are out close to a year. If it really looks better then, call the band for the victory parade! Thirdly, scars are all different and not every scar can be improved. Scars that are very wide, raised, or persistently red after some time have a better chance for improvement than others. While many different types of scar revision treatments exist (visit http://www.scarscription.com for an overview of scar treatments), the reality is that most scar revisions involve some form of cutting them out and reclosing them. Many of the other methods of scar revision, such as the laser, are adjunctive treatment methods that complement surgical excision but are not primary treatment methods. Lastly, all bets are off when it comes to the nastiest of scars….keloids! Many patients think they have keloids but they do not. Keloids are raised overflowing scars which keep on growing and cause significant pain and distortion. They are bad actors and few treatments even work, let alone work well. This doesn’t mean we don’t try, but the failure rates are horrendously high.
It is my job as a plastic surgeon to guide each patient and help them determine if scar revision is worth the effort. Sometimes it is…and sometimes it is not. The consideration for scar revision must be done on an individual basis.

Dr. Barry Eppley
http://www.eppleyplasticsurgery.com
http://www.ologyspa.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis

Concern about scars, those one already has or those that might occur from an upcoming surgery, is a frequent patient concern. As a plastic surgeon, I see patients weekly that have existing scars from injury or surgery and would like them improved. While scars come in many varieties (see my scar website, http://www.scarscription.com/) and can be treated by numerous methods, a common treatment method is excisional scar revision. Simply put, the actual cutting out of the bad tissue (scar) and putting it together with fresh unscarred skin. While this creates a ‘new’ scar, the goal is that the new scar is better looking than the old one. The fundamental concept is…..no scar can be completely erased (we are physicians, not magicians) but can be made less noticeable.

Scar excision (revision) is appropriate for scars that are wide, raised, depressed, or are a relatively straight line that crosses the relaxed skin tension lines (RSTL) of the face. (RSTLs are the natural cleavage lines of one’s skin that become quite evident when we get old……as wrinkles and folds….scars that lie parallel to the RSTLs will stay narrower and are less noticeable than those that cross it at angles or run perpendicular to them) No amount of time or any other form of scar treatment will make a scar narrower or make its edges flush with the surrounding skin. When a scar is cut out, it can be put back together in numerous geometric ways….depending upon what scar configuration will look better.

If putting the scar back together allows it to lie in a straight line parallelling a RSTL (for example, a horizontal orientation in the forehead or part of a circular pattern around an arm or leg), then a simple straight line closure would be most favorable. If, however, closing the scar makes a line that runs at angles to the RSTL…then a more geometric scar closure pattern may be used.

Geometric scar revision is based on a simple visual concept…..the eye has a harder time following an irregular line than a straight one. If the cutout of the scar and the way it is put back together creates an irregular pattern, then the scar may ultimately be less noticeable. These geometic scar patterns can be done as running Ws (like the pattern created by pinking shears), intermittent Ms, or a variety of other configurations. This type of scar revision is known as a broken-line closure or pattern. The most well-known geometric scar revision is the Z-plasty. Creating a Z along the line of a scar is the ultimate use of geometry. Z-plasties are most commonly used in scars that cross a moving surface (and have created a tight band or scar contracture) such as a joint or when the scar lies directly perpendicular a RSTL on the face. Skin flaps are cut around the skin crease or RSTL and the limbs of the scar flaps interposed. (criss-crossed) A Z scar is subsequently created but, equally important, the scar is actually lengthened across this area. Mathematically, the angle of the skin flaps that are cut determines how much scar length is actually gained. This technique is particularly valuable in the release of scar bands as reorientation and extra length is usally needed so that they do not recur after scar revision.

Geometric and broken-pattern scar revisions are an essential technique for improving many types of scars. These scar revision techniques require a good dose of time after surgery to see their benefits.

Dr Barry Eppley
http://www.eppleyplasticsurgery.com/
http://www.scarscription.com/
http://www.ologyspa.com/
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis

Insight on Scar Revision by Dr Eppley in Indianapolis

The occurrence of scars is a frequent fact of life. As a plastic surgeon, I usually see several patients a week who come in just to have a scar evaluation and talk about what can be done to improve the appearance of their scars. Such requests are so common that I created a website dedicated to the topic of scars as a resource for patients called ScarScription. (http://www.scarscription.com) Patients are initially referred to it before their appointment so they can be better educated.

In reality, while scars can occur anywhere and from just about anything, there are only 4 basic scar problems that make them more noticeable than we would like. Treatments for scars are based almost exclusively on this appearance classification. Scars can be too high (raised), too low (depressed), too wide (wide), or with poor color. (red or brown)

While most scars can be cut out and reclosed, otherwise known as re-excision or scar revision, certain types of scars may be successfully treated by other methods. Raised scars can be treated by steroid injections, pulsed light, or mild laser resurfacing in an attempt to flatten them, depressed scars can be treated by injectable fillers although that effect may be only temporary, and scars with red or brown discoloration can be treated by pulsed laser light in an effort to remove the unnatural color. Wide scars can be treated only by….re-excision, as there is no non-surgical method to narrow a scar.

Much ado has been made of scar treatment gels, which have become very popular in the past decade. Certainly using topical gels early after the scar is created can’t hurt (whether they really help or not has not been conclusively proven for most of them), but an established scar rarely gets any significant improvement from the external application of any cream, gel, or salve.

Seeing an experienced plastic surgeon is the best way to get good answers to any scar question that you may have.

Dr Barry Eppley
http://www.eppleyplasticsurgery.com
http://www.ologyspa.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis

Scars – What to do

One of the most common questions we get asked in plastic surgery, on a daily basis, is about scars or scarring. Whether it be an old scar from a previous injury or surgery or a concern about a new scar from a planned surgical procedure, patients have great concerns about an external visible scar. What is often not clear to most is that scars are not all the same and, as a result, the treatments for different types of scars is……different! There is no one method of treatment, for example the laser, that is the miracle solution.. In an effort to deal with the many questions and concerns about scars, I have created a website dedicated to the topic. (http://www.scarscription.com/) It is a simple website that first establishes what type of scar you may have by description and appearance. From there, the many treatment options available for each type of scar is discussed, benefits and risks of each type of treatment, and their associated costs.

When we get an inquiry about scars, particularly by phone or e-mail, I always ask that the prospective patient first visit the ScarScription website. It provides an enormous amount of accurate information that is otherwise lacking on most internet sites.

Dr Barry Eppley
www.eppleyplasticsurgery.com
www.ologyspa.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis

Scars – What to do

One of the most common questions we get asked in plastic surgery, on a daily basis, is about scars or scarring. Whether it be an old scar from a previous injury or surgery or a concern about a new scar from a planned surgical procedure, patients have great concerns about an external visible scar. What is often not clear to most is that scars are not all the same and, as a result, the treatments for different types of scars is……different! There is no one method of treatment, for example the laser, that is the miracle solution.. In an effort to deal with the many questions and concerns about scars, I have created a website dedicated to the topic. (http://www.scarscription.com/) It is a simple website that first establishes what type of scar you may have by description and appearance. From there, the many treatment options available for each type of scar is discussed, benefits and risks of each type of treatment, and their associated costs.

When we get an inquiry about scars, particularly by phone or e-mail, I always ask that the prospective patient first visit the ScarScription website. It provides an enormous amount of accurate information that is otherwise lacking on most internet sites.

Dr Barry Eppley
www.eppleyplasticsurgery.com
www.ologyspa.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis