Acne and Scars

Scar Revision

Overview

Facial scars may result from prior trauma, burns, accidents, medical conditions, or previous surgery. While some scars heal well and may be barely noticeable, other scars are quite conspicuous and may affect self-confidence and esteem. Besides being unsightly, some scars also affect the function of the eye, nose, or mouth.

Scar treatment depends on the cause, type, location, and age of the scar.  With her extensive surgical expertise and in collaboration with dermatologists, Dr. Chung has successfully treated many patients from Boston and beyond with various types of scars. Improving and minimizing the appearance of a scar can provide dramatic improvements in self-esteem, confidence, and well-being.

Am I a good candidate for scar revision?

You are a good candidate for scar revision surgery if you have:

  • good health
  • healthy and realistic expectation for scar revision

What happens during the initial consultation?

During your initial consultation, Dr. Chung will listen to your concerns regarding your scars and your goals for scar revision. A detailed history is taken to discuss the time of the scar formation, progression, and cause. A thorough examination will elucidate the type of scar that you have, as this will significantly influence subsequent treatment. Is your scar raised, wide, discolored, or depressed? Is it a shallow, crater-like scar or is it deep and narrow, like an ice pick scar? Is the scar affecting the function of any facial features, such as your mouth, nose, or eyes?  All of these considerations will be taken into account during your initial consultation.

Depending on your scar and your skin type, Dr. Chung will design an individualized treatment protocol specifically for you. Treatment options include:

  • serial steroid injections to flatten a raised scar
  • surgical excision of a scar with restitching to narrow a wide scar or change the direction of a scar. On occasion, serial excisions may be necessary to allow the skin to relax between treatments.  This is particularly true for wide scars.
  • surgical subcision may help elevate an “ice pick scar”
  • non-surgical procedures, such as carbon dioxide laser and dermabrasion treatments, may be used to help scarring from acne
  • other non-surgical therapies including silicone, Restylane, Juvederm, or Boletero injections to fill in depressed scars

These are just some of the treatment modalities available for scar revision, and Dr. Chung will customize an appropriate treatment regimen just for you.

Because each scar is unique and the patients’ attitudes toward scars so personal, maximum improvement in facial scars may require more than one procedure, employing more than one technique. Timing of scar revision surgery is also very important. Typically, it is recommended that a scar should mature for at least a year before revision is attempted. Dr. Chung also prefers to wait at least 6 months for patients who are completing a course of Accutane.

What happens during scar revision surgery?

Scar revision surgery is usually performed in the office with local anesthesia. For scars that are surgically removed, Dr. Chung uses meticulous technique to remove the scar tissue and move healthy adjacent skin to fill in the area. Some patients may require a skin graft from another part of the face, while others may benefit from z-plasty, an advanced technique in which the direction of the scar is moved from a visible area into a natural skin crease or fold. For all surgical procedures, Dr. Chung closes the skin with tiny, fine stitches.

In dermabrasion. Dr. Chung uses a special surgical device to treat raised scars. (This procedure should not be confused with microdermbrasion, which is a skin treatment delivered by aestheticians.) In surgical dermabrasion, the scar is sanded down to the point where there is punctate bleeding. The goal of this procedure is to improve the appearance of a raised scar, and blend the edges of a depressed scar with the surrounding skin.

In laser resurfacing, the carbon dioxide laser is used over the scar to promote collagen formation, soften any raised areas, and blend the edges of a scar with the surrounding skin. In these laser procedures, patients may feel some heat during the resurfacing, but the local anesthetic use makes it a very comfortable procedure.

If your scar is being treated with serial steroid injections, a tiny amount of steroid will be injected into the scar. This procedure takes a few minutes and will need to be repeated.

What is the recovery like?

  • If you have stitches, they will be removed in 5-7 days
  • For skin resurfacing procedures, the treated area may appear raw and red for a week.

Most patients return to work the day after the treatment. You may need to wear a bandage to protect the treated area for a few days.

What will I look like?

The treated area will continue to improve in appearance over time. It is important to have realistic expectations and realize that scars cannot be erased completely. In some patients, repeated treatments with skin resurfacing techniques (dermabrasion and C02 laser) may provide further improvements. Dr. Chung will also direct you on the use of post-procedure scar creams and sun protection to enhance the results. With scar revision, you will see how an improved look inspires an improved outlook.

 

“Scars show us where we have been, they do not dictate where we are going.”

David Rossi