Scar Revision


Scar Revision

Introduction


The human body can form scars for any number of reasons, including trauma, previous surgeries, or even child birthing with Cesarean section. Many scars can have functional, emotional and cosmetic consequences. Some scars can be hypertrophic (overactive) or keloid (irregular scar production) in nature that require advanced treatment protocols to correct. If incisions are not closed properly, they can lead to excessive collagen production to close the wound.



Scar Revision

Candidates


Prime candidates for scar revision are individuals with scars that are cosmetically, functionally, or emotionally troubling. Examples of problematic scarring include previous cosmetic surgery that did not heal well, medically related surgeries such as Caesarean section or appendectomy, and/or scars from accidents or physical trauma.



Scar Revision

Results and Recovery

My typical approach for scar revision starts with appropriate scar diagnosis. Keloid scars require a specialized approach that uses multimodality therapy including radiation. Non-keloid scars are typically excised completely to start the healing process over in an optimal environment. The closure must be precise and close not only the skin but the underlying fascia layers to prevent excess deposition of scar tissue. The deep layers of sutures must take the tension off the skin so that the dermis (the inner layer of skin) can heal tension-free.

Dr. Barrett does not use absorbable sutures in the dermal layers because they routinely cause inflammation when the body has to attack the sutures to absorb them. Instead, Dr. Barrett uses non-reactive sutures that are taken out at week one and two post-surgery. This is followed by a taping protocol once a week performed in the office for 4 weeks. After taping is completed, patients are started on a 3-month massage and scar gel regimen. Dr. Barrett will schedule post-surgery consultations to closely monitor scar healing and if apply additional treatment if necessary. As an example, scars that produce too much collagen will be injected with kenalog or 5-Flurouracil to avoid the development of particularly thick scar tissue.


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