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
Breast augmentation continues to be one of the most popular plastic surgery procedures with over 300,000 women undergoing the procedure last year. With the return of silicone gel breast implants, in addition to existing saline breast implants, women now have two good choices for their breast augmentation procedure. Whether saline or silicone gel breast implants are ‘better’ for any single patient depends on a thorough knowledge of each implant type’s advantages and disadvantages.
Regardless of whether one chooses saline or silicone gel breast implants, every breast augmentation procedure requires a scar to be created somewhere. The choices for the incision location are either the armpit, nipple, under the breast, or the belly button. In my practice, the incision choices narrow down to either the armpit (for saline breast implants) or under the breast (for silicone breast implants). While I have always enjoyed the armpit (axillary) approach for saline breast implants, and I have never had to do a single scar revision with this approach and it certainly is hard to impossible to find later, I have come to really appreciate the scar under the breast (inframammary crease) with silicone gel breast implants. I have observed this is certainly a great place to put the scar, particularly with silicone gel breast implants which require a slightly longer incision. Since the breast usually hangs over the inframmary crease in most patients, it is really difficult to see. My patients are extremely happy with this approach even though the scar will have some potential redness and unevenness in the very beginning, which is normal. Using the nipple incision approach is difficult in many women because there is often quite a mismatch in nipple size and desired size of the breast implant that the patient wants. This makes it virtually impossible to put the proper size of breast implant through such a small incision area. Furthermore, the brown color of the nipple (areolar) margin can make even a well-healed scar look noticeable with its whiter color.
Both armpit and under the breast scars heal well, making them really ‘non-visible scar’ techniques for breast augmentation.
Dr Barry Eppley
http://www.eppleyplasticsurgery.com
http://www.ologyspa.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis
