A scar represents the body's attempt to heal itself. There are many factors involved in determining how a wound heals. These include the person's age, how healthy the individual is, whether the wound becomes infected, how quickly the wound is closed, the site of the wound, and whether the person has a tendency to form heavy scars ("keloids").
In many instances, an injury heals with minimal evidence of a scar. Unfortunately, in other cases, the prominence or the site of a scar detracts from a person's appearance.
Though a scar cannot be removed completely, it is possible to make it appear less obvious. Often, this can be accomplished with an injection or application of medications (e.g., steroid creams). Alternatively, scar modification can be achieved by performing minor surgical procedures.
Surgical revision can change the size of a scar, raise depressed areas, or lower elevated scars. While it is not possible to remove all evidence of a scar, revision procedures improve the appearance while leaving another (though less obvious) scar in its place. The redness associated with a scar ("erythema") will usually fade over weeks to months. Because every scar is different and requires a different approach, a consultation with Dr. Wall will determine the best approach to treat your scar. Most methods of scar revision are performed in our clinic using local anesthesia.
Surgical Scar Revision
During surgical revision, the scar tissue is excised. Next, the surrounding skin is carefully brought together, to minimize tension and to maximize contact at the healthy surfaces. In this manner, wider scars are narrowed, and longer scars are shortened.
An alternative method involves creating irregular or zig-zag incision lines (rather than a straight incision). When this incision heals, the new line is harder to recognize. This is because our eyes are not drawn to an irregular line, as they are to a long, straight scar. Dr. Wall employs this method to camouflage scars in less obvious sites, such as the hairline or a natural fold in the skin.
Punch grafting is often the best treatment for deep acne scars ("icepick" scars). This method utilizes a small instrument to remove the scar. Then, the site is filled with a new plug of skin. The new skin is secured into place for about seven days to permit healing. In other cases, the edges of the wound are re-approximated closely with sutures. With either method, the new scar will have a smoother contour and will be less apparent than the depressed scar. Some individuals with significant acne scarring maybe candidates for grafting followed by laser resurfacing to give the entire face a smoother, fresher appearance.
Injectable substances ("temporary fillers") can be used to raise depressed scars. The agents most commonly used in the Unities States are collagen products and hyaluronic acid derivatives (including Restylane, Juvederm and Perlane). See Non-Surgical Procedures for additional discussion of fillers.