Scar Revision
Scars can occur as a result of previous surgery, trauma or infections such as acne. Unsightly, noticeable scars are often thick, raised, irregular and pink. Even raised pale scars can be unsightly.
Problematic scars may make a patient feel unattractive or self-conscious. The scar may be itchy or tender to touch. At times the scar may impair movement of either the skin or underlying muscles or joints.
At your first consultation with Dr Flood a detailed history and examination is performed to assess your scarring. It will be important to assess what the original injury was to cause the scar. Racial, hereditary and skin pigmentation characteristics are important to note. Your age and general health are also important considerations.
Scars generally fall into categories of either hypertrophic scarring which are immature scars that take a long time to mature. Although over time they do improve, most patients are usually left with a widened scar or at times a 'tight feeling' scar.
Keloid scars are similar to hypertrophic scars except they do not mature over time. They tend to be red, raised and grow outside the confines of the original wound. Many patients find that they are itchy during hot, humid weather and are tender on touch.
Scar contractures often involve large areas of skin which tend to impede the underlying movement of muscles or joints. Common areas include the neck, hands and the armpits.
Facial Scars
Facial scars can be the most challenging. At times the scars may be hypertrophic or truly keloid in nature making them unsightly and very noticeable. At times the scars may be pale and flat however when a patient smiles the scar may cause a puckering or distortion to the cheeks or lips. At times the scar may be running along the wrong axis of the face making it more noticeable. The classic 'swash-buckler's scar' is often corrected by realigning the scar so that it sits in a more favourable position along the relaxed skin tension lines of the face.
Treatment for scars involves both medical and surgical. Scar taping and silicone ointments are often effective for treating early post-surgical scars, however are not as successful in fully established scarring. Having said this, first up often thickened scars are best treated with massage with Mederma cream and silicone gel oil or taping.
Steroid injections can be very effective to flatten a thickened scar and to reduce the redness. Indeed at times itchiness and tenderness can be resolved by steroid injections into a scar. The injections are performed under local anaesthetic and are usually spaced six to eight weeks apart. Most patients require two to three injections to obtain maximal scar benefit.
Soft Tissue Fillers
There are a number of soft-tissue fillers on the market which can be used to try and even out the hollows left as a result of a depressed scar. Acne scarring is a classic example.
Laser Therapy
Various lasers are available depending on the aspect of the scar that requires improvement. If a scar is persistently red then vascular laser therapy is very effective in reducing the appearance of the redness to make the scar paler. Fraxel laser has been shown to be effective in improving the appearance of acne scarring with the aim of inducing more collagen formation in the deeper part of the skin to fill out areas of unevenness.
Surgery
Plastic surgery involves removing the scar and closing the wounds under the least amount of tension. Deep dissolvable sutures that do not require removal are often used to help reduce wound tension on closure. New scar tissue formation can be modulated by the aid of Z plasties and W plasties. At times grafting or local flaps are required if large areas of scar tissue are required to be removed and closure of the wound primarily is unable to be performed.
Post-operatively scar tissue maturation is monitored closely by Dr Flood. Scar taping and the use of silicone gel oils are very important for final scar maturation. Indeed at times judicious use of steroid injections during this scar healing and laser therapy may be required to try and achieve the best scar outcome.
As a plastic surgeon, Dr Flood has the training and experience to perform all the surgical techniques available to improve scar appearance. Dr Flood also works closely with Dr Jim Walter, a dermatologist who has significant expertise in laser therapy. Dr Flood feels it is very important to work as a team to provide his patients with the best possible care and increase the likelihood of a pleasing outcome.
