Any time skin is cut through its full thickness, a scar will form. Unfortunately, all scars are permanent in the sense that they cannot ever be erased. They can, however, be manipulated to optimize function and appearance.
In general, every scar goes through what is called a maturation process. In adults, a scar takes about one year to fully mature. One can expect a surgical scar to generally look its worse approximately 6 weeks to 3 months following the surgery. This is during the most active healing period when the body is forming collagen to heal the initial wound.
Unless there is a fundamental problem with the scar, such as the need to alter the direction of the scar or to remove unhealthy tissue, it is generally best not to consider revision in less than approximately 1 year, when the scar can be considered mature.
“One cannot emphasize enough the importance in waiting for a scar to fully mature before considering surgical revision,” says Dr. Rapaport. “Patients need to understand that the body is generally remarkable if not miraculous in its ability to heal. But just like we understand that it takes time for our hearts to heal from an emotional wound, so too we must be understanding that physical healing also takes time, and we must be patient.”
During scar maturation, one can encourage and support ideal healing with silicone sheets or gels and strictly protecting the scarred area from the sun with sunscreen.
Unfavorable scars from surgery can be avoided if the scar is made in the most expert fashion and the wound is closed with the lowest amount of tension possible. A prime example of this is an abdominoplasty (tummy tuck) scar. The key to having an optimal tummy tuck scar is placing it in the right location (as low as possible) and closing it in layers such that the skin itself is under the least amount of tension possible. Achieving this goal requires that the entire procedure being performed in a skilled manner. With over 25 years of experience with scar revision, Dr. Rapaport’s surgical expertise will ensure that your scar is closed in the most expert way possible.
In adults, scars generally take one full year to mature. Therefore, scar revision surgery is usually recommended for scars that are one year or more in age. In children, scars frequently take as long as two years to mature. Therefore, it is usually appropriate to wait longer before revising scars on children. One must also consider the child’s stage of growth when properly strategizing the timing of scar revision. One may choose to wait until after a growth spurt before revising a child’s scar, which will clearly be subjected to the tension of that growth spurt.
Scar revision may involve a variety of surgical and non-surgical techniques, including local skin rearrangement, skin grafting, and laser therapies, used to alter the appearance of a scar with the intention of improving the appearance and function of the area involved.
Surgical scar revision generally refers to the excision of an existing scar followed by reconstruction of the wound through reapproximation of the tissue, possibly with flap reconstruction or Z-plasty (a type of skin manipulation performed to alter the direction of a scar).
Scar revision surgery may be employed to improve keloid scars, acne scars, burn scars, hypertrophic scars, depressed or retracted scars, facial scars, as well as scars caused by injury or previous operations.
Lasers may be used to reduce the pink coloring of a scar, or can act like microdermabrasion to essentially sand down the rough edges of an acne scar. A consultation with Dr. Rapaport will be the best way to determine whether a scar may be improved surgically or by other means.
There are several factors to consider when determining if a patient is a candidate for scar revision surgery. To assess whether a scar is appropriate for revision, Dr. Rapaport thoroughly considers the size and depth of the wound, the blood supply to the area, the thickness and color of the skin, the direction of the scar, the tension on the wound, and the way the patient’s body heals (based on the examination of the scars). During the consultation, Dr. Rapaport will discuss all of these factors to determine the best treatment option for each individual patient.
Scar revision surgery can frequently be performed as a minor procedure under local anesthesia. Of course, more extensive scars may sometimes require IV sedation or general anesthesia.
Scar revision surgery is almost always performed at Dr. Rapaport’s fully accredited, on-site surgical suite in his Manhattan office.