Facial Scar Revision

The source of scars can range from a traumatic injury, a burn, infection or surgery. Some facial scars are unattractive simply due to location, while others may affect facial expressions. Once a scar has formed, it is permanent, but surgically it is possible to alter scar lines and adjust the surrounding tissues to make the scar less visible.

Many scars that appear large and unattractive at first, may become less obvious with time. It is generally recommended to wait as long as a year after the scar is formed before undergoing scar revision. Surgical scar revision includes excision and approximation, reconstruction with flaps, skin/tissue transplants or Z-plasty.

Different scars require different treatments

1. Post-traumatic scars: the typical facial scar originating from accident, disease or surgery usually only requires a simple surgical revision, re-positioning of tissues (to match natural facial lines and contours) and careful approximation. For superficial post-traumatic scars, acne scars and stretch marks, microneedling therapy (Dermapen), laser treatment, TCA skin peel, dermabrasion or fat grafting, may provide satisfactory softening and improvement.

2. Burn scars: burns often destroy larger sections of skin and cause it to heal in a puckered manner (contracture). Surgery involves excising the scar tissue entirely (if possible). Skin flaps, composed of adjacent healthy unscarred skin, are lifted and moved to form a new incision line. Where flaps are not possible, expanders or skin grafts may be used.

3. Keloid scars: keloids are a result of the skin's overproduction of collagen after a wound has healed. These scars overgrows the original wound, and look like exaggerated scars, raised above the skin. Surgery involves the removal of the hard fibrous collagen within the scar, and then closing of the skin. Following the procedure, the scar needs monitoring for signs of keloid recurrence, as preventative measures can be implemented (pressure treatments, silicone gel pads, and steroid injections).

4. Hypertrophic scars: raised hypertrophic scars do not extend beyond the boundaries of the original wound as seen in keloid scars, but because of their thick texture, can be unsightly and restrict movement of underlying muscles. The excess scar tissue is removed, re-positioned, and made to heal in a less-visible fashion.

5. Atrophic scars: sunken fibrotic scars represent the opposite of a hypertrophic scar. These scars can range from slightly depressed to completely indented, with reduced soft-tissue substance and occasional adhesion to deeper tissues. This type of scar generally responds well to surgical release combined with fat transfer.

Suitable candidates for scar revision

Scar revision can benefit any person with functional and aesthetic concerns related to facial scarring - independent of age or skin type. Procedures are performed in local anesthesia or with intravenous sedation (TIVA). Due to the extensive number of scar types, the choice of revision is best reached in consultation. The most satisfactory results are usually achieved by combining treatments.