Acne and Scar Revision
Scar revision and the treatment of acne scarring is simultaneously some of the most challenging and some of the most rewarding work in plastic surgery. How the scarring occurred, previous treatments, and the course of healing all must be evaluated carefully in order to determine how to improve the healing process and alter the skin for a smoother, more attractive look. Often we must use several types of treatments or repeat treatments for maximum improvement.
About the Procedure
Here are a few of the ways we can achieve scar revision:
Excision: Sometimes when the original injury wasn’t sutured or developed an infection, a direct excision of the area with very careful closure is the first choice.
Z-plasty: A Z-shaped incision which can relax tension and alter the direction of an old scar.
W-plasty: A method of excising an old scar, which creates multiple angles and avoids a “string” effect in the new scar.
Dermabrasion: A sanding method which can level the surface of the skin for a smoother surface.
Laserbrasion: A powerful method of leveling the surface of the skin and simultaneously restructuring the collagen in the deeper layers of skin.
Chemical Peel: A technique using either powerful bases or acids to resurface the skin. Especially useful when there is a serious coloration problem. One of the best techniques when dealing with darker skin types.
Fat injection: Depressed areas can sometimes be elevated by freeing the deep attachments of the scars and filling the resultant space with fat Lipostructure).
With treatment, patients are able to achieve a healthy, smooth surface to the skin with minimal visibility of previous scarring and an even, attractive coloration. Freedom from embarrassment, improved self-confidence, and elimination of the “scarred” stigmata are all benefits.
Scar Revision FAQ’s
- I just finished a course of Accutane, and I was told that I need to wait a while before doing any of these procedures. Is that true?
For people with cystic acne, accutane can be a miracle drug; however, it does have volumes of complications. The most significant complication from a cosmetic viewpoint is that after being used for a period of time, there is a higher risk of unsatisfactory scarring. There is disagreement surrounding the optimum time frame that should elapse between the cessation of accutane and safe surgical procedures. This time frame ranges from as soon as 6 months to two years. We feel that the plastic surgery community as a whole believes that a period of one year should elapse between the last use of accutane and performance of any cosmetic procedure.
NOTE: Accutane has more profound side-effects than simple antibiotics, and should not be used symptomatically. It should be part of a comprehensive overall treatment plan. Once accutane therapy starts, careful blood tests need to be performed and the appropriate prescribed period of time should elapse before discontinuing use. It is entirely inappropriate to use accutane for a day or two because of an acne flair. It is extremely dangerous in terms of future scarring and severe complications.