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Find a Scar
Removal Specialist
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Patient Education
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 | | The Patient’s Guide is the most respected online publication providing information about scar removal. Our mission is to provide you, our reader, with unbiased, scientifically accurate information about scars, as well as potential treatments. | | >>More About the Patient's Guide | |
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Surgery
Certain scars can be helped with surgery.
Not all scars are good candidates for such procedures, however. Hypertrophic scars, including keloids,
can be particularly unsuitable because the scar that forms after the surgery may be just as large and
visible as the one that it’s meant to replace.
Your physician will advise you on whether surgery is a good option for you.
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Surgical Scar Revision
With this procedure, the scar is completely removed and the new incision
is then closed with skin flaps from adjacent healthy skin or with skin grafts
taken from other, less visible areas of the body. The goal is for the new scar
that forms to be thinner and shorter than the original one.
With surgical scar revision some scars can be neatly tucked into a
less conspicuous location, such as into a hairline or at the juncture where the nose
and cheek meet. And sometimes contracture scars can be repositioned
to improve flexibility.
When this surgery is used on keloids, it is often followed immediately
(even on the same day) by injections of steroids or interferons, or by low-level
radiation therapy. Because of cancer risks, post-surgical radiation therapy is usually
reserved for cases involving a keloid that has been shown to be resistant to other kinds of therapies.
Z-Plasty
Z-plasty is a type of surgical scar revision. This technique gets its name from the Z-shape of
the new incisions that are made along the scar. The incisions make it possible for the skin adjacent
to the scar tissue to be rearranged in a way that leaves the scar less visible. As a result,
a long scar can be reshaped into shorter, less noticeable scars, and a wide scar can be reshaped
into narrower ones. The incisions also loosen the tension in the scar tissue, thus improving flexibility.
What to Expect After the Surgery
Scar revision surgery can be performed in a surgical facility in your physician’s office or
in a hospital. Although the procedure offers many benefits, it also has some risks,
including serious ones, such as infection and permanent damage to nerves, muscles and
other underlying structures. Expect one to two weeks for the post-surgery swelling and
discoloration to fade. Healing (the development of the new, smaller scar) will take several more weeks,
and final results (the fading of the new scar) may not be apparent for up to a year.
Be sure to have a thorough conversation with your physician about the risks and benefits of scar revision
surgery and whether you’re a good candidate for the procedure.
Punch Incisions for Acne Scars
The deep acne scars known as “ice pick scars” can sometimes be improved with
a small incision that is then sutured closed, leaving behind a tiny thin scar that is level
with the rest of the skin. Over time, the scar usually fades—a process that can be helped along
with a chemical peel, microdermabrasion, or laser resurfacing.
Punch grafts use a larger incision and small skin grafts (often from the back of the earlobe) to replace the scarred skin.
Cryosurgery for Keloids
This treatment uses liquid nitrogen to “freeze” the scar tissue, causing the top layer of cells to die. A blister forms, which must be cared for carefully during the healing process to keep the keloid from building back up. Although the side effects of this treatment are minimal, the treated area of the skin can end up looking darker than it did before. Cryosurgery is usually repeated every 20 to 30 days for several months. It’s frequently used in combination with steroid injections.
Injections
Injections of steroids and interferons are used to treat hypertrophic (raised) scars, including keloids. Injections of dermal fillers, such as collagen or hyaluronic acid, can help improve the appearance of atrophic (indented) scars, including those caused by acne.
Steroids
The use of corticosteroid injections is generally considered the first line of treatment for keloids. They’re frequently used in conjunction with surgical scar revision and cryosurgery. Typically, the steroid is injected once a month. Non-keloid hypertrophic scars generally respond within six months or so, but keloids can take longer to show improvement. Some research suggests that up to 70 percent of people with keloids who receive steroid injections experience some kind of flattening of their scar. Unfortunately, however, the keloids often return once treatment stops.
Interferons
Interferon is a protein produced by the body’s immune system to fight off viruses, bacteria, and other harmful pathogens. Research suggests that injections of these proteins into keloids can help flatten the scar tissue. Interferon injections are sometimes used in combination with surgery.
Dermal Fillers
Dermal fillers are used to lift sunken scars, such as those caused by acne, so that they appear even with the surrounding skin. Different kinds of fillers can be used, including those made with hyaluronic acid (such as Restylane or Perlane), collagen (Cosmoderm), or even fat tissue taken from elsewhere on the body. Dermal fillers are not a permanent solution, however. They break down in the body over time and must be re-injected every few months or so.
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Ask The Doctor
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