Scar revision describes several surgical methods to change the appearance of an existing scar. While no scar therapy can remove a scar from the skin, many therapies can improve the appearance of scars.
A simple scar excision is the surgical removal of scar tissue and re-closure of the wound. Physicians sometimes perform scar excision for keloid scars or for hypertrophic scars that do not settle over time. Surgery on keloid scars can be problematic since keloids have a stubborn tendency to recur, sometimes larger than their previous size. Since surgical excision carries the risk of recurrence, surgeons sometimes choose to couple scar excision with steroid injections, radiotherapy or the use of pressure garments.
Hypertrophic scars lend themselves to a procedure that removes excess scar tissue before repositioning the incision scar in a more natural pattern in the skin. Z-plasty is a surgical technique that reshapes a scar, reorienting it into natural skin lines.
During the procedure, a plastic surgeon removes the old scar tissue and makes new incisions on either side of the scar. The new incisions effectively create flaps of skin shaped like triangles. Finally, the surgeon realigns the flaps to cover the wound at specific angles, creating a pattern shaped like the letter Z. The surgeon closes the wound with small stitches that he removes a few days after the procedure. Z-plasty lengthens the scar slightly, but by placing it into natural skin lines, it removes tension from the scar, rendering it less noticeable. Physicians perform Z-plasty under local anesthesia, unless the scar is particularly large, or the patient sensitive, in those cases, general anesthesia may be appropriate. Z-plasty is not applicable to all scars; patients should consult a plastic surgeon to determine whether the procedure is an option for them.
Last updated: 17-Nov-08