Salamanders Young Burn Survivors > Facts and Figures > Surgery for Scars

It is important to keep in mind that no scar can ever be removed completely. Scar revision is usually safe, but there is always a possibility of complications which can include infection, bleeding, a reaction to the anaesthesia, or the recurrence of an unsightly scar. In the case of hypertrophic and keloid scars, surgical removal of a scar may carry a very high risk of recurrent excessive scarring. After any kind of scar revision, it is very important to follow your surgeon's instructions to make sure the wound heals properly.

Scar Revisions

Chemical Peels use chemicals to remove the top layer of the skin in order to smooth depressed (sunken) scars and give the skin a more even colour. The amount of scarring and colour change determines the type of peel chosen. Deeper peels can take up to two weeks to heal. There is a risk of unwanted lightening or darkening of the skin.

Cryosurgery is a technique that uses special equipment to freeze the scar tissue using liquid nitrogen or carbon dioxide. It is only effective in around 30% of cases and it is mainly used to improve scars on the shoulders or back. In some cases there is a risk of unwanted lightening of the skin.

Dermabrasion involves removing the surface of the skin with a special instrument, similar to a drill-bit. It may be helpful where the scar is raised above the level of the skin around it. Afterwards there may be pain, redness and swelling for a period of a few days to a couple of weeks. This treatment sometimes results in the treated area looking either paler or darker than before.

Microdermabrasion is similar to dermabrasion, but gentler and performed without anaesthetics. 10 to 20 sessions (probably a greater number for more serious scars) are needed before you will see much difference.

Micropigmentation (sometimes called "permanent make-up") is a permanent method of implanting pigment (colour) into areas of lightened skin to make it match the surrounding skin, in what is basically a tattooing process.

Pulsed CO2 Laser surgery uses a high-energy beam to vapourise scars. The process requires new skin to grow from the deeper layers. During the first two weeks, quite a lot of redness and weeping of the skin can be expected. The skin may continue to show signs of pinkness or redness for several weeks following treatment. There may also be swelling and bruising, but this should only last for a couple of weeks.

Pulsed Dye Laser treatments can both lighten a scar and reduce the amount of scar tissue. During each session, the entire scar is treated with non-overlapping laser pulses. Immediately after treatment, bruising appears and can last for 1 to 2 weeks. Treatments are repeated at 6 to 8 week intervals. It is typical to see 50% or greater improvement in hypertrophic scars after two treatment sessions. More treatment sessions are often needed to improve keloid scars. The biggest side effect from treatment of these scars is darkening or lightening of the area, which usually improves over time.

Skin Flap Surgery is a procedure in which skin, along with underlying fat, blood vessels, and sometimes muscle, is moved from a healthy part of the body to the injured part. It is usually used when the area needing reconstruction does not have the blood supply needed to support a skin graft. In some flaps, the blood supply remains attached at one end to the donor site; in others, the blood vessels in the flap are re-attached to vessels at the new site.

Skin Grafting is removing skin from a healthy part of the body (the donor site) and using it to cover the injured area (the recipient site). The graft is said to "take" when new blood vessels and scar tissue form in the injured area. While most grafts from a person's own skin are successful, sometimes the graft doesn't take. Also, all grafts leave some scarring at the donor and recipient sites. The treated area may take several weeks or months to heal, and a support garment or bandage may be necessary for up to a year.
Split-thickness skin grafts (STSG) are grafts that include all the outside layer of skin (the epidermis) and part of the layer underneath (the dermis). If there is too little donor skin available, the graft is meshed (which involves cutting tiny holes in the donor skin) so it can be stretched to cover more surface area. The advantage of STSG is that is uses less skin, which damages the donor site less, and it is more likely that the graft will survive. The disadvantage of STSG is that it tends to contract more than full-thickness skin grafts.
Full-thickness skin grafts (FTSG) include both the epidermis and all of the dermis. The advantages of this type of graft are that it is less likely to contract, it looks more normal, and it is more resistant to injury.

Tissue Expansion is a procedure that enables the body to grow extra skin for use in reconstructing almost any part of the body. Your surgeon will make an incision (cut) next to the area of skin to be repaired, create a pocket beneath the skin, and insert a silicone balloon expander in the pocket. The expander includes a tiny tube and a self-sealing valve that allows the surgeon to gradually fill the expander with saline solution. The valve is usually left just beneath the surface of the skin. Once the incision has healed, the expander is injected periodically with more saline. As the expander gets bigger, your skin will stretch. When the skin has stretched enough to cover the affected area, you will have a second operation to remove the expander and reposition the new tissue. Most tissue expansion patients find they experience only mild discomfort, and can keep up with their normal routine while the expander is in place. Complications are rare, but sometimes an infection will develop around the expander. If this happens, the expander may need to be removed until the infection disappears. Occasionally, a leak can occur in the silicone expander, but the saline solution is harmless.

Z-plasty is a surgical technique used to reposition a scar so that it more closely follows the natural lines and creases of the skin, where it will be less noticeable. It can also relieve the tightness caused by contracture. In this procedure, the old scar is removed and new incisions are made on each side, creating small triangular flaps of skin. These flaps are then rearranged and interlocked to cover the wound at a different angle, giving the scar a "Z" pattern. The wound is closed with fine stitches, which are removed a few days later. The new scar should be thinner and less visible.

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