Scar Revision:  Correction of Suboptimal Scars

Scar Revision: Correction of Suboptimal Scars

I frequently see patients who have concerns about scars usually in highly visible areas that affect their appearance. These marks may be due to trauma, surgery, cancer, or poor wound healing. Scars cannot be erased. However, it is possible to improve their appearance.

On the face, there are certain factors that greatly improve the possibility of improvement of an undesirable scar.  The skin on the face is mobile, and as a result there are natural lines that develop due to the action of the underlying facial muscles. If a scar falls within these natural lines, there is a great chance that the scar will be overlooked by others. This is the strategy of plastic surgeons when we treat facial injuries. We place the scars in the wrinkles of the face.

What if the scar occurred due to trauma, and the scar is perpendicular to the lines of the face? The scar can be modified such that it blends into the skin lines by disrupting the direction of the scar. The straight scar is turned in to a zig zag, such that approximately 50% of the scar is now in the wrinkles and is less noticeable. Thick ropy scars can be removed and refined such that the resulting line is razor thin. The use of non-inflammatory sutures and sterile technique can eliminate some of the factors that led to poor scarring in the first place. This is especially the case in scars due to trauma.

In Figure 1, scars that are perpendicular to the wrinkles of the face are depicted. These are difficult scars to hide.

In Figure 2, scars fall into the lines of the face. There is a very good chance that these scars will disappear within a few months.

In Figure 3, scars that were perpendicular to wrinkles are made into a zig zag pattern to help hide approximately 50% of the scar into the wrinkles of the face.

The final component of scar modification is post surgical care.  Gentle mild soap and water, scar massage, and scar gel twice daily can greatly facilitate the healing and appearance of the scar. Sun protection is very important. UV rays darken scars, and this can be permanent. Scars are forever. However with appropriate treatment, they can be greatly reduced and blended with the surrounding skin.

 

Matthew C Camp, MD

Board Certified Plastic Surgeon

Member, American Society of Plastic Surgeons

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