Scar revision surgery and secondary deformity correction

What is scar revision surgery?

Because I spend so much time focusing on achieving optimal aesthetic outcomes from my skin cancer surgery, and because of my training in cosmetic surgery, it is no surprise that I have also been called upon to provide my services in scar revision surgery. You may have an unsightly scar from either trauma or previous surgery that you are unhappy with. This could be for various reasons including (but not limited to): keloid or hypertrophic scarring (red, raised or lumpy scars), scars being oriented in an unfavourable fashion, contour or colour mismatch or crossing anatomical subunits of the head and neck, “drawing the eye” to the scars.

Different types of scars

Keloid Scars

Keloid scars are raised and lumpy scars that escape from the original confines of the wound to create an overexuberant healing response and excessive production of collagen. They almost invariably occur after either injury or surgery and are often a different colour to the surrounding skin, appearing as raised and unsightly scars. These scars can arise months to years after the initial surgical insult or injury, are persistent and difficult to treat.

Hypertrophic Scars

These scars are thickened but often related to excessive tension on the wound and the scar is confined to the limits of the original wound. The colour mismatch is often less than the surrounding tissue, they are more responsive to treatment and generally more likely to fade over time. They are less raised than keloid scars and tend to occur within weeks of the original wound.

Elledge Surgical’s scar revision technique

I will use all my expertise to give you a better scar. This can include re-orienting scars with z-plasties or similar, re-excising and refashioning scars and using adjuncts such as laser, topical medications and/or dressings, intralesional steroid injections, dermabrasion, fat grafting, dermal fillers and more. It is important to note that I will not automatically jump to offer a surgical solution and will work with a multidisciplinary team of colleagues in dermatology to think about non-surgical solutions whenever appropriate.

My expertise in scar revision surgery

I completed Training Interface Group (TIG) Fellowships in the Management of Skin Cancer (Leeds, 2018) and Reconstructive & Aesthetic Surgery (Nottingham, 2018). The latter Fellowship gave me transferable techniques from cosmetic surgery and appreciation for a multidisciplinary and tailored approach to scar revision techniques, rather than pursuing a “one size fits all” ethos.

My work across the NHS spans skin cancer management and facial trauma, enabling me to draw on experience from having personally carried out thousands of cases of reconstructive surgery and soft tissue injury repairs in my career to make the best decision in each case, achieving the very best cosmetic outcome. Finally, working in conjunction with Dr Sajjad Rajpar at Midland Skin, enables my patients to access adjunctive treatments such as LASER to further augment post-operative results.

Scar Revision FAQs

Can scars be completely removed?

No, there is no such thing as complete scar resolution, but we can make things significantly better. By using one or more treatments we can improve the orientation, dimensions, appearance and character of scars. Generally, the eye is drawn to changes in contour, colour and dynamics of scars as movement occurs, as well as distraction of adjacent structures e.g. eyelids. By surgically and/or non-surgically refining scars, their visibility can be minimised to mean that whilst they are not “invisible”, they are much less noticeable.

What is a scar?

A scar is the result of healing of the skin from any wound, whether surgical or traumatic. In essence, when a wound occurs, there are various stages of healing that result in fibrous tissue being formed to replace the skin with a “basket weave” orientation of collagen. There are many different types of scars (e.g. keloid, hypertrophic, atrophic). The important thing in surgery is optimising healing by careful technique, patient selection, choice of suture material, systemic conditions to support healing, adjunctive measures, dressings and post-operative care.

How long does it take for a scar to fully mature?

Scars can take up to two years to fully mature. Patients often want immediate results, but patience is key in achieving the best results. Every surgical procedure results in scarring and sometimes the best healer is time, but this is a careful and mutually agreed decision. The power of spontaneous resolution, supported by optimum skin care and dressing selection, cannot be underestimated.

How is the procedure performed?

Most scar revision surgery can happen under local anaesthesia (awake) with minimal downtime and a procedure lasting no longer than 45-60 minutes. It involves excising the scar following anaesthesia of the skin, potentially with a geometric design to “soften” the scar, and the careful reapproximation of the skin edges with suitable suture material.

What are the risks of surgery?

Most scar revision surgery is straightforward, predictable and uneventful. All surgery carries risks however. With scar revision, these can include pain, swelling, bleeding, infection, wound breakdown, temporary or permanent sensory alteration (including numbness and/or neuropathic pain), temporary or permanent paralysis or weakness, and dissatisfaction. Optimum management of the operative technique, perioperative care and expectations translates into the best results however, an ethos that I am committed to achieving.

Are there any alternatives to surgery?

Yes, some scars may be suitable for a range of non-surgical treatment including (but not limited to) intralesional steroid injection, silicone dressings, cryotherapy, LASER therapy and skin camouflage.

Are there any additional things that can be done to improve the outcome following surgery?

Yes, all the non-surgical alternatives may be employed as adjunctive treatments to surgery where appropriate, to augment the potential for a favourable outcome. These will be discussed and planned for at the outset of treatment, as part of a comprehensive package of care.

Is the surgery painful?

Besides the initial injections of local anaesthesia, the surgery should be completely painless. Depending on the site of surgery, we can have some music on and a two-way conversation throughout the procedure discussing everything and anything under the sun to put you at ease and make the time pass.

How long does surgery take?

Naturally, there is an inherent variability with the duration of surgery depending upon the size of the scar to be revised. As a rule of thumb, appointments for surgical scar revision tend to be 45-60 minutes in length, although this includes all the paperwork and administration of the local anaesthesia.

Will I need to have my sutures removed and if so, when?

This will depend on the nature of the scar to be revised. If the scar is a simple linear excision and direct closure then I will usually use a technique called subcuticular suturing, placing a resorbable suture in a “zip” style under the surface of the skin to render it completely invisible. These sutures will not require removal. Where scars are irregular and/or cross anatomical boundaries or turn corners, I will usually use very fine non-resorbable sutures that require removal at 7-10 days. These can be taken out at the facility where your surgery was performed or alternatively at your GP, according to your preference.