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Scar revision following surgery

Author: By Dr. Davin S. Lim – Laser Dermatologist

Scarring secondary to skin cancer removal will occur, however the best scar results can be achieved with correct surgical technique and post-operative wound care. Taping, and reinforcing wounds after skin cancer surgery is paramount for a good scar result. Limiting stretching of the skin, and strenuous exercise will also help.

Established scars can be improved by Specialist laser dermatologists using state of the art ablative, vascular and Fractional – Fraxel lasers.

Facts on scars following surgery and removal

  • Scarring following surgery is seen universally
  • Correct surgical technique and wound care can reduce visible scars
  • Raised scars can be treated with injections, silicone sheets and laser
  • Atrophic or depressed scars can be treated with dermal fillers
  • Red scars following surgery will often fade over time but can be improved with Vascular laser
  • Specialist laser dermatologists work in with skin cancer doctors to provide the very best in scar revision techniques

Why do scars occur?

scar removal brisbaneScarring following all forms of surgery, including skin cancer surgery is universal. Correct surgical technique can reduce, but not eliminate scars. Scars following surgery or trauma to the skin occur in the deeper layers of the skin, known as the dermal layer.

 

Scars occur as a result of inflammation and altered arrangement of collagen in the deep layers of the skin. Red scars are due to a process called ‘neovascularisation’, a process in which new blood vessels form after surgery.

 

Keloid or hypertrophic scars are as a result of an exaggerated healing process in your skin.

Read more about scars and scar revision

How can I reduce scar formation following skin cancer surgery?

4 simples steps can help give you the best possible scar results following skin cancer surgery-

 

  1. Follow your dressing instructions and do not over exert your wound
  2. Tape the wound following suture removal. Remember your wound is weakest after suture removal
  3. Limit activity and stretching after surgery- especially for wound on the lower legs, shoulders, and back areas
  4. Apply BioOil or even better a Silicone Dressing Gel or sheet to your wound for 3 months post surgery.

What types of scars are there?

OLYMPUS DIGITAL CAMERAScars following skin cancer surgery can be classified in to 4 types, each type of scarring will have a ‘best treatment’ approach.

 

Hypertrophic scars- these scars are raised scars, and due to overproduction of collagen. Examples include keloid scars and also raised full thickness skin grafts. This form of scarring responds well to steroid injections or laser resurfacing.

 

Atrophic scars– this form of skin scars are opposite to hypertrophic scars, and result from loss of tissue, especially following cancer surgery and grafting. Atrophic scars respond well to dermal fillers, such as Juvaderm.

 

Pattered scars– as the name suggests, this type of scar takes the form of a pattern, such as a line, or in the case of a skin flap, a geometric shape. Patterns include ‘train-tracks’ or spread scars. This form of scarring responds well to ablative and fractional lasers including Fraxel.

 

Pigmented scars – this type of scarring from skin cancer surgery can occur if a flap is performed, or if surgery is conducted in darker skin patients. Red scars can often be faded with vascular laser. Darker scars respond best to conservative treatment, rather than laser therapy.

How much improvement can I get following scar removal procedures?

All scars can be improved, no matter how severe.

Raised scars on the face respond best to a series or laser treatments, or a combination of anti-inflammatory injections and laser. The extent of scar improvement will depend on many factors including the type of scar, the scar location and most importantly – how your immune system responds to treatment.

 

Read more about scars and scar revision

 


What are keloid scars and where do they occur?

OLYMPUS DIGITAL CAMERAKeloid and hypertrophic scars are lumpy, and often itchy scars that extend beyond the border of a surgical wound. They occur because you body’s immunity is too strong, and results in overproduction of collagen and scar tissue. Keloid scars usually occur a few weeks or months after skin cancer surgery.

 

The most common location for keloid and raised scars are on the chest, back, and shoulders. These types of scarring are more commonly seen in the younger age group.

 

Keloid scars can be treated by Specialist Dermatologists using a combination of vascular V BEAM laser and Corticosteroid injections.

If I get scarring following surgery, does that mean my doctor is not experienced?

No. Scars will occur following any form of surgery on the skin. What your scar eventually looks like will depend on many factors, some beyond the control of your skin cancer surgeon, dermatologist, or even plastic surgeon.

 

Factors that may affect scar formation include the following-

  • Personal or family history of scars
  • Location of lesion- skin cancer: back, chest, shoulders scar much more compared to face or scalp
  • Size of skin cancer and skin defect
  • Type of procedure performed- skin flaps vs. skin grafts vs simple closure
  • Racial history- Asians and darker skin races tend to scar much more
  • Age of patient- young patients scar easier
  • Sex of patient – females will scar easier compared to males, especially with keloid scarring
  • Patient factors- poor wound healing is associated with smoking, and diabetes

What is involved with laser treatment of scars?

laser for scarringDr Davin S. Lim, laser dermatologist explains laser treatment of scars secondary to skin cancer surgery:

“Essentially 3 types of laser can be used to treat scars secondary to skin cancer surgery. Each type of laser has a specific function and represents a method of treatment.”

 

 Ablative lasers- This is the most common laser I use to treat surgical scars. As the name suggests this totally removes the upper and middle layers of the skin, enabling me to remove excess tissue, especially with over corrected skin grafts. This also helps reduce the appearance of old suture lines and ‘cuts’. Usually only one treatment is needed, however the recovery time approaches 8-10 days. All ablative laser procedures are conducted in a laser theatre, often under very mild sedation.

 

 Fractional lasers- including ProFractional, PEARL, and FRAXEL laser. This form of laser resurfacing treats ‘fractions’ of skin, and not the entire surface

Who performs scar revision?

dr davin lim laser dermatologistSpecialist laser and cosmetic dermatologists perform scar revision. Dermatologists are specialist physicians and surgeons who work with skin cancer doctors. They have extensive training in the use of highly skilled techniques, including the use of lasers to resurface, and revise all forms of scarring, including surgical scars and acne scars.

My Skin Cancer Centre refers to Westside Laser Dermatology for all scar revision work.

 

Read more about scars and scar revision

How long will I take to heal following scar revision treatment?

Heal times following revision of skin cancer surgery scars will depend on the procedure. As a guide-

 

  • Removal of lines, raised scars using ablative laser, heal time of 7-9 days
  • Removal of red scars and blood vessels, bruising for 2 days
  • Flattening of raised hypertrophic and keloid scars, no downtime- only injections performed

How many sessions will it take for optimal scar revision outcomes?

scar specialst brisbaneOnce again this depends on the surgical scar type and location. If scars are raised follow flap or graft surgery, as few as one laser scar removal session will give the desired outcome.

 

If scars are hypertrophic or keloid, then several sessions are needed to flatten surgical scars.

 

Red scars will require 2-3 sessions of vascular laser before lightening.

How soon after surgery can I get my skin cancer surgery scars removed and revised?

fraxel for scarsScar revision can occur immediately after suture removal. If you have the tendency to have red lumpy and raised scars, V Beam laser immediately after surgery can reduce likelihood of scar formation.

 

Lumpy raised scars from grafts, flaps and skin cancer excisions can be treated with either erbium or CO2 – Fraxel laser within weeks of the procedure.

Can skin graft and flap scars be removed by laser surgery?

Skin grafts and flap scars can be improved by laser methods. Your GP or skin cancer doctor will refer you to a Specialist Laser Dermatologist for this procedure.

 

Laser can improve a surgical scar by several methods-

  • Lumpy raised scars, such as a skin graft can easily be flattened by ablation using either an ERBIUM laser or a CO2 Laser
  • Scar lines can be blended in with an ablative laser
  • Red scars, including surrounding blood vessels can be corrected with a vascular laser

Can all types of scars be improved?

scar removals 3Almost all scars, no matter how severe can be improved. Scars secondary to skin cancer surgery, burns, trauma, acne, chick pox and accidents can all be improved with a combination of laser and physical modalities.

 

Each scar type will have an optimal method of scar revision. Note that 2 forms of scars respond very poorly to any form of treatment –

  1. Darker scars or hyperpigmented scars on the legs
  2. Self induced cuts on the forearms

How much does scar revision by a Specialist cost?

Scar revision is a highly specialized field, conduced by Consultant Laser Dermatologists and Plastic surgeons. Most cases will be partially claimable by Medicare, however an out of pocket fee is applicable.

 

As a guide, out of pocket expenses for scar revision ranges from $190 to $2900.

 

Fees are dependent on –

  • The treatment used (injections vs Vascular laser vs Ablative laser)
  • The complexity of the procedure
  • The location of scars
  • The number of treatments needed

 

My Skin Clinics work in conjunction with Specialist Dermatologists at Westside Laser Dermatology and Plastic Surgeons for scar revision procedures.

Read more about Westside Laser Dermatology

What is the first process towards removing my surgical scar?

scar specialist brisbane 2A consultation with a Specialist is the very first step in scar revision. During the initial consultation, your Specialist will discuss the type of scar you have, and methods to visibly reduce scarring. We also undertake a full medical history, as well as photographic documentation of the scars.

 

Specialists will discuss issues such as –

  • Downtime
  • Expected results
  • Cost of scar revision procedures
  • Risks of laser surgery and possible complications

 

For more information on booking an appointment to see Dr Davin S. Lim or Dr Shobhan Manoharan, call Westside Laser Dermatology on 07 3871 34 37.

Specialist viewpoint on scar revision and scar treatment

Dr Davin S. LimDr Davin S. Lim

Laser Dermatologist

Westside Laser Dermatology

 

 

“Scars following skin cancer surgery are universally seen, and can be improved. Scarring will depend on many factors, including genetic, but also dependent on site of skin cancer or mole, and the techniques used to close the defect.”

 

“Raised scars are the easiest to treat, especially following skin grafts. I use a combination of methods to help improve scars, including steroid injections to flatten the scar, as well as lasers. For keloid scars, most patients will require a series of 2-3 injections spaced 4-8 weeks apart. Laser ablation of raised scars will often only require one treatment. Red scars do particularly well with vascular lasers.”

 

“No matter how old the scar is, improvement can always be achieved.”