This leaflet is for anyone who needs an operation to improve the appearance of a scar. This leaflet will help you understand and prepare for the procedure.
It is important that you read and understand this leaflet before agreeing to have a scar revision operation.
What is scar revision?
It is important to realise that no scar can ever be removed completely, however a plastic surgeon may be able to improve the appearance of your scar through a surgical procedure known as a scar revision.
The treatment that you will need to revise your scar will depend on many factors. These factors may include:
The severity of your scarring,
The size and depth of your original wound,
The blood supply to the area,
The thickness and colour of your skin and
The direction of your scar.
Your plastic surgeon will discuss your specific scar revision needs with you at your clinic appointment.
What does a scar revision operation involve?
Scar revision is collective name for a number of procedures that may improve the appearance a scar. The procedure that your surgeon will use will be the most suitable technique to improve your particular scar. Some of the procedures used in scar revision may be as simple as cutting out the scar and closing the wound with stitches, or they may be more complex. Your surgeon will discuss your individual needs with you.
Why are you having a scar revision operation?
Your scar may be causing you discomfort or may be interfering with the normal functioning of your body. The operation to revise your scar may relieve your symptoms.
What are the risks associated with this operation?
Most operations are straightforward, however with any surgical procedure there is a small chance of side effects or complications. This list of risks and complications is not intended to put you off having the operation, however you need to be aware of any potential risks before you sign a form consenting to the operation.
Possible risks and complications associated with scar revision are listed below:
Bleeding. There is a risk that you may experience bleeding from the site of the operation; this could result in a collection of blood beneath the stitch line. If this occurs you could experience pain and swelling in the area, the collection of blood may need to be removed, this may necessitate another operation.
Infection. There is a risk of wound infection, which can occur at any time following surgery. Symptoms of infection may include increased swelling, redness, fluid leakage and increased pain at the site of the operation. If your wound becomes infected you may need treatment with antibiotics. After a wound infection healing could be delayed and you may need dressings for a prolonged period of time.
Scarring. Even after a scar revision operation, you will still have a permanent visible scar on your skin; scars tend to improve over a period of 18 months following surgery. In some patients, for unknown reasons, scars can become raised, red and lumpy; unfortunately this is largely beyond surgical control. The way a scar develops depends as much on how your body heals as it does on your original injury or on the surgeon's skills. Certain areas of the body are more prone to developing thicker and more unsightly scars than others. Scars on your shoulders, chest and ears carry a higher risk of becoming raised and lumpy than other areas. Scars on your back or limbs have more of a risk of becoming stretched and may not have as good a cosmetic result as scars in other areas.
Wound breakdown. There is a risk that your wound may break down following surgery. This could happen because the stitch line does not heal properly and the wound may gape, or if the blood supply to the skin becomes interrupted. If wound breakdown happens you will require dressings for a longer period of time than usual and your scar may not have as good a cosmetic result.
Reaction to the local anaesthetic. If your operation is being performed under local anaesthetic, there is a very slight risk of you developing a reaction to the local anaesthetic used to numb your skin before your operation. If this happens you could experience swelling of your lips or mouth and in more severe cases you may experience tightness of your chest or difficulty in breathing. Your surgeon is trained to deal with this situation if it arises. If you are having a general anaesthetic, this risk may still apply as your surgeon may also use local anaesthetic medication to provide you with pain relief.
Failure to achieve expectations. It is important to remember that even after scar revision surgery there is a risk that you may still be left with an unsightly scar, and that the end results may not meet your expectations. There is also a risk that your scar may look worse after surgery.
There may be other risks specific to your individual case; your surgeon or nurse will discuss any further risks with you.
What preparation will you need?
If your GP prescribes aspirin, ibuprofen or other medications which may cause bruising or bleeding, you may be asked to stop taking these for a period of time before your operation. These medications may increase the risk of bleeding during and after your operation. Your surgeon will advise you about this when you see him / her in clinic.
If you normally take warfarin tablets you may be asked to stop taking these 3 days before your operation. You may also be asked to have a blood test on the day of your operation.
Before your operation:
If your operation is being carried out under local anaesthetic, you may eat and drink normally.
If your operation is being carried out under a general anaesthetic, you will need to stop eating and drinking for a period of time on the day of your operation, the nursing staff will advise you of when this will be.
Please bring all your medicines into hospital with you including tablets, inhalers and sprays.
Please remove all nail varnish before you come to hospital and keep make-up to a minimum. If possible, please leave all jewelry at home. Please bring in a dressing gown and slippers.
You may have to wait for your operation; it is advisable to bring something with you that will help you to pass time, such as a book or magazine.
What happens when you arrive at the hospital?
Admission depends on the hospital hence information will vary
A nurse will discuss your operation and try to answer any questions that you may have.
You will be asked to sign a consent form agreeing to your operation.
You will be asked to change into a gown and to remove any remaining jewellery, make up and nail varnish before your operation.
What type of anaesthetic will you need?
Many scar revision operations can be performed under local anaesthetic. This involves the surgeon giving you an injection of local anaesthetic to numb the area around your scar before operating.
Larger scars or scars requiring skin grafts or flaps are more likely to be revised under a general anaesthetic. If you need a general anaesthetic, your anaesthetist will give you more information about your anaesthetic and will discuss anaesthetic risks and complications with you prior to your operation.
What happens after the procedure?
You may have stitches and are likely to have a dressing over the wound, however this depends the technique used to revise your scar. If you have a skin graft you will have two wounds; the skin graft itself and the donor area from where the skin graft was taken.
If you have had a local anaesthetic, you will be allowed to go home when your follow up appointments have been arranged, and nursing staff are happy with your wound.
If you have had a general anaesthetic, you will need to stay in hospital until you have recovered from the anaesthetic, this may be several hours.
If you have had more complex surgery you may need to remain in hospital for a period of time following surgery, your doctor or nurse will discuss this with you prior to your operation.
Going home
You should not drive yourself home after a general anaesthetic and it is advisable not to drive after a local anaesthetic, so please arrange for someone to take you home.
Your local anaesthetic should wear off after about 2-3 hours. If you experience pain after this please take a mild painkiller if necessary, such as paracetamol.
You will experience some swelling around the site of your operation; elevating the affected area may relieve this. If your operation was on your:
Head or face, you should sleep with an extra pillow.
Leg or foot, you should elevate your leg on a footstool or sofa whilst sitting and should keep your leg on a pillow in bed.
Arm or hand, you may be given a sling to elevate your arm. At night you should sleep with your arm on a pillow.
Please keep your wound or dressing dry. Please do not remove your dressings and avoid touching your wound as this could cause an infection.
If your wound begins to bleed after you have gone home, apply pressure to the area for 5 minutes using a clean handkerchief or something similar. If your wound continues to bleed you can contact the hospital.
Please do not smoke as smoking can impair wound healing.
Follow up care
You will either be given an appointment to return to dressing clinic, or will be asked to have your dressings done at your GP's surgery by your Practice Nurse. At this appointment your wound will be checked and stitches will be removed if necessary.
If you require further follow up, you will receive an appointment for the out patients department.
At this appointment the plastic surgeon or a member of his team will review your new scar
Once your wound has healed you should massage your scar regularly as this may help it to settle down.
It is advisable to protect your scar from the sun for at least a year after your operation; exposure to the sun could cause your scar to darken in colour, this change in pigmentation could be permanent.
What can go wrong?
It is normal to have some bruising, swelling and tenderness around your wound following the operation.
However, if you suffer from any of the following symptoms after your discharge from hospital you should telephone the plastic surgery department for advice.
Persistent or increasing levels of pain
Fever
Redness or excessive swelling around the wound.
A feeling of heat or burning in the wound.
Leaking, or a feeling of wetness around your wound.
When can you resume your normal activities again?
You should ask your surgeon or nurse to advise you about whether you need to take any time away from work or whether you should refrain from driving.
Please ask if you require a doctors' certificate for your work.
Please ask your surgeon or nurse to advise you about whether you can take part in exercise or sporting activities.
Leaflet information
This information leaflet has been devised by:
Mr. A.M. Juma, Consultant Plastic & Reconstructive Surgeon.
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