Facial scars can be especially difficult for people to display regardless of why they occur as they can add an edgy element to one’s looks. A scar may appear in the skin due to an accident, skin condition, or disease. The permanent marks may cause disfigurement, or serve as a reminder of a traumatic event that caused serious injury. There is a social stigma attached to scars of the face and others may notice the healed wounds and cast judgment unknowingly. Revesse of Toronto features facial plastic surgeon, Dr. Robert Mounsey, who offers nonsurgical and surgical restoration to scarred areas to minimize their appearance on the face through scar revision.
How Do Scars Form?
When the skin has been injured to the depth of the dermis, or deepest layer of skin, the damaged tissue promotes a type of healing to regenerate skin in the area where it is missing. Fibrous tissue composed of collagen replaces that which has been lost during the time of injury, and often appears thicker and discolored in comparison with regular skin tissue.
Scars form to create healthy skin to protect the body against organisms like bacteria or disease from entering a person’s bloodstream after the skin has mended itself. Intact skin is important to overall health. When there are breaks in this barrier, scar formation is a natural byproduct of the healing process. Though it is a widely held belief that scar tissue is stronger than regular skin tissue, this is incorrect.
Scar Revision Techniques
There are a number of revision techniques available to employ during scar revision surgery, and can be tailored to suit a patient’s needs. While scar removal cannot completely remove a scar, the procedure will minimize its appearance in the skin in size, color, and texture. Because there are a number of scars that can occur in facial skin, there are numerous ways to address the marks.
In certain skin types, and common in people of African American, Latino, and Asian descent, keloid scars form as raised grows that can be larger than the injury site itself. When occurring on the face, the keloid scars are common on the earlobes due to piercings, and the cheeks, often because of acne. While these scars cause a mostly cosmetic issue, the tissue can become irritated and may hinder movements if they keloids become large enough in certain areas of the body. Steroid injections, special dressings, laser, cryotherapy (freezing the tissue) and other methods tend to be more effective than surgical excision, which can exacerbate the issue.
In skin that has been damaged by acne scars, there are a number of ways to generate the healthy regrowth of new tissue. Microdermabrasion, chemical peel, laser skin resurfacing, and in older individuals, facelift can greatly improve the overall look of the skin. The sloughing away of the upper layers of skin promotes the formation of collagen and elastin, which in turn leads to a less-blemished epidermis, or surface layer of skin. Faclift surgery may offer the excision of some of the affected skin tissue, and pulls the remaining skin taught. A third solution for certain icepick scars, also called pock marks, is dermal injections to raise the height of a divot to that of the surrounding skin.
Raised or Elongated Scars
Certain scars may require excision, where the tissue will be surgically cut away and the skin will be sutured together in a more desirable way. The closure can provide more natural movement of the face during expressions and the removal of obviously scarred tissue. The scar may be able to be disguised in natural skin folds, and treated with topical solutions to ensure the best healing.
Dr. Mounsey’s most utilized technique is the geometric broken line closure (GBLC) scar revision, where a linear scar is excised and the surrounding skin is sutured together in a specific fashion to provide camouflage that the eye does not readily perceive. The excision cuts form an irregular shape designed by the surgeon, so the areas of skin that once surrounded the scar fit together like puzzle pieces. The shapes may be square, rectangular, or triangular in shape and each incision of the pattern is generally no more than 6mm in length. He can take into account the curvature or plane of the facial surface, as well as the location and natural movement of the surrounding features to provide the best revision possible. The benefits to undergoing this type of cosmetic procedure are expertly concealed defects of the skin that will not increase the length of the original scar.
Also termed the zigzag plasty, this version of scar revision surgery is similar to the GBLC method described above. Rather than excising the scar through a random pattern of shapes that fit together once the skin is sutured closed, the W-plasty is performed through a zigzag pattern. The cuts are created in triangular shapes at no longer than 6 mm each, with angles under 90°. The shape surrounding the original scar appears as a repeating pattern of the letter W, though the broken lines provide a less noticeable new scar once healed. The W-plasty is successful in making raised, linear, and curved scars less noticeable. Similar to the GBLC method, the length of the new scar will not be extended beyond the previous scar, and the line breaks of the zigzag pattern will help redistribute area tension, for a more natural look while the face is resting or during movement. The W-plasty scar revision surgery is effective in repairing scars that are straight or as curved as a semicircle, and can effectively treat pincushion deformities where tissue appears bulbous on one or either side of an original scar.
Another method of cosmetic scar revision surgery is the Z-plasty. Less intricate than the W-plasty, the Z-plasty is what is known as a transposition flap technique that connects two triangular-shaped flaps of skin that have been realigned within the adjacent tissue incisions of the same shape. The scar is not excised, but the flaps allow for a breakup in the pattern of the damaged tissue by stretching and suturing the tissue of opposite incisions to reorient the direction of a scar. Undergoing this procedure will elongate the length of an existing scar, but still serves to improve its appearance. The newly positioned surgical cuts arrange for a release in tension, as part of the new scar formation will be parallel to relaxed tension lines within the facial skin. While the Z-plasty technique is well-known in plastic surgery scar revisions, its application is limited to scar band contractures that are linear and scars on or around emotive features, like the eye and mouth.
The Scar Revision Procedure
Dr. Mounsey performs scar revision procedures in the office setting or at one of the hospitals or private clinics in Toronto he is affiliated with. Nonsurgical skin refinishing treatments are typically performed in-office with topical anesthetic and no sedation. Patients are usually free to drive themselves home afterward, and have few limitations other than to keep the facial skin clean, apply medicated ointment, and remain out of the sun.
Surgical scar revision techniques such as excision are often performed with local anesthesia and sedation or with general anesthesia. Through a surgical removal procedure, Dr. Mounsey creates incisions in the skin and removes the scar. He then closes the surgical cut with very small sutures, resulting in a thinner, less noticeable scar. Another technique referred to as Z-plasty repositions the existing scar so that it is hidden in a less conspicuous area, typically within a natural skin crease or line of tension. During this procedure, two equal triangular flaps of skin are created through incisions, designed around the existing scar to allow for greater flexibility of the skin and underlying tissues as the triangular sections of skin can be rearranged.
Some advanced methods of scar revision surgery are layered closure and tissue expansion surgery. During a layered closure, which is best suited for deeper scars or those in areas with a lot of movement, the different layers of skin are sutured closed in a gradual repair of the area. Another way to treat scar tissue is utilize a flap surgery, where intact tissue is removed from one area of the body and implanted in another, which may require the use of tissue expansion balloons for gradual expansion.
The Scar Revision Recovery
Keloid scar revision is performed in an office setting with topical anesthesia, and may require one or more treatments to ensure optimal results. Dermal injections are performed similarly, at the practice without any recovery time. Following mechanical or chemical dermabrasion treatments for nonsurgical scar revision, patients may feel some discomfort. Commonly, the facial skin may appear and feel sunburned, which can be treated with medication and topical ointment. There are numerous settings within each laser, microdermabrasion can be performed at various speeds, and chemical peels are available in varying strengths, so recovery will differ amongst each patient.
The recovery after surgical scar revision may involve some minor swelling and bruising. Patients may also experience some discomfort which can be alleviated with medication. Bandages may be applied after surgery and these usually remain in place for one week. The scar will likely appear red immediately after surgery but it will eventually fade to a fine line. Most patients find that they can return to work within a few days to one week, or sooner if they are comfortable wearing a bandage to work.
Scar Revision Candidates
Dr. Mounsey accepts patients for scar revision based on certain criteria. Typically, patients should be non-smokers, in generally good health, and without any serious skin conditions that may negatively impact the procedure. Patients should be realistic in their goals, and relay if any facial scarring hinders any facial movements so this can be addressed during the procedure.
Scar Revision FAQs
Is it possible to fully eliminate scars from the body?
Revised scars are typically replaced by new scars, but those which have been expertly created through incisions and closed to ensure the most discreet end result. The doctor can reposition the scar within the skin, excise excessive scar tissue, and create better mobility of areas of the face. The new incisions can be disguised in skin creases and placed along tension lines.
Is scar removal painful?
The doctor will perform this surgery under a local anesthetic along with sedation, or general anesthesia so the patient will be comfortable asleep during the surgery. The site may be sore following the procedure, but pain can be managed through proper care and medication.
What forms of scar removal does the doctor perform?
The best way to learn about the individual techniques the doctor chooses to employ for patients can be learned through the doctor-patient consultation. His preferred methods are based upon his success rate and expertise.
Do patients undergo multiple scar treatments?
Typically, a single surgery is sufficient in scar revision. In nonsurgical cases, the techniques may be repeated until the best results are achieved. Skin refinishing treatments are commonly performed multiple times.
Dr. Mounsey with Revesse of Toronto
Dr. Robert A. Mounsey, MD, FRCSC, FACS, is a top-rated facial plastic surgeon of Toronto, Ontario and is the preferred doctor of the surrounding suburban areas. The doctor focuses his practice on facial plastics and offers numerous nonsurgical and surgical options for a wide array of conditions.
Schedule a consultation with Dr. Mounsey to discover how to enhance your looks through facial plastics.
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Related Procedures: Flap Reconstruction, Ear Reconstruction, Complex Nasal Reconstruction, Fat Transfer