Scar Revision Overview
A scar is a constant reminder of a wound that once existed. It can be located anywhere on the body, come in a variety of shapes and sizes and may be raised or recessed. Some scars can be very unsightly or disfiguring and cause insecurity for an individual. Scar revision treatment at Scottsdale Plastic Surgeons is a cosmetic surgery by our board-certified surgeons, Dr. Holden and Dr. Tsujimura, that helps minimize the appearance of a scar and improve its condition. Although a scar revision can provide a more pleasing appearance or improve skin tissue that has healed poorly, it cannot be completely erased.
"Rhinoplasty - Scottsdale, AZ - I couldn't be happier with my new nose.I hated my nose for as long as I can remember, when I looked in the mirror or at pictures of myself that's all I saw. The first time I met with Dr.Holden he pin pointed my exact issues with my nose with out my having to tell him. He was very kind and patient and answered all of my questions. While talking to him it was obvious he knew what he was talking about and was an expert in his field. I felt so comfortable and confident with him that I canceled my other consultes (with another surgon I used in the past) and scheduled by surgery for the next week. Dr.Holden also saw me at every one of my follow up appointments, not some nurse, which was very important to me and helped with my post surgery anxiety. With being 34 years old and a mother of 3 it was very important to me for my new nose to look natural. It does. I am thrilled when I look in the mirror and the people close to me have all remarked how wonderful it looks. While people that I haven't shared my surgery haven't noticed or at least not enough to say "oh my gosh you got a nose job!" I still look like me. :)"- S. / RealSelf / Jul 30, 2015
"I Couldn't Be Happier! - Dr. Holden is a very talented physician. Not only is he exceptional at facial plastic surgery, he is kind, compassionate and caring. I am extremely pleased with my eye lift and face lift, I couldn't be happier. He makes you feel comfortable every step of the way explaining the surgery and recovery in detail. He has the best bed-side manner of any physician I've encountered!"- S. / RealSelf / Nov 28, 2018
"Dr. Holden for Rhinoplasty! - I had a rhinoplasty procedure yesterday, after years of wanting to have one, but not actively pursuing to do so. I wanted a small refinement to my profile. I chose Dr. Holden because of his warm and caring nature, and his close attention to detail. In the initial consultation and meeting with Dr. Holden, I knew I had chosen the right doc for the job. Not only is he a fantastic plastic surgeon..."- A. / RealSelf / Oct 18, 2018
"Dr. Paul Holden is a Very Gifted Plastic Surgeon. - Dr. Paul Holden is a fantastic plastic surgeon. I would highly recommend that anyone needing facial plastic surgery use him. My results were outstanding. Arizona is very fortunate to have him as a resource in our area."- D. / RealSelf / Sep 19, 2018
"Walking through the fear! - I initially went to talk to Dr. Holden in May of 2016 about straightening my septum and removing a bump on my nose from when it was broken when I was young. I got nervous and opted not to do it. A friend of mine went to see him for a similar surgery and went through with it. After seeing the results and the success that my friend had I opted to go through with it in March of 2017. Tonight I..."- B. / RealSelf / Sep 16, 2018
Types of Scars
There are various methods available to treat unsightly scars, but it helps to first understand the different kinds of scars.
- Superficial scars are the most subtle type of scars. They do not cause any issue other than an unsightly appearance.
- Keloid scars are larger, painful scars, which are often discolored and tend to extend beyond the edges of a wound.
- A hypertropic scar does not extend beyond the wound, but it continues to become larger, thicker, and more painful over time.
- A contracture scar develops over a larger section of skin creating a tight feel and impairing one’s ability to move. A severe burn is an example of this.
Scar Revision Surgical Technique
Scar revision treatment will be chosen based on the scar’s location, type, size and overall extent. There are various techniques to consider.
For scars that are raised, a shave excision may be performed to remove the top of the scar and even-out the surface with the rest of the skin. This creates a smoother, flatter appearance. During the procedure, a surgical shaver is used to slowly shave off the raised portion of the scar. Sutures are not needed in most shave excision cases.
This is also a technique used for raised scars. It can be accomplished a couple of different ways. First, is the elliptical removal pattern. This involves removing the scar as well as an edging (ellipse) of skin encompassing the scar so a clean enclosure can be made. The sutures may be placed on the inside or outside of the skin. Sometimes a scar exists because the incision was closed poorly. By reopening the scar and resuturing the skin in a different direction, the new scar can be minimized.
Skin Grafting/Tissue Expansion
Large scars may require a skin graft (skin taken from another area on the body) to close the wound once the scar has been removed. Carefully placed sutures will be used around the graft to close and blend the skin together for healing. If a skin graft will not be used, tissue expansion may be used instead. During this process, a tissue expander will be placed under the skin where the scar resides and filled with a sterile solution. Once the expansion process is complete, the surgeon will stretch and join the edges together and place sutures carefully into the tissue wall.
Scars that are depressed or concave may benefit from a filler material known as injectable derma filler. There are a wide variety of fillers on the cosmetic surgery market that may be considered. Collagen is a common filler used for scar revision. During the procedure, the injectable material will be injected into the skin through a syringe. The surgeon may manipulate the outside of the skin to help shape the surface accordingly.
Some scars can be treated with a series of skin rejuvenation treatments, which can soften the surface of the skin, smooth out uneven scarring, reduce uneven pigmentation and lighten the skin where needed. Some scars may even become non-existent because of the skin removal mechanism. Skin surface treatments include laser skin resurfacing, chemical peels, dermabrasion and skin bleaching.
Scar Revision During/After Surgery
All scar revision procedures are performed in our surgical facility. Some procedures will require sedation, but most will only need local anesthesia. Following this procedure, patients will need to adhere to a daily scar treatment regime so the wound site and new scar can heal. It is important to protect this area of skin from sun exposure to avoid any further skin discoloration. While this treatment does not fully eliminate a scar, the visible imperfections are certainly minimized. Most patients feel more confident exposing the section of skin where the unsightly scar once resided.
Scar Revision Expected Cost
The cost for scar revision treatment varies depending on what type of procedure was performed. Unfortunately, this can range from several hundred dollars for a skin resurfacing treatment, to several thousand for a surgical procedure.