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One of the most frequent and challenging demands placed on a plastic surgeon is for the improvement of a scar. Though a scar can never be completely erased, it can usually be improved. There is a pervasive misconception that plastic surgeons can remove scars, that is, restore the patient to their pre-injured state. That is not possible.

Scar revision techniques may make a scar less visible to the eye. They also frequently give the patient more flexibility and mobility in the damaged area.

There are few things more significant than a trauma that leaves daily reminders in the form of scars. It is understandable that patients and, indeed, physicians, want to intervene quickly after a scarring injury occurs. This is not always the wisest course to take because time is a great healer. Often, one of the most difficult things for surgeon and patient to do is nothing. The appearance of a mature scar is often much better than that of a fresh or immature scar.

Every scar revision must be tailored to the individual. A common desire is to treat the entire scar at one time. For large scars, this may not be the best option. Instead, a series of intermediary revisions tends to give more predictable results. There is nothing more frustrating than a failed scar revision.

The two most common complaints about scars are irregularity of contour – whether the scar is depressed or raised, wide, or thick – and irregularity of color – whether it contrasts significantly with the surrounding skin.

Depressed Scars

Depressed scars are often characterized by widening due to tissue loss. Revision frequently involves advancing healthy skin over the depressed area and securing it with fine sutures.

Raised Scars

With this type of scarring, there is too much tissue. Revision involves resecting the excess scar tissue and advancing healthy skin in its place. Raised scars may also be treated with serial chemical peels or serial dermabrasion.

Thick Scars

Keloid scars comprise the bulk of this category. Keloid scars continue to grow even after a wound is healed. They often extend beyond the borders of the original injury forming hard, raised, bands of tissue. Keloid scars may cause intense itching and even pain.

Initial treatment of any thick scar usually involves injections of medications containing steroids to soften and flatten the scar while stopping production of additional scar tissue. This may be combined, particularly in burn patients, with an external compression dressing or garment that mechanically flattens the scar. If these techniques are unsuccessful, the thick scar may be excised. There is however, a high rate of recurrence when excision is used to treat keloid scars. In some patients, irradiation therapy is administered immediately after the scar excision.

Color/Pigment Irregularities

Bleaching medications and chemical peels are frequently used to lighten dark or discolored scars. Surgical tattooing may be used to darken light scars.

To learn more about scar revision techniques, see the sections on chemical peels and dermabrasion.

See also
> Botox� & Botox� Cosmetic
> Chemical Peel
> Dermabrasion
> Fat Injection
> Injectable Fillers

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