Important factors to be discussed with your surgeon include:
The goal of facial scar treatment is to disguise the scar, relocate it, or minimize its prominence.
Skin type and color, ethnic background, individual healing rates, age
Different types of scars respond to different plastic surgery techniques. One must understand that there is no way of removing scars completely in facial scar revision.
Timing of surgery is another important choice. Some surgeons advise against any scar revision in cases of injury for a period that might extend up to a year after the injury. This interval allows the body enough time to heal fully.
SCAR REVISION SURGERY
Most scars can be treated with simple excision.
Contracture type scars generally involves removing the scar tissue entirely.
Complex excision and skin flaps may be necessary in some cases,
Some scars on the face can be made less visible by scar reorientation or scar irregularization,
MINIMALLY-INVASIVE SCAR REVISION
With subcision one can use special Nokor needles to undermine a depressed or tethered scar, or even acne scars. The fibrous band under the scar is divided, allowing the skin to return to its normal position. Once undermined with the needle, one typically uses fillers or fat grafting.
Dermabrasion and laser resurfacing are methods a surgeon uses to make “rough or elevated” scars less prominent by removing part of the upper layers of skin with an abrading tool or laser light. Clearly, the scar will remain, but it will be smoother and less visible.
Typically early laser resurfacing allows to improve scar results and can be started at suture removal. Dermabrasion allows to flatten an elevated scar or helps a scar blend into the tissues and camouflage it better. Best timing for first dermabrasion is 6 weeks after injury.
Lasers that target blood vessels are commonly used for red scars, and ablative (destructive) and nonablative fractional lasers have advanced treatment substantially for some patients with traumatic scars, although multiple treatments are usually needed.
For pitted scars on can use chemical peels to reconstruct the pit by wounding in a procedure called TCA-cross.
Keloid or hypertrophic scars are often treated first with injections of steroids to reduce size. If this is not satisfactory, the scars can be removed surgically, and the incisions closed with fine stitches, often resulting in less prominent scars. Other options are a part from injected corticosteroids also topical steroids, injected chemotherapeutic agents (eg, fluorouracil), silicone gel sheeting, cryotherapy with liquid nitrogen, and irradiation.
Injections of fillers allow to improve depressed or atrophic scars.
Injections of botulinum toxin around the scar in certain areas of increased movement will allow to relax muscles around the area and in this way puts less strain on the healing scar.
Scar minimization is scar wound care, that keeps the scar moist and warm, which are favorable healing conditions. Effective early wound care are important to minimize scar formation. Physical therapy, pressure, and other treatments can help minimize contracture formation after injury.
Our cosmetic care consultant may assist with scar camouflage, either with cosmetics or dermopigmentation.