Scar treatment: Revision therapy to reduce scarring

Reducing the visibility of scars is done for a number of reasons. Scars that are large or very severe can undermine your confidence, as they’re visible to the world around you. Severe scars may also limit your movement, especially if they’re across a limb. Scar revision treatment is a way of decreasing scar visibility, giving you more confidence and increasing mobility.

Who is a good candidate for scar treatment?

There is an important criteria we have to consider before commencing with treatment. Not all scars will respond to treatment in the same way, and not all scars are suitable for revision. Along with this, there are psychological factors which also need to be considered prior to treatment. The most important factors which determine whether you are a suitable candidate or not, include:

What are your expectations?

As your doctor, we have to be sure you understand the likely outcomes of this treatment. Scar revisions will reduce your scars, but not remove them completely. The treatment sometimes requires multiple surgical procedures. Long lasting results are achieved as a result of ongoing treatment for months or even years.

The age of the scar

Scars that are younger than 18 months are not suitable candidates for revision. That is because it takes the scar that long to heal and regain 70-80% of the healthy skin’s tensile abilities. In some cases, it is necessary to do scar treatment or revisions earlier. We like to wait for 12-18 weeks in adults, and 6 months in children below the age of 7. Scars that have not had that healing time are prone to hypertrophy, and the skin revision treatments are not as effective. To minimise scarring during the waiting period, we can give you intralesional steroid injections and treat your scars with a silicone sheet.

Candidates should be well-nourished

Diets rich in vitamins A, C, and E, as well as zinc, will promote improved wound healing. A well-balanced diet will also allow for optimal protein synthesis. Prior to scar revision treatment, all herbal remedies (particularly those that may cause bleeding/blood thinning) should be stopped. If you have a condition like diabetes or any other autoimmune condition, this needs to be factored in so that we may take extra precautions to guard against slowed wound healing.

Smokers are not good candidates

Tobacco causes vasoconstriction (narrowing of the blood vessels), hypoxia (oxygen deficiency), thrombogenesis (blood clotting) and it slows down the wound healing process. We encourage you to stop smoking, or at least cut-down, prior to scar revision therapy,  to get the best results possible from the treatment.

What is scar treatment? 

Non-surgical scar treatments:

• Camouflage
• Topical therapy
• Intralesional agents
• Cryotherapy
• Laser resurfacing

Surgical scar treatment and revision:

Surgical excision
We shave down layers of the scar to reduce its size. Sometimes, this may take several appointments – the treatment is then called serial excision as it is performed in a series of treatments. We have to do it in stages to prevent it from pulling adjacent areas of the skin.

Flaps, Grafts and Artificial Skin
In the case of extensive injury, like burns, there is sometimes not enough skin at the site to regrow and cover the wound. To minimise the scarring, the upper layer of skin may be removed from another part of the body and placed there. The new skin is harvested with care to keep all the blood vessels intact, ready to embed in the new area and heal.

Z-plasty and W-Plasty
This form of treatment is not used to treat keloids or hypertrophic scars. This form of surgery is used to redirect a scar to run along a natural line or facial feature, making it less visible. It is a fairly complex process by which the scar is sutured in a Z or W shape and the flaps of the incision are re-sewn to direct the scar into a more favourable position.

The different types of scars

Keloid scars

Keloid scars often protrude higher than the surrounding healthy skin. It arises as a result of rigorous healing but can after a time, limit mobility. We can treat keloid scars with steroid injections, silicone sheets (to flatten the scar) and in some cases, cryotherapy.

Contracture scars

Contracture scars may cause pulling in the skin, affecting surrounding healthy skin too. Contracture scars are often the result of burns, which tighten the skin.  Contracture scars can go quite deep, affecting nerves and muscles.

Hypertrophic scars

Hypertrophic scars are similar to keloid scars, except that unlike keloid scars, hypertrophic scars do not extend beyond the original injury. The treatment for hypertrophic scars is the same as the treatment for keloid scars.

Acne scars

Acne scars are the result of severe acne, even after the condition has gone, the scars may remain. There are a number of treatments available for this type of scarring. We will assess your scars and recommend the best way forward.

The risks associated with scar treatment and revision

Scar widening and hypertrophy

These side effects are rare, we are able to take measures to prevent hypertrophy, especially among those prone to it. Intralesional steroid injection is prophylaxis (preventative treatment) to prevent hypertrophy.

Haematoma formation

It is possible that a haematoma may form following the treatment. In order to prevent this, we assess the case, it if there is a high risk of this side effect developing, we leave a small drain in place to prevent the haematoma.

Infection

Post-treatment wound care is paramount to proper healing. We will guide you on how to care for your wound when you are at home.

Wound dehiscence (the suture lines reopening after the procedure)

This can also be prevented by following the post-treatment wound care guidelines. In order to keep the wound closed and safe for its healing process, we use steri-strips and take measures to minimise tension on the epidermis (the outer layer of the skin).

Dermatology and scar reduction

We are fortunate to live in the times that we do. There are wonderful medical advancements now – scar reduction is one of them. Not only are people able to regain movement, but the visibility of their scars can also be reduced, drastically. We would love to help you on your journey to healing. If you have a scar you would like to have reduced, contact us.