Surgery & Other Options

It is amazing sometimes to what extent advertising "muddies the waters" of plastic surgery. In the treatment of scars, this makes informing the prospective patient a hurdle at times. It's almost like a debriefing in my office. So let's go through some of what is known about scars and the circumstances under which they might be improved.

Scars of the skin are 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.

A Case Example...A Burn Scar Of The Lower Leg

This young lady came to consultation years after sustaining a muffler burn to the lower leg. The wound had healed after some time with a "dent" in the contour of her leg. The scar was thinned and changed in color at its mid portion having roughly the shape of a "V." She was scheduled for a staged scar revision under local anesthesia. The lower arm of the scar was excised and tissue mobilized and moved into the "crater." The closure was in layers with a long term absorbable suture. The marked area notes the portion of the scar that was removed/addressed.

3 months later the improvement is evident as the width of the lower arm of the scar has been thinned considerably. The contour defect has also been improved by moving healthy tissue into the wound following the scar excision. The surgical scar somewhat darkly pigmented is not mature at this stage and should fade over the next nine months to a year. At that time, further scar excision and layered closure may improve the remaining scar elements to the upper right of the revised scar area.

Scar Revision Surgery and Scar Treatment In General

Take into account that scar revision surgery is an operation that removes a scar, but a healing wound will form another scar. The idea is that this scar be less problematic than the one that was originally there, 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. Surgeons that guarantee an improvement may be "guilding the lilly" somewhat.

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. Each insurance plan has varying criteria for coverage. Some will cover surgery if the scar serves to functionally impair movement. I do not fabricate indications to get them covered. Fewer than 25% actually are covered by insurance.

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.

"OK, I have This Scar and I Want To Avoid Surgery...."

There are a few things you can try to improve a scar that is raised or discolored. Silicone gel sheeting has been used for years in the treatment of burn scars. Plastic surgeons often place it in tight garments directly juxtaposed to the scar. Many of these scars improve. Take into account that many of the "over the counter" scar solutions have little or no evidence of efficacy. Silicone sheeting isn't 100%, but it has been used with success. Don't buy polyurethane. Many of the products I have seen are composed of polyurethane and there is no evidence of which I know showing that they work. There are silicone gels, but they tend to absorb to clothing. Massage can also improve scars over the long term. Vitamin E oil is of no proven benefit either. Any product claiming it works 100% of the time is suspect here.

SCAR CARE PRODUCTS AVAILABLE ONLINE