There are a few lessons I have learned after 10 years as a cosmetic plastic surgeon in Louisville, Kentucky.
First, a fact about wound healing. If your skin is injured or cut deep enough into the dermis, the deep layer of the skin, your body heals that injury by making scar tissue. Every cut heals by making a scar. Some scars are more noticeable than others but that is how the human body heals. Like it or not, that’s what nature stuck us with.
Factors that affect how your scar looks include your genes, age, skin color, skin thickness, scar location, how you were injured, and how the wound was repaired.
In general, though lasers are an option, most scars are revised by excision and re-closure.
Here are some things I consider when I look at your scar.
Location: Scars over joints are tough. The skin is constantly moving and the chances the scar will widen again are high. I usually shy away from these. Scars on the upper chest always heal poorly. Not open heart scars, but scars off the midline. These have a high chance of doing poorly with revision too.
Who repaired it: If the intern on the trauma service repaired your cut in the ER at 4 a.m. after being on call for 24 hours, well, brand me cocky, but I think I may be able to do better. With all due respect to interns, I was one too many years ago, I feel like an additional 18 years of experience are helpful. Contrast this with a scar that was repaired by an experienced surgeon in the OR. He was working in an ideal environment, the O.R., with the best light and the best instruments possible. Chances are, technically, he did what I would do. I would be less certain I could make an improvement.
What type of wound was it? If you had a dirty cut with dirt and grass or gravel in it that got infected afterward, I’m pretty optimistic a revision would help. Again, contrast this to a surgical incision repaired in the OR. Not so optimistic.
The bottom line is there are 3 possibilities when we revise scars. It can turn out the same, better, or worse. Your Plastic Surgeon can give you guidance on which one he expects but you MUST be willing to accept all three possibilities. If you can’t, don’t have the surgery. But in the end, remember, once you have a scar, you will always have a scar, hopefully a less noticeable one though.
Lee Corbett, MD
All posts on this blog are authored by Louisville plastic surgeon Dr. Lee Corbett. Dr. Corbett specializes in cosmetic plastic surgery including facelifts, browlifts, blepharoplasy, Botox, Juvederm, Restylane, breast augmentation, breast lifts, breast reductions, body lifts, liposuction, and tummy tucks.