Scar Revision

Scar revision covers the procedures used to improve the appearance or function of a scar left after an injury, a burn, an operation or a skin condition. A scar cannot be erased completely, but it can become thinner, flatter, less visible or better blended into the natural lines of the skin.

The method is chosen according to the type of scar, its age, its location and the way each person's skin heals. At Detalii Med, in Baia Mare, the assessment and surgical revision are carried out by the clinic's plastic surgeons.

The procedure may be suitable for people who have:

• widened, depressed or irregular scars after a wound or an operation;
• hypertrophic scars, thickened and raised above the skin;
• keloid scars, which extend beyond the edges of the original wound;
• contracture scars, which pull the skin and may limit movement, for example around the joints;
• scars that are aesthetically bothersome or cause itching or discomfort.

It is important that the person has realistic expectations and is able to follow the aftercare instructions.

Revision can make the scar narrower, flatter and closer to the colour of the surrounding skin, can realign it with the natural tension lines and can release a contracture scar, improving mobility.

No method can remove a scar completely. After revision there is still a scar, usually a more discreet one. Keloid scars tend to recur, even after correct treatment. With very extensive scars, for example after burns, several stages may be needed.

At the consultation, the plastic surgeon examines the scar, its age, colour, thickness and elasticity, as well as the area where it is located. How it appeared, what treatments have already been tried and whether the patient tends to form thickened or keloid scars are discussed.

As a rule, a scar needs about 12 to 18 months to mature, and during this period its appearance may improve on its own. The doctor may recommend waiting and conservative treatment before any surgery. A plan is drawn up, which may combine surgery with other methods.

Depending on the case, revision may include:

• excision of the scar and careful layered suturing, for a new, finer scar;
• local plasty techniques, for example Z- or W-shaped, which change the direction of the scar and release tension;
• transfer of the patient's own fat beneath depressed or tethered scars;
• local corticosteroid injections, especially for hypertrophic and keloid scars;
• complementary treatments, such as silicone gels or sheets and dermatological procedures.

The type of technology used for complementary treatments is chosen at the consultation, according to the indication. As a guide, surgical procedures last from 30 minutes to one or two hours.

Most scar revisions are performed under local anaesthesia; the patient is awake and can go home the same day. For extensive scars, sensitive areas or children, sedation or general anaesthesia may be recommended.

After the procedure, a dressing is applied, and stitches are usually removed after 5 to 14 days, depending on the area. Discomfort is generally mild. In the first weeks, tension on the area, exertion that stretches the scar and sun exposure are avoided.

Aftercare is very important: scar massage, silicone, sun protection and, if needed, repeated injections can influence the result. The doctor sets the check-ups needed to monitor progress.

The risks are discussed at the consultation and include:

• recurrence of a thickened or keloid scar, especially in predisposed people;
• a new scar that is widened or more visible than hoped;
• infection, bleeding or wound opening;
• changes in skin colour or sensation;
• with corticosteroid injections: thinning of the skin or small pigmentation changes;
• the need for several sessions or procedures.

The new scar goes through the same stages of maturation: at first it may be reddish and slightly raised, then it gradually fades. The final result is usually assessed after 6 to 12 months, sometimes longer. Progress depends on the area, the skin type and how closely the recommended aftercare is followed.

Scar revision can significantly improve the appearance and comfort of a scar, even though it cannot make it disappear. The best result is achieved by choosing the right timing and technique and through careful aftercare. The plan is set at the consultation.