As a Plastic Surgeon I get a lot of requests to check patients to see if they are a candidate for scar revision surgery. A lot of times the answer is a quick, easy “Yes” but not always. And when I tell the patient that I can’t help they are usually fairly unhappy so I want to go over what I, as a plastic surgeon, am thinking when I see a scar.
First, I want to know how old it is. It takes at the very least 6 months to get a good idea of what a scar may turn out like. A lot of times what looks pretty bad at a month or two ends up looking quite good by the 9-12 month point. 1 year is the usual point where I will consider a surgical revision.
Secondly, I want to know the circumstances that left the scar. If the scar resulted from a traumatic laceration I am more willing to consider revision. Traumatic lacerations are usually dirty wounds that involve a crush component to the wound edges. This is not very favorable and can leave a worse scar. If on the other hand, the scar resulted from a surgical procedure I am not quite as willing to take a revision on because the wound was already repaired by a trained surgeon under ideal circumstances.
Third, the location of the scar is important. Any scar over a joint, on the upper back, or the upper mid chest is not going to heal well no matter who sewed the cut up the first time. These areas are just very unfavorable. So location in important.
Your biology is important. If you have a keloid scar or a hypertrophic scar, well these are errors in wound healing that tend to be genetic. There are some things we can try to defeat these problems but unfortunately, especially with keloids, your genes win and the scar returns. Bottom line is some people just don’t heal as well as others and there is nothing I can do to change that.
Finally, if you have a scar and want it completely gone, well that is impossible. It ranks right up there with getting rid of stretch marks. Sounds good but it isn’t gonna happen.
So if you have a scar and your surgeon tells you “I can’t help” there are a lot of good reasons and probably a lot of experiences behind that statement.
Lee Corbett, MD
Medical Director Corbett Cosmetic Aesthetic Surgery and MediSpa