Cosmetic Surgery



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Overview


Scar Revision

Scar revision is surgery to improve or reduce the appearance of scars. It also restores function, and corrects skin changes (disfigurement) caused by an injury, wound, or previous surgery.

How Is Scar Revision Performed?

Your doctor will be the best judge of which procedure is best for you. Here are some possible options : -

Collagen Injections Collagen Injections are used to raise, or fill in, sunken scars. Collagen is a natural animal protein, usually produced from purified cow skin. Before using collagen, you should take an allergy test to ensure that you are not allergic to the substance. The results of collagen injections are immediate but not permanent. The scars will eventually have to be re-filled as the body slowly absorbs the collagen.

Dermabrasion Dermabrasion smoothes out surface irregularities such as deep lines or scars by removing the topmost layers of the skin. The afflicted area will be sprayed with a numbing chemical spray and then carefully “sanded” with a rotating wire brush or a diamond wheel until the desired amount of skin is removed.

Vascular Laser Vascular laser works by shrinking the blood vessels that feed the scar. This treatment is done without anesthetic. During the process, the sensation is much like that of a rubber band snapping on the skin.

Laser Skin Resurfacing There are two types of lasers used for reducing the uneven surface of scars: the CO2 Laser and the Erbium:Yag Laser. The CO2 laser is typically used for deeper scars, while the Erbium is used for superficial scars and deeper skin tones. Both lasers remove the topmost layers of skin, allowing new, smooth skin to form. There are some color lasers that can be effectively treat the abnormal red pigmentation of hypertrophic and keloid scars as well.

Punch Grafting Deeper scars can be filled in with skin grafted from other places on the body. A tiny instrument is used to punch a hole in the skin, removing the scar. Then a piece of normal skin, usually taken from the back of the earlobe, is put in the scar’s place. The “plugs” are taped in place until they heal. The grafts do form scars of their own but they are less visible then the pitted scars they replace. This procedure is often done in conjunction with dermabrasion or laser skin resurfacing.

Silicone Gel Sheets Silicone gel sheets can help flatten hypertrophic and keloid scars. These clear sheets are placed on the scar and wrapped firmly with tape.

Skin Grafts In this procedure, doctors take skin from a healthy part of the body and transplant it to the injured area. Grafts aren’t always cosmetically pleasing because the grafted skin may not match the surrounding skin’s color or texture. The area where the graft came from will also scar -- but skin grafts can greatly restore function to a severely scarred area.

Steroid Applications and Injections Steroids can help flatten and reduce the redness of hypertrophic and keloid scars. Steroids are applied or injected into the scar to break down the skin’s collagen. This is especially effective on hypertrophic and keloid scars, both of which continue to form collagen after the wound has healed. These injections can also help reduce the itching and/or pain associated with these scars.

Tissue Expansion In this procedure, a small balloon is inserted under a patch of healthy skin near a scar. The balloon is filled with a saline solution to stretch the skin. When the skin has been adequately stretched, which can take several weeks or months, the balloon is removed. The scar is then surgically removed, and the balloon-stretched skin is pulled over the previously scarred area and carefully closed.

Z-Plasty and Related Tissue-Rearrangement Techniques Z-Plasty is a technique used on hypertrophic and keloid scars that do not respond to steroid treatments. The scar is surgically removed by cutting the skin around the scar in small triangular flaps. These flaps usually follow a Z-shape (hence the name), but the technique your doctor chooses will depend on the shape of the scar. The flaps are repositioned to follow natural lines and creases of the skin. The new scar is thinner and less noticeable. Z-plasty can also help relieve the pressure of contracture scars.

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Why The Procedure Is Performed ?

Problems that may indicate a need for scar revision include: -
  • A keloid, which is an abnormal scar that is thicker and of a different color and texture than the rest of the skin. Keloids extend beyond the edge of the wound and are likely to come back. They often create a thick, puckered effect that looks like a tumor. Keloids are removed at the place where they meet normal tissue.
  • A scar that is at an angle to the normal tension lines of the skin.
  • A scar that is thickened.
  • A scar that causes distortion of other features or causes problems with normal movement or function.


Risks

Risks for any anesthesia are: -
  • Reactions to medications
  • Breathing problems
Risks for any surgery are: -
  • Bleeding
  • Infection
  • Blood clots
  • Scar recurrence
  • Keloid formation (or recurrence)
  • Separation (dehiscence) of the wound


Exposing the scar to too much sun may cause it to darken, which could interfere with future revision.

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After The Procedure

For keloid revision, a pressure or elastic dressing may be placed over the area after the operation to prevent the keloid from coming back.

For other types of scar revision, a light dressing is applied. Stitches are usually removed in 3 to 4 days for the facial area, and in 5 to 7 days for incisions on other parts of the body.

When you return to normal activities and work depends on the type, degree, and location of the surgery. Most people can resume normal activities soon after surgery. Doctors usually recommend that you avoid activities that stretch and may widen the new scar.

If you have long-term stiffening of the joint, you may need physical therapy in addition to surgery to restore full function.

Avoid exposure to the sun for several months after treatment. Use sunblock or a dressing (such as a Band-Aid) to keep the sun from permanently tanning the healing scar.


Scar Repair - Before The Procedure

Regardless of the skin procedure that you choose, perform some research to see if the method is right for you. Each kind of scar repair does have its repertoire of side effects that should be fully understood before deciding for sure that the procedure is the thing for you. You must consult a professional to help you choose the right option.

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How Long Do The Treatments Take?

Collagen injectons are quick but may have to be repeated in several years because the body absorbs the collagen.

Dermabrasion can take anywhere from a few minutes to an hour depending on how large the area being treated is and how deep the scars are.

Vascular Laser involves a series of three to five treatments, three to five weeks apart.

Laser skin resurfacing can take several minutes to two hours, depending on the size of the afflicted area.

Skin grafts are more complex procedures that can take several hours.

Silicone gel is normally applied for 12 to 24 hours a day, for several months.

Steroid applications and injections are quick but may have to be repeated if keloid scars re-form.

Tissue Expansion can take weeks to months of saline injections for the healthy skin to stretch enough. The surgery itself is usually completed in less than an hour.

Z-Plasty and related techniques usually take less than a half hour for small scars and under one hour for most other scars.


Scar Repair - After The Procedure

If you are using creams, then the skin tissues change gradually and normally, you shouldn’t have any side effects or post usage issue to worry about. Plastic surgery patients on the other hand have to worry about post surgery sessions to ensure that they are recovering well and need to consult with their surgeon for good skin habits to retain their new appearance.





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