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Scar Revision for Surgical, Traumatic, and Keloids Scars

About Waynelle Ize-Iyamu

Waynelle Ize-Iyamu is a high school senior attending Viewpoint School. She spends her time developing her leadership skills in organizations like Leadership Summit, SDLC, and Student Council. She is an avid reader, artist, social justice activist, and is planning to follow a pre-med track in college. Waynelle researched and wrote this article as part of the Medical Scholars Program sponsored by the Osborne Head and Neck Foundation.

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About Dr. Jason Hamilton

Jason S. Hamilton, M.D. is the Director of Plastic and Reconstructive Surgery for the Osborne Head and Neck Institute based at Cedar-Sinai Medical Towers. Dr. Hamilton has advanced training in plastic and reconstructive surgical techniques involving the face, head, and neck, and limits his practice to the treatment of these areas exclusively.

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What is Scar Revision?

Scar Revision refers to a procedure that reduces the appearance of scars by matching them to the texture and color of the surrounding skin. It also helps improve function by releasing scar tissue, thereby returning movement to an area of the body (fingers, nose, mouth, eyelids) that may have been tethered by scar tissue. 

Why Do People Get Scar Revision?

There are many reasons to consider scar revision. These include:

  • Irritation: scars can be itchy, tender, and painful 
  • Function: scar tissue is less flexible and can inhibit function or movement 
  • Appearance: scars can make people feel self-conscious, anxious or depressed

Surgical Scars:

Surgical scars can be planned to minimize their appearance, size, and risk of resultant tissue dysfunction. However, some patients heal poorly from even a planned surgical incision and desire scar revision. Post-surgical treatments can be used first to reduce scar size and avoid the need for another surgery. Avoiding the sun or using strong sunblock for a year after surgery will limit hyperpigmentation of the scar. Compression over the scar can reduce hypertrophic scarring, which is when excess collagen accumulates and produces a raised scar. This can be done through taping, gently massaging, or using silicone gel and sheets. However wide, thick, or hyperpigmented scars can still form even if proper post-surgical treatments are implemented. In these cases, scar revision can be considered.

Burn Scars:

Burns may be initially treated with skin grafts, which is the use of healthy donor skin from elsewhere on the body to cover the burn site. 

Donor Sight of the Skin Graft The FDA approved clinical trials for “spray-on skin” in September of 2018. Named ReCell (Avita Medical, Valencia, California), this new technology is an example of an early skin cell regenerator. It enables doctors to produce a suspension of cells by culturing a sample of the patient’s own skin. This suspension contains the cells necessary to regenerate the outer layer of natural, healthy skin and is prepared and applied at the point-of-care in as little as 30 minutes. This could prove an exciting new option in the treatment of burns that will spare the patient the pain of healing a donor site wound. 

Keloids

What Are Keloids?

Keloids are raised bumpy scars that form from excess collagen production at the site of tissue trauma. This can happen due to surgery, an accident, or something as simple as ear-piercing in the susceptible individual.

Keloids can be itchy and tender for some people when they are forming, but the itch stops once the Keloid stabilizes. If a keloid does form on a joint it can restrict movement.

People of color are more prone to develop keloids. People under 30 are also at a higher risk. They can appear anywhere on the body; however, keloids are more common on the face, neck, ears, chest or shoulders where there is little underlying fatty tissue. 

Keloids can be painful, itchy, uncomfortable, unsightly and bothersome. People can undergo scar revision to help make these less visible or irritating.

Scar Revision for Keloids:

Removal of the keloid is not advised because the trauma from the incision will simply result in another keloid, and often one that is larger. Alternatives include:

  • Cryotherapy: freezing the keloid using liquid nitrogen
  • Steroid injections: might decrease itchiness, burning, and redness. It might also help to flatten the keloid and, in some cases, make them smaller. 
  • Laser surgery done in conjunction with other treatments can smooth the keloid, reduce discoloration, or flatten the keloid.  
  • Topical silicone treatment
  • External beam radiotherapy: typically performed in conjunction with a surgical excision for refractory keloids
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