DR G DE AGUIAR

PLASTIC, RECONSTRUCTIVE & COSMETIC SURGEON

Procedures - SCAR REVISION


Scars are visible signs that remain after a wound from surgery or injury has healed. Every time the skin is cut or damaged through its full thickness it will heal with a scar. Some people naturally make better scars than others. Scars mature over time after an initial injury or surgery and even a wound that heals well can result in a scar that affects your appearance. They are unavoidable results of injury or surgery, and their development can be unpredictable. The way a scar develops depends as much on how your body heals as it does on the original injury, the manner in which it was treated, on the surgeon's skills and the post-injury wound / scar management program.

As each person is a unique biological system, the individual response to injury and surgery is unpredictable. Many variables can affect the severity of scarring, including genetic factors, the location, 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. Scars may be raised or recessed, different in color or texture from surrounding healthy tissue or particularly noticeable due to their size, shape or location. How much the appearance of a scar bothers you is, of course, a personal matter.

While no scar can be removed completely, plastic surgeons can often improve the appearance of a scar, making it less obvious through the injection or application of certain steroid medications, by using scar management programs or through surgical procedures known as scar revisions.

If you're considering scar revision, this will give you a basic understanding of the most common types of scars, the procedures used to treat them, and the results you can expect. It can't answer all of your questions, since a lot depends on your individual circumstances. Please be sure to ask your doctor if there is anything about the procedure you don't understand.

Making The Decision:
Many scars that appear large and unattractive at first may become less noticeable with time. Some can be treated with steroids to relieve symptoms such as tenderness and itching. For these reasons, many plastic surgeons recommend waiting as long as a year or more after an injury or surgery before you decide to have scar revision. If you're bothered by a scar, your first step should be to consult a specialist plastic surgeon. The surgeon will examine you and discuss the possible methods of treating your scar, the risks and benefits involved and the possible outcomes. Be frank in discussing your expectations with the surgeon, and make sure they're realistic. Don't hesitate to ask any questions or express any concerns you may have.

Risks and Considerations:
While scar revision is normally safe, there is always the possibility of complications. These may include infection, bleeding, a reaction to the anesthesia, or the recurrence of an unsightly scar. You can reduce your risks by choosing a qualified plastic surgeon and closely following his or her advice, both before surgery and in follow-up care.

Keloid Scars
Keloids are thick, puckered, itchy areas 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 back / shoulders. 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 a course of steroid injections directly into the scar tissue to reduce redness, itching, and burning. In some cases, this will also shrink the scar. You will also be required to follow a scar management program which may include scar massage, taping, use of silicone sheeting, pressure garments, topical wound gels / creams and possibly the use of laser or ultrasound treatment. If the above scar treatment program is inadequate or if the keloid has been there for some time, the scar tissue can be cut out and the wound closed with one or more layers of stitches. This is generally an outpatient procedure, performed under local anesthesia. You should be back at work in a day or two, and the stitches will be removed in a few days. A skin graft (see the section on skin grafting) 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 surgeon may combine the scar removal with steroid injections, direct application of steroids during surgery, or radiation therapy. You will need to continue with the scar management program. You may be required 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 (with the help of a scar management program)-though it may take a year or more-or with the help of steroid applications or injections as well.

If a conservative approach doesn't appear to be effective, hypertrophic scars can often be improved surgically. The plastic surgeon will remove excess scar tissue, and may reposition the incision so that it heals in a less visible pattern. This surgery may be done under local or general anesthesia, depending on the scar's location and what you and your surgeon decide. You may receive steroid injections 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, tendons and joints, 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. Newer techniques, such as tissue expansion, are playing an increasingly important role. If the contracture has existed for some time, you may need physical therapy after surgery to restore full function.

Facial Scars
Because of its location, a facial scar is frequently considered a cosmetic problem, whether or not it is hypertrophic. 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") the surgeon may be able to reposition it to run parallel to these lines, where it will be less conspicuous. (See Z-plasty) Some facial scars can be softened using a technique called dermabrasion, a controlled scraping of the top layers of the skin using a hand-held, high-speed rotary wheel. Dermabrasion leaves a smoother surface to the skin, but it won't completely erase the scar.

Z-Plasty
Z-plasty is a surgical technique 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, however, and it requires an experienced plastic surgeon to make such judgments. 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. Z-plasty is usually performed as an outpatient procedure under local anesthesia. 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 serious than other forms of scar surgery. They're more likely to be performed in a hospital as inpatient procedures, using general anesthesia. 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. 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 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. The cosmetic results may be less satisfactory, since the transferred skin may not precisely match the color and texture of the surrounding skin. In general, flap surgery produces better cosmetic results than skin grafts.

After Scar Revision:
With any kind or scar revision, it's very important to follow your surgeon's instructions after surgery to make sure the wound heals properly. Although you may be up and about very quickly, your surgeon will advise you on gradually resuming your normal activities. As you heal, 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. It is not uncommon for a scar to look worse at first and the final results of your surgery may not be apparent for a year or more.

Procedures by Dr De Aguiar

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Body

Just as the facial muscles may sag or wrinkle with age, so can the skin on the torso, breasts, thighs and upper arms.

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Breast

Loss of skin elasticity, the force of gravity and other factors such as weight loss, pregnancy and breast-feeding ultimately affect the shape and firmness of a woman’s breasts.

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Face

As part of the natural aging process, our skin progressively loses its elasticity and our muscles tend to slacken.

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Reconstructive

From the top of the head to the tip of the toe, and from newborn babies to the very elderly, reconstructive surgery is used to treat a wide range of conditions.

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Non Surgical

Apart from the cosmetic uses of Botox, the drug has been used to treat more than 70 medical conditions.

Commitment

Choosing to have plastic surgery requires thorough research and educated decision-making. This website is designed to help guide you get to know a little bit more about my practice and understanding of the procedures and treatments available to you. I look forward to meeting you which will allow you to make a better informed decision around treatments or surgery best suited to you.

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FAX: 011 304 6800
CELL: 072 144 9901

ADDRESS: Room GF07, Netcare Waterfall City Hospital