Scars / Stretch Marks

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Scar Revision
Scars - whether they're caused by accidents or by surgery - are unpredictable. The way a scar develops depends as much on how your body heals as it does on the original injury. Many variables can affect the severity of scarring, including the size and depth of the wound, the blood supply to the area, the thickness and color of your skin, and the direction of the scar.

While no scar can be removed completely, the doctor can often improve the appearance of a scar, making it less obvious through the injection or application of certain steroid medications or through surgical procedures known as scar revisions. Dr. Harvey and Dr. Hardy might perform V Beam Laser, Fraxel Laser ,Z-plasty, Skin grafting or Flap surgery on: Keloid Scars, Hypertrophic Scars, Contractures and Facial Scars.

Keloid Scars
Keloids are thick, puckered, itchy clusters of scar tissue that grow beyond the edges of the
wound or incision. They are often red or darker in color than the surrounding skin. Keloids occur when the body continues to produce the tough, fibrous protein known as collagen after a wound has healed.

Keloids can appear anywhere on the body, but they're most common over the breastbone, on the earlobes, and on the shoulder. They occur more often in dark-skinned people than in those who are fair. The tendency to develop keloids lessens with age.

Keloids are often treated by injecting a steroid medication directly into the scar tissue to reduce redness, itching and burning. In some cases, this will also shrink the scar. If steroid treatment is inadequate, the scar tissue can be cut out and the wound closed with one or more layers of stitches. You should be back at work in a day or two, and the stitches will be removed in a few days. A skin graft is occasionally used, although the site from which the graft was taken may then develop a keloid.

No matter what approach is taken, keloids have a stubborn tendency to recur, sometimes even larger than before. To discourage this, the doctor may combine the scar removal with steroid injections, direct application of steroids during surgery, or radiation therapy. Or you may be asked to wear a pressure garment over the area for as long as a year. Even so, the keloid may return, requiring repeated procedures every few years.

Hypertrophic Scars
Hypertrophic scars are often confused with keloids, since both tend to be thick, red and raised. Hypertrophic scars, however, remain within the boundaries of the original incision or wound. They often improve on their own - though it may take a year or more - or with the help of steroid applications or injections.

If a conservative approach doesn't appear to be effective after approximately 9 months, hypertrophic scars can often be improved surgically. the doctor will remove excess scar tissue, and may reposition the incision so that it heals in a less visible pattern. You may receive steroid injection during surgery and at intervals for up to two years afterward to prevent the thick scar from reforming.

Contractures
Burns or other injuries resulting in the loss of a large area of skin may form a scar that pulls the edges of the skin together, a process called contraction. The resulting contracture may affect the adjacent muscles and tendons, restricting normal movement.

Correcting a contracture usually involves cutting out the scar and replacing it with a skin graft or a flap. In some cases a procedure known as Z-plasty may be used. And techniques, such as tissue expansion, are playing an increasingly important role.

Facial Scars
There are several ways to make a facial scar less noticeable. Often it is simply cut out and closed with tiny stitches, leaving a thinner, less noticeable scar. If the scar lies across the natural skin creases (or "lines of relaxation"), Dr. Harvey and Dr. Hardy may be able to reposition it to run parallel to these lines, where it will be less conspicuous.

Some facial scars can be softened using a technique called dermabrasion, a controlled scraping of the top layers of the skin using a handheld, high-speed rotary wheel. Dermabrasion leaves a smoother surface to the skin, but it won't completely erase the scar.

Z-plasty
This surgical technique is used to reposition a scar so that it more closely conforms to the natural lines and creases of the skin, where it will be less noticeable. It can also relieve the tension caused by contracture. Not all scars lend themselves to Z-plasty; only the doctorwill be able to judge.

The Procedure For Z-plasty Scar Revision
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 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.

While Z-plasty can make some scars less obvious, it won't make them disappear. A portion of the scar will still remain outside the lines of relaxation.

Skin Grafting and Flap Surgery
Skin grafts and flaps are more extensive than other forms of scar surgery. 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.

The Procedure For Grafting
Grafting involves the transfer of skin from a healthy part of the body (the donor site) to cover the injured area. 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. In addition, all grafts leave some scarring at the donor and the recipient sites.

Flap surgery is a complex procedure in which skin, along with the underlying fat, blood vessels, and sometimes the muscle, is moved from a healthy part of the body to the injured site. In some flaps, the blood supply remains attached at one end to the donor site; in others, the blood vessels in the flap are reattached to vessels at the new site using microvascular surgery. Skin grafting and flap surgery can greatly improve the function of a scarred area.

After the Procedure For Grafting
Keep in mind that no scar can be removed completely; the degree of improvement depends on the size and direction of your scar, the nature and quality of your skin, and how well you care for the wound after the operation. If your scar looks worse at first, don't panic - the final results of your surgery may not be apparent for a year or more.

If you have any questions, or wish to schedule a Scar or Stretch Mark consultation, please call 
Ponte Vedra Dermatology & Aesthetic Surgery at (904) 285-7546 or email consultation@pvderm.com.