Scar Removal (Excision of Lesion & Scar Revision)

There are various small benign lesions or scars particularly on the face which give unsightly appearance and may warrant removal or revision. The aim of scar revision, is to make the old scar look better or less noticeable. This operation leaves behind another scar at the site of excision or revised scar. The amount of the scar could vary due to various factors like the person’s age, heredity, race, skin characteristics and the type, direction, depth, size and location of the wound.

Skin graft means removing skin from one area and placing it in another area. Only on rare occasions, after removing a large lesion or scar, a skin graft is applied. Skin grafts look like patch even after 1 to 2 years.

Facts about Scar Healing & Scar Maturation
In a sutured wound, during the first two weeks, the basic scar is formed. During the next 8 weeks the scar overgrows (proliferates). At the end of the proliferative stage the scar is red, slightly raised and somewhat lumpy. It takes approximately 6 to 12 months from the time of injury or surgery for a scar to fully mature. A mature scar is pale or white, soft and flat. (Younger the age of the patient, longer the time to mature.) The new scar after a scar revision surgery will look better in most instances but may look almost the same in other instances. Some types of scars have much better chance for improvement by surgery than other types of scars. Some areas of the body form better scars after surgery than others. These facts are taken into consideration when a decision is made for a scar revision surgery.

Hypertrophic scars are the ones which continue to grow and look red, raised and lumpy.

The Operation
This operation is usually done under local anaesthetic as an OPD case. Area of the lesion or the scar is marked out, injected and cut out. This wound is then sutured with fine sutures which are removed on 5-7 days.A small dressing covers the wound postoperatively. Lesions are usually subjected to histopathology.

Some scars (like small pox scar or pimple scars) are improved upon by dermabrasion.  Dermabrasion means sanding of the skin and it is almost like sanding the wood. Patients with darker complexion are not good candidates for Dermabrasion surgery.  Alternatively chemical peel or lasres are also used in some cases to improve appearance of scars cosmetically.

Keloid Scars
A Keloid scar is not a normal scar. It grows continuously, even after the first 8 weeks. It is thick and appears like a tumour. The commonest places for a keloid are the ear lobes and anterior chest wall.

Keloids & Hypertrophic scar requires cream massage, silicone gel sheet and sometimes intralesional steroid injections.

Some keloids are resistant to the above treatments and can reoccur even after the above methods of treatment.