Scar Revision: Techniques and Treatments for Improved Appearance

Scars are a natural part of the healing process, yet they can have a profound impact on an individual's self-esteem and daily life. While some wear their scars as badges of survival, others seek ways to minimize their appearance. Scar revision is a collective term for a range of procedures aimed at improving the condition and appearance of scars, affecting individuals of all ages and genders.

Scars are the body's way of repairing skin after an injury. They are the visible signs of the skin's mending process, but they can sometimes be unsightly or cause discomfort.

Symptoms

Scars can appear as discoloured, raised or indented areas on the skin. They may also be itchy or painful, particularly if they are keloid or hypertrophic scars.

Causes

Scars form as a result of the skin healing after an injury, surgery, burn or acne. The type of scar that develops depends on factors such as the depth and size of the wound, the location on the body, and individual skin characteristics.

Impact and Complications

Severe scarring can lead to restricted movement, especially when located near a joint, or cause significant cosmetic or psychological distress.

At Risk Groups

• Individuals with darker skin tones may be more prone to keloid scars.
• Those with a family history of heavy scarring.
• People undergoing major surgeries or those who have suffered significant injuries.

Importance of Treatment

Seeking treatment for scars can help improve one's quality of life by restoring function, reducing discomfort, and enhancing appearance.

Although it can’t erase the scar completely, treatment can improve the appearance of a scar, reduce pain and improve your range of motion. - Johns Hopkins Medicine

Diagnosis

Scar revision is typically a clinical diagnosis, meaning it is based on the physical examination and patient history. However, some investigations may be performed to assess the scar and plan the treatment:
1. Physical Examination: The doctor will examine the scar to assess its size, location, and severity. This will help determine the best treatment options.
2. Patient History: The doctor will ask about the history of the scar, including how it was acquired, any previous treatments, and any symptoms it may be causing.
3. Photography: Photos may be taken for medical records and to help plan the treatment.
4. Dermatoscopy: In some cases, a dermatoscope may be used to examine the scar more closely.
5. Biopsy: In rare cases, if the scar is suspicious or not healing as expected, a biopsy may be performed to rule out other conditions, such as skin cancer.

Treatment Options

The treatment for scar revision typically depends on the type, size, and location of the scar, as well as the patient's overall health and personal preferences. Here are some common treatments, generally in the order they might be considered:
1. Topical Treatments: These include silicone sheets or gels, corticosteroid creams, or other creams that can help reduce the appearance of scars.
2. Injections: Steroid injections can help flatten and soften raised scars.
3. Laser Therapy: Different types of lasers can be used to reduce scar tissue and improve the appearance of scars.
4. Dermabrasion: This is a procedure that removes the surface of the skin to help reduce the appearance of scars.
5. Surgical Revision: If other treatments are not effective, surgical revision may be considered. This involves removing the scar tissue and re-closing the wound in a way that should result in a less noticeable scar.
6. Skin Grafting or Flap Surgery: In severe cases, skin may be taken from another part of the body and used to cover the scarred area.

Doctors and Specialists Likely to Be Involved in the Patient’s Care

The following specialists may be involved in the management of a patient with a scar requiring revision:
- Dermatologist: A dermatologist is often the first specialist to assess and diagnose the scar. They can also provide initial treatments such as topical treatments, injections and laser therapy.
- Plastic Surgeon: If surgical revision is needed, a plastic surgeon will typically perform the procedure. They have specialised training in scar revision techniques.
- General Surgeon: In some cases, a general surgeon may be involved, especially if the scar is related to a previous surgical procedure.
- Psychologist or Psychiatrist: If the scar is causing psychological distress, a psychologist or psychiatrist may be involved in the patient's care to provide support and help manage any mental health issues.

Related Conditions or Complications

Scars can sometimes lead to complications such as infection, especially if not properly cared for. They can also be associated with emotional distress or lowered self-esteem.

The goal of scar revision is to help your scar more closely match the colour and texture of your skin. But it won’t completely eliminate your scar. - Cleveland Clinic

Outlook and Prognosis

The success of scar revision varies depending on the scar's characteristics and the chosen treatment method. Some scars can be significantly improved, while others may only see modest changes.

Practical Tips & Coping Strategies

• Follow your healthcare provider's instructions for wound care to minimise scarring.
• Protect scars from the sun to prevent darkening.
• Consider silicone sheets or gels to help flatten and soften scars.
• Maintain a healthy diet to support skin healing.