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Dr John Di Saia, an orange county california plastic surgeon

Scar Revision: Plastic Surgery For Scars

Scars can be improved when they have certain characteristics. Healing in the body cleans them up over the first months to a year after wounding occurs. During that time creams or scar sheets might be of benefit. But what do you do when you are a year or more down the line with an ugly scar?

Visible scars represent points at which the differences between previously wounded and unwounded skin become apparent. While they do in general improve with time, they are never converted into "normal skin." Scar tissue never attains the strength or color of normal skin. The differences between the two tissues therefore can be frequently seen. The treatment of scars is more likely to make these differences less obvious under several conditions:

(1) The scar is wide - If the scar tissue is wide that often means that separation occurred between the two edges of the healing wound over the time over which the wound healed. A carefully planned operation called SCAR REVISION may offer some benefit here. The scar tissue is removed and the two edges of the wound are mobilized surgically and brought together to be closed in layers. This usually reduces the separation and the wound has another chance to heal. Dependent upon the quality of this healing, the scar may be improved.

(2) The wound from which the scar formed is recent - In the first year or so after a wound is formed, healing has the best chance of improving the scar itself by a process called Re-modeling. Wound healing occurs in an optimal manner if the wound is appropriately handled in the first place, has little infection, and is kept from direct sunlight. Once the wound closes, scar tissue goes through stages. Some believe that the application of silicone sheeting (now available over-the-counter at drug stores) may help early scars to heal with less tissue distortion. This should be assisted by a physician in all but the simplest wounds as putting it on open or infected wounds can make things worse.

(3) The scar is colored - In some individuals pigmented scars can be improved. This is a little more difficult unless the scar is wide or was poorly handled when the wound was first formed.

Scar Revision Surgery

Take into account that scar revision surgery is an operation that removes a scar, but a healing wound will form another scar. Special techniques are employed (that is the plastic surgery part) to set up the wound to enable it to heal better than it did before. The idea is to try to make the new scar be less objectionable than the original, but this cannot be guaranteed. Your surgeon can operate (or decide not to operate in the appropriate case), but cannot do the healing for you. Technique is important, but surgeons that guarantee an improvement may be "guilding the lilly" somewhat. A good surgeon can choose well however. :)

Scar revision surgery for smaller scars can often be performed under local anesthesia (numbing shots only) in the office to keep the costs down. The surgeon and materials are still not cheap when a plastic surgeon is involved, but local office surgery can cut thousands off the price. Please note that Dr Di Saia offers scar revision as time permits. He is not always in the position to accept new scar revision patients. You may of course call the office for availability.

Pictures & Video:
scar revision before surgery
scar revision before surgery

On Medical Insurance

Over the past few years I have learned to be very non-committal on the issue of medical insurance. In the case of scar treatment, it is pretty unlikely that insurance will "cover" a surgical procedure especially if that surgery occurs in a doctor's office.. Each insurance plan has varying criteria for coverage. I do not fabricate indications to get them covered. Fewer than 25% actually are covered by insurance in my practice.

Avoiding Scars in The First Place

Surgery usually involves making cuts. Cuts result in scars. Plastic surgeons are trained in techniques that help make scars less visible, but not invisible. Getting your surgery performed by a plastic surgeon (when possible) may help minimize poor scarring but cannot prevent it entirely, especially if you are known to have a history of healing with poor scarring. Realistic expectations are important in this type of surgery in particular.


© John Di Saia, MD... an Orange County California Plastic Surgeon       

Serving Southern California since 1997 * (949) 369-5932


Please note that this resource is offered freely to individuals considering cosmetic surgery. No rights are granted and it is not to be reprinted or copied without the author's prior written consent. Understand that some of the information presented may be a matter of professional opinion. Although efforts have been made to assure accuracy, no guarantees are expressed or implied.