Surgery on Facial Scars

When the skin is in the process of recovering from an injury, whether the result of an accident, tumor, surgery, a burn, or acne, scarring will occur wherever multiple layers of the skin have been affected. Once a scar forms, it is permanent but may be made less visible or relocated surgically.

With very few exceptions most people are self-conscious about facial scars. Some people may also experience diminished functioning of the eyes, mouth, or nose due to scarring. If you’ve wondered how facial scar revision could improve your appearance, your self-confidence, or your level of facial functioning, you need to know how scar revision works and what you can expect from this procedure. This pamphlet can address many of your and provide you the information to begin considering facial scar revision surgery.

A person considering facial scar revision must understand that there is no way to remove scars completely. The goal is to improve the appearance of the scar either by disguising it, relocating it, or minimizing its prominence. Skin color and type, age, and the type of scarring, are all important factors that must be part of the discussion prior to surgery.

Different types of scars respond to different plastic surgery techniques. Timing of surgery is another important choice. Some surgeons advise against any scar revision in cases of injury for a period that might extend up to a year after the injury. This interval allows the body enough time to heal fully. Steroid injections are sometimes performed for better appearance in the meantime.

Different scars require different treatments. For example, severe burns that destroy large sections of skin cause the skin to heal in a puckered way. As the skin heals, muscles and tendons may be affected in this “contracting” movement. Keloid scars are a result of the skin’s overproduction of collagen after a wound has healed. These scars generally appear as growths in the scar site. Hypertrophic scars, unlike keloids, do not grow out of the boundaries of the scar area, but because of their thick, raised texture, can be unsightly and may also restrict the natural movement of muscles and tendons.

Because scars are highly individualistic and the patient’s attitude toward scars is so personal, maximum improvement in facial scars may require more than one procedure, and more than one technique may be employed.

When a scar is of the contracture type, surgery generally involves removing the scar tissue entirely. Skin flaps, composed of adjacent healthy, unscarred skin, are then lifted and moved to form a new incision line. Where a flap is not possible, a skin graft may be used. A graft involves taking a section of skin tissue from one area and attaching it to another, and time must be allowed following surgery for new blood vessels and soft tissue to form. Z-plasty is a method to move a scar from one area to another, usually into a natural fold or crease in the skin to minimize its visibility. While Z-plasty does not remove all signs of a scar, it does make it less noticeable.

Keloid or hypertropic scars are often treated first with injections of steroids to reduce size. If this is not satisfactory, the scars can be removed surgically, and the incisions closed with fine stitches, often resulting in less prominent scars.

You can expect to feel some discomfort after facial scar revision surgery. Some swelling, bruising and redness are generally unavoidable. It is important for you to follow your surgeon’s after care recommendations to the letter. Though the sutures will be removed within days after the surgery, your skin needs time to heal.

Dr. Hsu generally insists on decreased activity after surgery and instructs the patient to keep the head elevated when lying down, to use cold compresses to reduce swelling, and to avoid any activity that places undue stress on the area of the incision. It is important to remember that scar tissues require a year or more to fully heal and achieve maximum improved appearance.

Insurance does not generally cover surgery that is purely for cosmetic reasons. Surgery to correct or improve scars caused by injury may be reimbursable in whole or in part.