Your skin is unique. The way it reacts to trauma and develops scars is very different from the way another person’s skin reacts. Varying in shape depending on the severity of the wound, scars that heal properly tend to become faint and silvery, so much so that they may be barely noticeable. However, sometimes excess or inadequate tissue develops during the healing process, creating scars that are prominent in both texture and colour. They can be aesthetically displeasing and a source of concern, particularly when they are visibly located, like on the face. While non-surgical technologies can help reduce their appearance, only surgical scar revision can achieve such dramatic results for you in a single procedure.
Enjoy a beautiful complexion without scars. Call 905-849-4282 to book your medical appointment with Dr. Stephen Brown for scar revision surgery.Dr. Brown has over 25 years of experience treating unsightly scars, making them less prominent for an enhanced complexion. You won’t have to hide your scars with makeup anymore.
Scar revision is performed after you have had time to heal (usually a year or so after the initial trauma). By this time, the tissues that create your scar should be strong enough so that your wound is totally repaired. While all scars are permanent, the aim of your treatment is to make your scar less noticeable — so much so that you and others can barely see it. Like most of our patients, you may experience a 90% chance of visible improvement even if you have hypertrophic scars or keloids (the most problematic type of scarring).
Frequently, a scar revision can be performed in our office under local anesthetic, allowing you to go home soon after the procedure. Dr. Brown will meet you at the initial consultation and let you know if a scar revision would be of benefit to you.
Surgical Scar Removal
The surgical removal of scars is necessary when non-surgical techniques are deemed ineffective. Non-surgical options include the following:
- Laser technologies to improve tone and texture
- Fillers to “fill in” depressed and sunken scars, making them more uniform in texture
- Silicone gel sheets, particularly useful in smoothing down hypertrophic and keloid scars
This may be the case for patients who wish to reduce the size and/or length of their undesirable scar or smooth it down/elevate it to make it more even with the healthier skin surrounding it. While scar removal is not designed to eliminate the appearance of the scar entirely, it can minimize it to the point that it becomes barely noticeable.
During surgical scar removal, anesthesia is administered. The type of anesthetic is usually local, although general may be administered if the scar requires extensive treatment. Dr. Brown removes the scarred tissue by excision, then sutures the remaining healthy skin together with a little tension as possible to create a smaller scar. The incisions made to do this may not be straight. Rather, they may be irregularly shaped or zig zag (z-plasty) to help create a less noticeable scar by following the natural creases in your skin.
For deep scars that are often the result of acne, punch grafting may be a more suitable surgical technique. A small device is used to create a hole in the skin where the deep acne scar is, removing it. A small piece of skin is then placed into the hole and taped into position. Over the course of a week or so, this heals over, making the surface of the skin more even.
Because it takes time for scars to heal, you may need to wait for up to a year to see how your results are. During the recovery period, you should follow Dr. Brown post-operative care instructions to ensure proper healing.
What Causes Scarring?
Our natural skin traits factor heavily into how we scar. Studies have shown that patients who fall within the Fitzpatrick Scale’s Type III to VI categories (groups ranging from white/olive to very dark brown/black skin colouration) are much more likely to develop excessive or abnormal scarring. Patients with darker skin are more likely to suffer from keloids (large, painful marks), hyperpigmented (discoloured) scars and scars that are large in volume (hypertrophied). These factors lead to a scar that is more easily visible and unsightly.
Collagen is a substance that naturally helps to repair wounds. If a patient’s genetics make them prone to collagen overproduction and insufficient collagen degradation, they are more likely to develop keloids and hypertrophied scars.
Younger patients may be more likely to suffer from widened scars due to the higher tensile strength of their skin. Older individuals typically scar better since aged skin isn’t as tight and places less tension on the wound as it heals.
Iatrogenic factors, simply put, are injuries caused by doctors as part of a medical treatment. For example, the type of incision a surgeon creates during a procedure would be an iatrogenic factor of the scar left behind. Since scars are formed as the result of a wound’s healing, Dr. Brown understands the importance of minimizing soft tissue trauma as much as possible during surgery. Improperly closing the edges of the wound can create unnecessary skin tension that leads to depressed scars. If the wound isn’t properly supported deep within the tissue, too much tension can be placed on the site and an overly wide scar is created. In addition, if stitches are taken out too early or too late the resulting scar will be too wide or have a noticeable, cross-hatched appearance. If steroids or medications like Accutane (isotretinoin) are used too closely to surgery they may also cause problematic scarring. Patients who have taken Accutane or steroids should wait at least 12 to 18 months after completing the medication course before undergoing any type of facial surgery.
Achieving the Best Scar
Clinical studies have helped doctors learn how to improve their surgical techniques and avoid causing the kind of damage that leads to abnormal or excessive scarring. These studies have determined that skin does not run in straight lines and also changes structurally with time. It is also anisotropic, meaning that it possesses mechanical properties that change based on direction.
Understanding the anisotropic nature of skin has helped doctors identify lines of minimal tension within the operating area. If surgical incisions are made parallel to these relaxed skin tension lines (or RSTLs) undue stress can be avoided during the healing process. There are also areas of the skin that are better at extending. These are known as lines of maximal extensibility (or LMEs). If incisions are made parallel to the RSTLs and then closed in the direction of the LMEs, there will be very little tension on the operating site as it heals and the best possible scar is left behind.