Scar Revision

Cosmetic Scar Revision

Many patients have scars they don’t like or would like improved. Scars that are thick, have widened, hypertrophied, or are otherwise suboptimal can usually be improved by excision and re-closure using plastic surgery techniques. Other scars may benefit from injections, or other techniques that Dr. McInnes can discuss with you. Most of these cases are not a benefit of the medical services plan of BC, much like prescription drugs and physiotherapy.

Candidates

• Individuals without complex medical conditions
• Non-smokers (patients must be able to stop smoking at least 4 weeks prior to surgery to decrease their risk of complications)

Consultation

Dr. McInnes will examine the specific areas of concern and discuss the procedure with you, including the risks involved.

Procedure Details:

These procedures are normally done under local anesthetic, commonly in the office. Most lesions are excised as an ellipse, to minimize the skin puckering that would result from a circular excision. After excision of the area, Dr. McInnes will usually loosen up the surrounding skin before closing it, so the tension on the closure site is minimal. This allows the skin to re-drape properly without causing contour problems. The sutures may or may not be absorbable depending on the excision location. Often the sutures are hidden entirely below the skin and do not need to be removed. This allows the skin to heal with a straight line, with no visible suture marks. Afterwards, either surgical glue or a small amount of incisional tape (steri-strips) is placed over the incision.

Recovery

Following your procedure, you will be asked to apply pressure to the area for 5-10 minutes to minimize the risk of bruising. You will be given specific verbal and written instructions on how to care for the surgical site, and what medications to take for pain afterwards (usually just Tylenol and Advil). Antiobiotics are usually not prescribed.

Results & Expected Outcome

The vast majority of patients have excellent results from their procedure. Although this is always expected, like all things in medicine and surgery, there is never a 100% guarantee. If a complication arises, Dr. McInnes will help you with it.

Scar Management

It takes a full year for a scar to mature. Initially after surgery it will be a perfectly flat line, with no visible suture marks. After a number of days, it will start to become a bit red and inflamed. It will typically start to fade to a white colour after 6+ months. If it gets too much sun while it is healing, it can turn permanently dark, so Dr. McInnes recommends keeping the area out of the sun as much as possible. Techniques include sun-avoidance, long clothing, blocks (eg. a Band-aid over the area when in strong sun), and applying sunscreen (SPF 30) even if it’s cloudy. Dr. McInnes typically recommends using a non-irritating facial moisturizer that contains sunscreen daily.

After 3-4 weeks, assuming the incision is well healed, you may begin scar massage to the area to help soften the scar. I recommend using a lotion or cream that doesn’t irritate your skin, and massaging it into the scar for 5 minutes, several times per day.

At most, a mature scar may achieve 60%-80% of the strength the skin had before surgery. Stretching the scar can lead to unfavourable results, such as a wide scar or hypertrophic scar. It is important to keep this in mind while the incision is healing. For example, if a lesion was excised from the middle of your chest, it would be important not to stretch your arms out too far to the sides while things are healing.

Risks

There are certain patients who are predisposed to make keloid or hypertrophic scars, but the vast majority of the time, patients end up with a small faint scar.

• Mild Bruising
• Mild swelling
• Infection (<5%)
• Incision separation (<5%)
• Other risks depend on the location

If you are unlucky and have a complication, Dr. McInnes will help you manage it.

Please download the consent form designed by the American Society of Plastic Surgeons (ASPS) for a detailed list and description of the risks involved (found here). Risks of surgery will be discussed prior to your consent. It is important to address all your questions directly with Dr. McInnes.

Cost

Cosmetic scar revision in not a benefit of the Medical Services Plan in Canada, much like prescription drugs or physiotherapy. Prices for scar revision surgery will vary based on your individual surgical requirements, the length and location of the scar, and your quote will be provided after your assessment. Prices for this type of procedure typically start at $550 dollars (plus GST) for small areas.

Your quoted cost will include the following:

• Facility fee
• Equipment and supply fee
• Surgeon fee