Almost everyone has a scar of some sort, but when a scar is located on the face, it can cause a negative impact on self esteem. Scars form when skin recovers from an injury such as an accident, a burn, or even severe acne. When a scar forms, it is difficult to erase it completely. However, the appearance of scars can be reduced significantly with proper treatment, including surgical scar revision.
After the initial insult or repair, it is suggested that patients wait up to 12 months after an injury to allow sufficient healing time and scar maturation. For really bad deformities, scar revision surgery can be performed at 6 to 9 months, but it almost always better to wait the 12 months to allow the scar to heal fully and mature. Depending on location and severity, some patients may require multiple revision procedures to properly correct a scar, but this is uncommon. It is important to consult a facial plastic surgeon when considering scar revision on the face, because different types of scars respond to different techniques. After evaluating a scar, I decide which method of revision will work best for the patients skin type, skin color, and age of the scar. Typically I choose from the following methods of revision: Direct Excision, Z-Plasty, W-Plasty, Geometric Broken Line Closure, or Laser Therapy.
Sometimes when the original injury wasn’t sutured or developed an infection, a direct excision of the area with careful closure is the first choice. If you have keloid or hypertrophic scars, they may first be treated with steroid injections prior to removal to reduce the scar size or after to prevent recurrence of the keloid. If the scars do not satisfactorily respond to steroid treatments, they best option may be surgical removal.
The Z-plasty is a method that reorients a scar to minimize visibility by placing it in the same direction as the natural wrinkle of the face. It may also be used to treat scars the form a web or become indented on curved surfaces such as the edge of the ear lobe. The Z-plasty involves a series of small incisions on both sides of the area of scar removal, which create V-shaped skin flaps it may also be performed in series on longer scars called a running Z-plasty. The result is a thin, less noticeable scar because it was removed and is hidden in a natural fold or crease in the skin.
Like the Z-plasty, the W-plasty diminishes the visibility of a scar by turning a straight line into an irregular one, but it does not require repositioning skin flaps. It is a fact that visual cortex of the brain notices irregular patterns less perceptibly than straight line patterns. During W-plasty, a series of short incisions are made to form a zigzag pattern, excising the old scar replacing the straight line pattern of the scar with a less noticeable irregular one.
The Geometric Broken Line Closure is the preferred technique of scar revision to create an “irregularly irregular” scar without affecting the length of the scar. This technique is particularly well suited for scars located on flat surfaces such as the cheek or forehead.
To facilitate the best healing for scars after any revision or early after the initial injury, I suggest Cutera laser genesis scar remodeling treatments. This quick treatment helps build collagen, reduce redness and smooth skin texture with minimal discomfort and no downtime and may require only one to three treatments. We are the only practice to provide this service in the Atlanta area. I also advise using Biocorneum silicone scar cream with SPF 30. This formula flattens, softens, and smoothes scars, reduces discoloration, as well as relieving itching, pain or discomfort associated with healing.
Post provided by Benjamin Stong MD
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