Plastic surgery restores form and function through reconstructive procedures, cosmetic enhancements, and body contouring.
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The consultation is a careful evaluation, not just a talk about looks. The surgeon checks the scar’s flexibility, thickness, color, and direction. They also review how the scar happened, how it healed, and what treatments have been tried before.
This phase determines the biomechanical feasibility of revision. The surgeon assesses the laxity of the surrounding skin to determine whether there is enough slack to remove the scar and close the wound again. If the skin is too tight, immediate excision may not be feasible without distorting the skin.
Modern practice utilizes high-resolution photography and 3D simulation tools. These systems create a topographic map of the scar, analyzing its height, depth, and volume relative to the surrounding skin. This objective data helps in planning the volume restoration or reduction needed.
While simulation cannot perfectly predict wound healing, it allows the surgeon to demonstrate the intended geometric changes, such as the new angle of a Z-plasty or the reduced width of an excision. This aligns patient expectations with the surgical limitations.
The “pinch test” is a key part of the exam. The surgeon pinches the skin at a right angle to the scar to check how loose it is. If the skin pinches easily, there is enough slack to remove the scar and close the wound directly.
If the skin is tight and cannot be pinched, excision risks widening the new scar or distorting nearby features. In such cases, the surgeon may recommend serial excision (removing the scar in stages) or tissue expansion. This tactile assessment dictates the surgical strategy.
Operating on an immature scar is a recipe for failure. The surgeon assesses the scar for signs of maturity. An immature scar is red, firm, itchy, and tender. A mature scar is pale, soft, flat, and asymptomatic.
Most surgeons require a scar to be at least 12 months old before revision. However, checking for pliability (softness) is more accurate than a calendar. If the scar is still firm and vascular, the surgeon will delay the procedure and may prescribe massage or silicone therapy to accelerate maturation.
Scar revision requires the body to heal perfectly; therefore, the patient’s systemic health is scrutinized. Conditions that impair microcirculation, such as diabetes or vascular disease, can compromise the delicate flaps used in Z-plasty or W-plasty.
Nutritional status is also evaluated. Protein deficiency or vitamin deficiencies (A, C, Zinc) can lead to weak wound strength. The surgeon ensures the patient is metabolically optimized to support the rapid collagen synthesis required for a fine scar.
Nicotine is the single most significant modifiable risk factor in scar revision. It causes severe vasoconstriction, reducing blood flow to the skin edges by up to 40%. In complex flaps like Z-plasty, where blood supply is already tenuous, nicotine can cause the tips of the flaps to die (necrosis).
A strict no-nicotine rule is enforced. Patients must stop all nicotine products including vapes, patches, gum, and cigarettes for at least 4 weeks before and after surgery. Urine tests may be used to check for nicotine before surgery.
To achieve a fine, hairline scar, bruising and hematoma must be avoided. Blood thinners, including aspirin, ibuprofen, fish oil, and Vitamin E, increase the risk of bleeding at the incision site. A hematoma causes pressure that can widen the scar or lead to infection.
Patients are instructed to stop these medications 10 to 14 days before surgery. The surgeon coordinates with the patient’s primary care physician when prescribing anticoagulants. A dry surgical field is essential for microsurgical precision.
A detailed history of the patient’s tendency to scarring is vital. If a patient has a history of forming keloids from minor scratches or ear piercings, surgical excision carries a high risk of recurrence sometimes resulting in a scar worse than the original.
For these patients, the consultation shifts to a discussion of multimodal therapy. Surgery may still be an option, but only if combined with immediate post-operative radiation or steroid injections. This risk stratification protects the patient from predictable complications.
Scar revision can be an emotional process. Some patients feel trauma or regret about their scar. The surgeon checks the patient’s reasons for surgery and makes sure they understand what to expect. It’s important to stress that the scar will look better, but won’t be gone.
Patients expecting a “photoshopped” result are not good candidates. The consultation aims to establish a shared vision of a less conspicuous, but still present, mark. Psychological stability ensures the patient can handle the healing process and final result.
To optimize the surgical site, pre-operative skin care is often prescribed. This may include hydrating creams to improve skin elasticity or topical retinoids to prime the skin for turnover. If the scar is in a hair-bearing area, instructions on grooming are provided.
Sun protection is emphasized in the weeks leading up to the surgery. Sunburned or tanned skin is inflamed and reactive, making it an unsuitable substrate for surgery. Patients are advised to shield the area for weeks before the procedure.
Most scar revisions are outpatient procedures performed under local anesthesia. However, logistical planning is still required. If the scar is on a limb, mobility may be restricted. On the face, social downtime for swelling and stitches must be considered.
Patients are advised to arrange for time off work and assistance with activities that might stretch the wound. “Nesting,” or preparing the recovery area with supplies such as ice packs and wound-care ointment, reduces stress on the day of surgery.
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We perform a “pinch test” during the consultation. By pinching the skin around the scar, we can feel if there is enough extra skin to pull the edges together comfortably after the scar is cut out. If it’s too tight, we might need to stretch the skin first.
For most small-to-medium scar revisions, yes. We use local anesthesia to numb the area thoroughly, so you feel no pain, only pressure. For young children or those with huge scars, we may use sedation or general anesthesia.
Smoking shrinks your blood vessels and cuts off oxygen to the skin since scar revision involves moving and stitching delicate flaps of skin. Poor blood flow can cause the skin to die, leaving you with a worse scar than you started with.
It is risky. If you form keloids, cutting out a scar might trigger a new, bigger keloid. We can still operate in some cases, but we must combine the surgery with radiation or steroid injections to stop the keloid from coming back.
No, please do not shave the area yourself within 48 hours of surgery. Shaving can create tiny micro-cuts that harbor bacteria and increase the risk of infection. We will clip the hair with sterile clippers immediately before the procedure if needed.
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