You Don't have to be Scarred for Life


by STEVEN H. DAYAN, MD, FACS | March 17, 2002 @ 09:00AM

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For many of us, a scar may be the untoward result of a chicken pox virus, teenage acne, or the sharp end of grandma's coffee table. In some cultures, however, elaborately designed scars are adored and created with purpose and beauty. Unfortunately, for others, a scar can be the distinguishing and undesirable reminder of a traumatic event.

Often a scar is hidden in an unnoticeable part of the body and poses little concern, but for those who are bothered by an overtly located scar, what are the best options for treatment? There are many different methods for treating a scar and the best treatment is individualized. Below I have listed some of the more commonly asked questions by those considering scar revision surgery.

How do I treat a recent injury to prevent scarring?

In the early stages of an injury, maintaining a clean and moist environment around the wound will promote healing and help to prevent scar formation. It is important to avoid an infection and/or a dry crusted scabbed wound. Over-the-counter antibiotic ointments are readily available and frequently recommended by plastic surgeons for maintaining a moist wound bed. Once the open wound heals, application of topical silicone seems to reduce the redness and thickness associated with an angry wound. As the scar matures, patience will be necessary.

Our bodies, with time, are incredibly efficient at reducing the appearance of the scar; and usually, surgical scar revision is delayed until the scar reaches a mature state. The maturation process may take up to a year. Once the scar reaches maturity and is no longer progressing, surgical intervention is often an appropriate option for improving the scar's appearance.

What can I do to treat a permanent mature scar?

Our goal in scar revision is to camouflage a distinguishing mark into one that is no longer noticeable. Techniques in scar revision depend on the location and type of scar. Often we excise the scar and attempt to rearrange it into one that is hidden within natural creases of the skin. You may hear terms like "Z-plasty," "W-Plasty," or "Geometric broken line closure" to describe our techniques. Reducing tension across the area of wound closure is another important execute for preventing a widening scar. It should be recognized that the ideal outcome in scar revision surgery often involves a two-part procedure. Six to 12 weeks after the initial scar revision we may recommend an in-office dermabrasion in order to blend the healing area with the normal surrounding skin.

How long does it take to achieve the result?

This is the hardest part to accept in scar revision surgery. You must understand that it can take many weeks to months for the scar revision site to completely heal and that the final outcome often takes up to a year. Throughout the healing period, many facilitating maneuvers can be performed in order to assure the best outcome. But realize that the scar often will get worse before it gets better.

What if I have a keloid?

Keloids are scars that outgrow their borders. They are common to African Americans and to those of Mediterranean descent. They can be difficult to treat and tend to recur. We have many options for treating them, some with great success; however, if the patient does not follow up or continue with recommended treatments, the keloid can return with a vengeance. Recurrent keloids are usually worse than the original.

Does the laser help?

Recent studies have shown that certain lasers initiate collagen reformation and remodeling, which result in an improvement in the appearance of scars. This research is new but exciting and in my practice I have had an overwhelming amount of success using a KTP and Nd:YAG laser to reduce the appearance of certain scars. With time, we should have more answers to this question.

Does insurance cover scar revision?

The insurance companies routinely consider scar revision surgery cosmetic in nature. Therefore, it usually is not covered by third party payers. Occasionally, a child with a distinguishing scar who is at risk for damaging psychological insults may be awarded a covered benefit. Check with your carrier if you have questions.

Is scar revision for me?

If you want an improvement in the appearance of a defining mark, have patience for a healing period, and realize that you may have to settle for a reduction, not complete removal of the scar, then scar revision surgery may be for you.

One organization in particular helps woman who have suffered scars at the behest of domestic violence. The American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) has teamed with the National Domestic Violence Project to treat woman who have suffered scars secondary to domestic abusefor free . The hope is that by removing these marks the victims can regain some of their lost self-esteem.

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