Scar Revision Surgery

A scar is a mark left after a wound has healed. Scar revision surgery can help improve the look of a scar or make it less visible. It can make it thinner, or less raised. If the scar is tight and restricts movement of the skin, revision can improve this. No scar can be completely erased. But scar revision surgery can help a scar look and feel better.

Scar revision surgery can be done in a number of ways. The method used depends on the type of scar you have and where it is on your body. You and your doctor will discuss these details before the surgery. Common methods of scar revision surgery include:

• Excision. The scar is surgically removed, and the area closed with stitches.
• Skin graft. Scar tissue is removed. It's then replaced with a piece of healthy skin (graft) taken from another part of the body.
• Z-plasty. A Z-shaped incision is made through the scar tissue and some healthy skin. (If the scar is very large, more than one incision may be made.) The Z-shape creates pointed skin flaps that can then be arranged for a more pleasing look and contour. This may loosen the scar as well.
• Tissue expansion. This is sometimes used instead of skin grafts. A balloon is placed underneath the skin near the scar. The balloon is slowly filled over time to expand the healthy skin close to the scar. When the skin has been stretched enough, the balloon and the scar are removed. The healthy stretched skin is moved to replace the scar. This type of revision may need more than one surgery.

Prepare for the surgery as you have been told. Also:

• Tell your doctor about all medicines you take. This includes herbs and other supplements. It also includes any blood thinners, such as warfarin, clopidogrel, certain anti-inflammatory medicines, and daily aspirin. You may need to stop taking some or all of them before surgery.
• If you smoke, stop smoking before the surgery. Tobacco and other products with nicotine can slow wound healing.
• Follow any directions you are given for not eating or drinking before surgery.

Before the procedure, you will be asked to sign an informed consent form. This form will give information on the procedure. It will also list the risks, benefits, and alternatives to the procedure. You can ask questions before you sign the form. Make sure all of your questions are answered before you sign the form.

The surgery takes 2 to 4 hours. You may go home the same day. Or you may stay 1 or more nights at a hospital or an ambulatory surgical center.

• An I.V. (intravenous) line is put into a vein in your arm or hand. This line delivers fluids and medicines.
• You will be given medicine (anesthesia) to keep you pain free during the surgery. You may receive sedation, which makes you relaxed and sleepy. Local anesthesia is also used to numb the surgical area. In certain cases, general anesthesia is used instead. This puts you into a state like deep sleep during the surgery. With general anesthesia, a tube will be inserted into your throat to help you breathe. The anesthesia provider will discuss your choices with you.

• Your doctor will repair the scar using the method discussed with you before the surgery.
• You will be taken to a recovery room to wake up from the anesthesia. You may be sleepy and nauseated. If a breathing tube was used, your throat may be sore at first. You will be given medicine to manage pain. If the revision is to a large area, you may stay 1 or more nights in the hospital. Once you are ready to go home, have an adult family member or friend drive you.

Once at home, follow the instructions you have been given. Your doctor will tell you when you can return to your normal routine. To help your healing:

• Take any prescribed medicines exactly as directed.
• If advised by your doctor, use a cold pack wrapped in a thin towel to ease discomfort and control swelling. It's important not to leave the cold pack on for too long or put it on unwrapped. This can damage your skin. Put the pack over your bandages for no more than 10 minutes at a time. Then leave it off for at least 20 minutes. Repeat this as often as needed during waking hours until swelling starts to improve. Don't fall asleep with the cold pack on. If you're not sure how to safely use the cold pack, ask your doctor.
• Follow all instructions from your doctor for taking care of the incision. Leave the bandage in place until you are told to remove or change it. Once you can change your bandage, do so every 24 hours or as directed. Also replace the bandage whenever it gets wet or dirty. Wash your hands before changing the bandage.
• Keep the surgical site clean and dry. You can get it wet after 48 hours. Rinse the surgical site gently and pat it dry.
• Keep the surgical site out of the sun as it heals. This will help make sure of a better outcome. At first, cover the healing skin with a bandage or clothing. When your doctor says it's okay, you can use sunscreen on the site.

Contact your doctor if any of the following occur:

• Chest pain or trouble breathing (call 911)
• A fever of 100.4° F (38°C) or higher, or as directed by your doctor
• Symptoms of infection at an incision site, such as increased redness or swelling, warmth, pain that gets worse, or foul-smelling drainage
• Bleeding or clear drainage from the incision that doesn't stop when pressure is put on the site. First, replace your current bandage with a clean, dry bandage or gauze. Then apply pressure directly to the incision for a few minutes. If the bleeding or drainage continues, call your doctor.
• Pain that is not relieved by medicine

You will have follow-up visits so your doctor can see how well you're healing. During these visits, your doctor can keep track of the results of your surgery. Let your doctor know if you have any questions or concerns.

Risks and possible complications include:

• Bleeding.
• Infection.
• Blood clots, which can travel to the lungs, heart, or brain.
• Damage to nerves, muscles, or blood vessels.
• Changes in skin sensitivity.
• Skin discoloration.
• Not liking the look of the revised scar.
• The recurrence of a keloid scar.
• Risks of anesthesia. The anesthesiologist will discuss these with you.