The old unsightly scar has to be removed first. Any planned surgical incision heals in exactly the same manner as any other deliberate or accidental cut, i.e. it produces scar tissue which is nature’s method of healing. Once an incision is made and sutured the surgeon has little control over the healing process, a fact which must be appreciated by the patient.
It is often not realized that a period of 6 to 18 months must elapse before the scar is mature, the stage where no further change or improvement will occur.
Initially, any scar will be red and raised above the level of the surrounding skin and may often be hard in consistency. Gradually the redness and hardness lessen and resolve leaving a soft scar which is level with and somewhat paler than the adjacent skin.
For these reasons scar revision must not be undertaken too soon because adequate time must elapse to allow the original healing tissues to mature.
When revising a scar on the face the surgeon attempts to get the best possible result by placing the new scars parallel to or actually in one of the normal crease lines of the face. This usually means that the direction and shape of the original scar has to be changed.
Although scar revision often requires surgical treatment, non-surgical treatment should be considered appropriately and sometimes considered first.
Excision of large scars or blemishes may require several operations over a period of time. It must also be mentioned that some areas of the body always produce noticeable scars, e.g. nose, chin, chest, shoulders, upper back and parts of the arms and legs.
It is most unlikely that any scars can be removed completely, but the aim of the procedure is to make them less noticeable and perhaps easier to disguise with make-up. The goal in scar revision is improvement and not perfection. Patients who are unable to accept this should not have treatment.
