What is scar revision?
Most of the time, scar revision means to remove that scar, literally excise the scar, and then stitch it up nicely.
That's the first thing and probably applies to the majority of the people. When we do that, they are going to form another scar, but it can be much better than the initial scar.
If a scar keeps coming back, what treatment do you offer?
In some patients, when you do this, they still develop another scar that is as prominent and just as noticeable. So, in these patients, just removing that scars again is not going to do it; they may need some other treatment.
Many times I also inject along with scar revision a medication called cortisone. Cortisone tends to flatten out the scar.
What are Keloids?
In some patients who come in initially, a cortisone injection is all they may need instead of scar revision. Cortisone tends to flatten out scars it reduces inflammation is sort of breaks down the collagen in the scar and flattens and smooths it out.
Cortisone can be done, but certain patients have really resistant scars, that are super thick that they have had several scar revisions and it's coming back thicker and thicker.
This type of scar we may call a keloid. Keloid is now a scar that is really thick and exceeds the boundary where the actual scar was.
How does radiation help keloids?
These are actual tumors they grow. These types of scars, if you remove it they are going to come right back. If you are going to take care of this kind of scar, I end up actually removing this scar and do radiation at the same time.
Many people know that radiation is done for cancer, but radiation can be done for this kind of scar because this type of scar is like a tumor.
Patients undergo just the removal of the scar and scar revision, follow it with three treatments of radiation. Radiation will suppress the scar tissue from coming back, and this has been very effective in treating patients with very bad and thick scars.
Does radiation have complications?
Radiation itself has certain complications but these days the radiation oncologists have a great tool they just literally radiate just that area so that they don't expose other parts of the body to radiation.
However, again, this type of procedure with radiation, I try to reserve as a last resort. Generally, with most of the patients, I am able to remove the scar and closing it really nicely with the smallest stitches that don't react with the skin much.
What is scar removal procedure?
Scar removal is a very tricky area for any of us in plastic surgery because it is unpredictable.
Scars themselves depends on many factors and these factors include your ethnic background. Meaning that certain ethnic people tend to get worse scars than others.
Does scarring differ from individual to individual?
Certain ethnic people tend to get the worst scars than others.
For instance, if you have darker skin you can get thicker scars. If you have lighter skin like many of the Caucasians your scar tends to be much better and flat.
Then even within the ethnic population, certain people just develop thick scars and you don't think that they would.
Scars not only depend on the ethnic nature of the patient but also on the location where it is.
What causes bad scarring?
If you close these cuts in the different parts of your body under a lot of tension, you really pull the skin together to close it that scar will be worse.
If you have a contaminated wound that scar will be worse. If it becomes infected like when you have a dog bite or a human bite then that scar can be really bad.
Scar is a huge subject and it depends on who it is and what part of the body and how you got it on.
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