A scar is the natural result of an injury that the body uses to heal itself. In plastic surgery we are most often involved with scars of the skin. Scars can be a problem based on the changes they can cause in appearance or function. Unfortunately plastic surgery techniques cannot remove a scar and return things to the normal, preinjury state. We do try to minimize scars, modify them, conceal them, and otherwise work with them to make the appearance more acceptable.
Surgical and Non-Surgical techniques
The first technique is non-surgical and includes make-up techniques, topical or injected medications, or silastic sheeting with or without compression garments. Chemical peel treatments of the skin may have a role to play in a very few cases.
Dermabrasion is a surgical tool that can improve some scars. It is most commonly restricted to use on facial scars. A rough, textured scar can be smoothed with dermabrasion. Scars are not erased with this technique, and your expectations must be realistic. Due to the basic nature of healing of the skin, we are limited as to how much we can do. Going too deep will result in additional scarring and poor results. When using this technique, in particular, it is often better to perform multiple conservative procedures than a single, overly-aggressive procedure.
The most common approach to scar revision is to surgically cut around the old scar, remove the central portion, lift the surrounding normal skin, and carefully close the incision. A scar will remain, but it is expected that it will be an improvement over the old one in appearance or function. Unfortunately, not all scars can be improved. Your physician will evaluate whether or not a procedure will be beneficial in your initial consultation.
Risks and Complications
As indicated, there can be no guarantee of the final result. Much of what goes into the healing of a scar is not controllable by surgeon or patient. We also know that it takes at least twelve months or longer for the natural healing process to be completed, whether from the initial injury or from revisional surgery. The risks of anesthesia must also be considered. Any surgery has risks of bleeding, infection, and damage to other tissues. Bandages must often be worn, and stitches are in place for several days. Activities must be restricted until the area is healed.
Insurance payment for this kind of surgery is sometimes controversial. Reconstructive surgery is usually covered by insurance whereas cosmetic surgery is not covered. Prior authorization, including photographs, is commonly required, and this process can take three or four weeks on average. Homeowner insurance, auto insurance policies, workers' compensation plans, and other diverse, third party payers are commonly involved with these cases, as each case must be examined individually.