Author(s): Tom Shokri, MD (Penn State Hershey Medical Center): Jessyka G Lighthall, MD (Penn State Hershey Medical Center)
Scarring may result following injury sustained to the skin and soft tissues after surgery or trauma. The amount of overlying skin loss affects not only the appearance of scars but the degree with which surrounding areas are distorted as well. The degree of scar deformity is influenced by extent of soft tissue loss, scar orientation, position with respect to certain facial landmarks, patient age, and genetic factors which may influence the healing process and scar formation. Scar revision involves optimization of the appearance of the scar. Ideally, scars are thin, flat, and match the color of the surrounding skin with orientation along relaxed skin tension lines or wrinkles. Scar revision procedures aim to change the characteristics of scars in such a way that they become more ideal. Of course, there are limitations imposed by the extent of the scar, shape, neighboring landmarks, and variable healing. It is important to note that the goal of this procedure is to alter a poor scar into a better appearing, less noticeable, scar.
Different types of scars include:
-Discolored scars/surface irregularities
-Hypertrophic scars (thick clusters of scarred tissue; often raised with changes to pigmentation)
-Keloids (typically larger than hypertrophic scars, maybe painful or itchy, and extend beyond edges of the original wound)
Contracture: restrict functional movement due to scarring and resultant tethering of underlying tissue.
The type of scar you have, in addition to its extent and distribution, will determine the appropriate techniques your plastic surgeon will use in revising it.
What to Expect at Your Otolaryngologist Office Visit:
Initially, your evaluation will begin with a review of your medical history. Be prepared to answer questions regarding your current and prior medical conditions. Your current medications will be reviewed as well as any surgical procedures you’ve had performed in the past. Tell your provider if you are allergic to any medications.
To best determine your treatment options, the physician will then perform a physical exam. The provider may also take photographs for your medical record. It is important to have a frank discussion regarding your expectations during your initial visit. Explain your main concerns and your goals in terms of your appearance after your procedure. The risks, benefits, and realistic goals will be discussed.
Prior to undergoing any procedures, your doctor will ask you to stop smoking. This is due to the fact that smoking decreases blood flow to areas and increases your risk of vascular disease. This results in considerable impairment to your healing process following surgery. Patients are instructed to avoid the use of anticoagulants (Warfarin, Eliquis) prior to surgery. The physician that manages your anticoagulants will need to determine how long prior to surgery you need to stop taking these medicines. Aspirin and nonsteroidal anti-inflammatory drugs should also be discontinued for at least 2 weeks before surgery.
Smoking must be discontinued for at least 4 weeks before surgery. All herbal preparations, vitamins, and homeopathic treatments should also be avoided for 2 weeks before surgery because of the risk of postoperative bleeding and intraoperative anesthetic complications. Additionally, if you have chronic medical conditions, close communication will be required with your primary care physician, and any specialists involved in your care, to determine suitability for elective surgery and obtain medical clearance.
Herbal supplements to avoid prior to surgery include: Ginkgo Biloba, St. John’s wort, Echinacea, ginseng, valerian, glucosamine, vitamin C (>2000 mg daily) fever few, golden seal, vitamin E (>400 mg daily), Fish oils (omega-3 fatty acids), garlic, licorice, Kava, or Licorice
Scar revision minimizes scars, making them less conspicuous allowing them to blend in with surrounding skin. Your physician will remind you that scars are unavoidable results of injury and their progression may be unpredictable. Although scar revision can decrease scarring in a controlled manner, the scar cannot be completely erased. Your doctor will recommend the best choice for you.
You will be kept comfortable during your procedure through the administration of medications including local or general anesthesia, or intravenous sedation. Your procedure may be performed either in the operating room or in the office depending on the extent of the surgery and your general health.
The specific type of scar revision procedure you undergo will be dependent on the severity of your scarring. The type, location, and size of your scar will be taken into consideration. A combination of techniques may be recommended by your surgeon to achieve optimal results.
Topical treatments including silicone gels, tapes, or external compressive dressings may help wound closure and healing. These products may be used to aid in the healing process following your procedures. Injectable treatments, such as Dermal fillers, may be used to augment depressed or concave scars. These treatments are typically repeated to maintain results. Injection of steroid-based compounds may reduce scar formation and can help alter the texture, size, and appearance of your scar.
Surface treatments such as dermabrasion, laser therapy, chemical peels, or skin bleaching agents may be recommended as well. Advanced techniques in scar revision may be required including excision of your scar with complex closure patterns such as W-plasty or Z-plasty techniques aimed at better hiding the scar with irregular patterns. Local tissue rearrangements may be performed to reposition a scar so that it is less conspicuous.