When the skin is in the process of recovering from
an injury, whether the result of an accident, surgery, a burn, or
acne, scarring will occur wherever multiple layers of the skin have
been affected. Once a scar forms, it is permanent but may be made
less visible or relocated surgically.
With very few
exceptions most people are self-conscious about facial scars. Some
people may also experience diminished functioning of the eyes, mouth,
or nose due to scarring. If you've wondered how facial scar revision
could improve your appearance, your self-confidence, or your level
of facial functioning, you need to know how scar revision works
and what you can expect from this procedure. This section can address
many of your concerns and provide you with the information to begin
considering facial scar revision surgery.
Successful facial
plastic surgery is a result of good rapport between patient and
surgeon. Trust, based on realistic expectations and exacting medical
expertise, develops in the consulting stages before surgery is performed.
Dr. Maloney can answer specific questions about your specific needs.
Is
Facial Scar Treatment For You? The most basic requirement for all surgery is good
health. Other requirements are more subtle and should be carefully
considered in discussion with Dr. Maloney. Expectations of the surgery
must be realistic. A person considering facial scar revision must
understand that there is no way to remove scars completely. The
goal is to improve the appearance of the scar either by disguising
it, relocating it, or minimizing its prominence. Skin color and
type, age, and the type of scarring, are all important factors that
must be part of the discussion prior to surgery.
Different types
of scars respond to different plastic surgery techniques. Timing
of surgery is another important choice. Dr. Maloney usually advises
against any scar revision for a period that might extend up to a
year after the injury. This interval allows the body enough time
to heal fully.
Making
the Decision For Scar Treatment
Whether the surgery is desired for functional or cosmetic reasons,
your choice of a facial plastic surgeon is of paramount importance.
Dr. Maloney will examine the scar in order to decide upon the proper
treatment and inform you of outcomes that can be expected from facial
scar revision surgery.
Different scars
require different treatments. For example, severe burns that destroy
large sections of skin cause the skin to heal in a puckered way.
As the skin heals, muscles and tendons may be affected in this "contracting"
movement. Keloid scars are a result of the skin's overproduction
of collagen after a wound has healed. These scars generally appear
as growths in the scar site. Hypertrophic scars, unlike keloids,
do not grow out of the boundaries of the scar area, but because
of their thick, raised texture, can be unsightly and may also restrict
the natural movement of muscles and tendons.
Some facial scars are unattractive simply because of where they appear on the face,
while others affect facial expressions. All surgical possibilities
will be discussed in the initial consultation along with risks involved
for each type of scarring. The agreement between you and Dr. Maloney
on how to proceed is a prerequisite for successful surgery. After
you both decide to proceed with scar revision, Dr. Maloney will
inform you about the anesthesia, the surgical facility, any supportive
surgery options, and costs.
Because scars
are highly individualistic and the patient's attitude toward scars
is so personal, maximum improvement in facial scars may require
more than one procedure, and more than one technique may be employed.
Understanding
the Surgery When a scar is of the contracture type, surgery generally
involves removing the scar tissue entirely. Skin flaps, composed
of adjacent healthy, unscarred skin, are then lifted and moved to
form a new incision line. Where a flap is not possible, a skin graft
may be used. A graft involves taking a section of skin tissue from
one area and attaching it to another, and time must be allowed following
surgery for new blood vessels and soft tissue to form. Z-plasty
is a method to move a scar from one area to another, usually into
a natural fold or crease in the skin to minimize its visibility.
While Z-plasty does not remove all signs of a scar, it does make
it less noticeable.
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.
Keloid or hypertropic
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.
What
to Expect After the Surgery
You can expect to feel some mild discomfort after facial scar revision
surgery. Some swelling, bruising and redness are generally unavoidable.
It is important for you to follow Dr. Maloney's after care recommendations
to the letter. Though the sutures will be removed within days after
the surgery, your skin needs time to heal. Dr. Maloney generally
insists on decreased activity after surgery and instruct the patient
to keep the head elevated when lying down, to use cold compresses
to reduce swelling, and to avoid any activity that places undue
stress on the area of the incision. Depending on the surgery performed
and the site of the scar, Dr. Maloney will explain the types of
activities to avoid. No medication should be taken without first
consulting Dr. Maloney. It is important to remember that scar tissues
require a year or more to fully heal and achieve maximum improved
appearance.
Facial plastic
surgery makes it possible to correct facial flaws that can undermine
self-confidence. Changing how your scar looks can help change how
you feel about yourself.
Insurance does
not generally cover surgery that is purely for cosmetic reasons.
Surgery to correct or improve scars caused by injury may be reimbursable
in whole or in part. It is the patient's responsibility to check
with the insurance carrier for information on the degree of coverage.
The most basic requirement for all surgery is good
health. Other requirements are more subtle and should be carefully
considered in discussion with Dr. Maloney. Expectations of the surgery
must be realistic. A person considering facial scar revision must
understand that there is no way to remove scars completely. The
goal is to improve the appearance of the scar either by disguising
it, relocating it, or minimizing its prominence. Skin color and
type, age, and the type of scarring, are all important factors that
must be part of the discussion prior to surgery.
When a scar is of the contracture type, surgery generally
involves removing the scar tissue entirely. Skin flaps, composed
of adjacent healthy, unscarred skin, are then lifted and moved to
form a new incision line. Where a flap is not possible, a skin graft
may be used. A graft involves taking a section of skin tissue from
one area and attaching it to another, and time must be allowed following
surgery for new blood vessels and soft tissue to form. Z-plasty
is a method to move a scar from one area to another, usually into
a natural fold or crease in the skin to minimize its visibility.
While Z-plasty does not remove all signs of a scar, it does make
it less noticeable.