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SCAR REVISION

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SUMMARY

  • Cutaneous scars are a critical consideration for the dermatologic surgeon, as patients often judge the ultimate success of their surgery based on the final appearance of the surgical scar.

  • Numerous techniques are available for surgical scar revision, ranging from topical therapy to laser treatment to surgical intervention.

  • Timing of scar revision is usually planned several months following surgical intervention to allow for the scar to improve naturally, though in some instances—such as cases of hypertrophic scarring and keloid formation—more rapid intervention may be appropriate.

  • Minimally invasive approaches, such as topical and laser therapy, may be considered sooner.

image Beginner Pearls

  • The majority of favorable scars are produced within RSTLs.

  • Scars continue to mature and remodel for up to 12 months, and the appearance of scars continues to improve even beyond one year.

  • Intralesional corticosteroids are the mainstay of treatment for hypertrophic and keloidal scars.

image Expert Pearls

  • The 585-nm pulsed dye laser (PDL) was the first laser to gain wide acceptance for use in treating scars postoperatively, though the 532-nm KTP laser or IPL may also be used for erythema in surgical scars.

  • Fusiform excision, Z-plasty, V–Y advancement flaps, and subcision may all be used to improve scar cosmesis as well.

image Don’t Forget!

  • Patients who are pregnant or immunosuppressed should not be injected with 5-FU.

  • Fractional ablative and nonablative laser resurfacing has also been used for scar revision.

  • Dermabrasion is often performed 4 to 8 weeks postoperatively when tissue remodeling is taking place, though it may also be used significantly later.

image Pitfalls and Cautions

  • Ultimately, tension is the greatest enemy of the surgeon, and excess tension is responsible for many scar-related complications.

  • Therefore, meticulous surgical design coupled with outstanding suturing technique may mitigate many scarring complications.

image Patient Education Points

  • Explain to patients prior to any procedure that every surgical procedure results in a scar.

  • Ideally, a preoperative explanation that every surgical procedure may ultimately benefit from a staged approach helps patients understand that additional treatment may be beneficial, and helps them anticipate this eventuality rather than see it as a complication.

image Billing Pearls

  • Z-plasty may be billed using the 140XX series codes and is often reimbursable from insurance.

  • Most laser- and light-based treatments are excluded from insurance coverage.

INTRODUCTION

Cutaneous scars are a critical consideration for the dermatologic surgeon, as patients often judge the ultimate success of their surgery based on the final appearance of the surgical scar. Revision of surgical scars is sometimes necessary for functional reasons, aesthetic reasons, or both. Numerous techniques are available for surgical scar revision, ranging from topical therapy to laser treatment to surgical intervention. Consideration of the texture, contour, erythema, hypo- or hyperpigmentation, and quality of the scar will affect the revision technique employed. Knowledge of these techniques allows the surgeon to achieve the best ...

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