Scar Revision
Scars can be occur due to a variety of reasons. Some can heal beautifully naturally, whist others may look unsightly.
Scars can be caused by:
- Previous surgery
- Traumatic injury
- Burns
- Infections
- Piercings
- Other skin conditions such as vasculitis, diabetes, dermatitis, allergies, etc.
People seek scar revision for a variety of reasons which may include:
- For improved cosmetic appearance
- For functional reasons where scars may be itchy, painful or restrict movement of joints
- For recurrent breakdown of a scar, or worry that the area is not healing.
- For treatment of hypertrophic or keloid scars
How one scars is related to both the cause of the original scar, as well as the patient’s genetics, skin colour, genetic background and how the wound healed after the scar was made.
Normal scars become less pink and flatter with time. The best scars are as thin as possible, flat, and white in appearance. Scars are often darker or pigmented in people from Asian, subcontinental, or African backgrounds.
Normal scars may require revision if:
- They create a cosmetic problem – for example a distortion of a facial feature
- Cause a functional problem such as movement of joints
Hypertrophic scars have the following features:
- Unlike normal scars these are
- Pink and elevated
- Can be itchy
- Can be pigmented
- Have failed to flatten over time
- Unlike keloid scars
- They do not continue to grow beyond the boundaries of the original scar
- Hypertrophic scars generally respond well to treatment
Keloid scars
- Unlike both normal and hypertrophic scars, keloid scars
- Are raised, pink and have enlarged well beyond the site of the original scar/injury
- They often continue to grow
- They can continue to be itchy and painful
- Can be disproportional to the site of original injury/trauma
- Can exhibit periods of rapid growth during hormonal changes e.g. pregnancy
- Keloid scars can be problematic to treat as surgery alone is often associated with 100% recurrence. Therefore multi-modal treatment is utilised depending on the patient, location and size of the scar and can include
- Surgery
- Steroids
- Pressure
- Radiotherapy
The best candidates for scar revision are those who:
- Are physically and mentally healthy
- Have realistic expectations
- Understand that scar management is just as important as surgery
- Are willing to accept the risks of surgery including scar recurrence
We can perform scar revision in our rooms at Gordon, under local anaesthetic. Alternatively (especially for larger scars) these can be performed in a day surgery or hospital setting.
- Anaesthetic: LA, Assisted local or general anaesthetic.
- Time: Depends on the scar and treatment involved.
- Hospital: May be possible to be performed in our rooms at Gordon, or in a day surgery/private hospital setting.
- Medicare/Health fund rebate: Yes
- A small Medicare rebate may be available for in rooms procedures
- A Medicare/health fund rebate is available if performed in day surgery/private hospital however you may need to take into account the excess on your medical insurance policy.
- Recovery: You may get some bruising or swelling at the site for a few days, but most of this has resolved by one week. If on the face, external sutures are removed early around the 1 week post-operative mark.
- Results: Usually excellent although final scar results vary according to skin colour, type and genetic background. You will be given instructions on how to improve the scar after the wound has healed at the 2 week mark, and these need to be followed for around 3 months for optimal scar results.
Procedure Information
Smaller procedures can be performed under local anaesthesia in our Gordon rooms whist larger procedures may require sedation or general anaesthesia and these are performed in a day surgery or private hospital setting.
- Most often the scar is excised either as a straight or zig zag line.
- For keloid scars the scar is placed within the existing scar, taking care not to breach normal skin.
- In some cases it may be necessary to import tissue using local flaps, and Dr Aggarwal will speak to you regarding the design of these flaps and the scars these will entail, pre operatively.
- The skin is closed in layers
- In some cases steroid medication will be placed at the surgical site at the time of surgery.
- Dr Aggarwal will place dressings over the incisions.
- You will be able to get the area wet after 48 hours. However you will not be allowed to swim in a pool or beach for at least 2 weeks after surgery.
- You will be given a script for antibiotics by Dr Aggarwal which you must continue for 1 week (if needed). You will also be given appropriate pain relief medications.
- While most sedentary activities can be resumed when you go home, you must not perform any activities that raise your blood pressure for the first 48 to 72 hours.
- Dr Aggarwal will see regularly after your discharge from hospital.
- Some patients who are at high risk of bad scarring will be reviewed 6 weekly and may have doses of steroid injected at the surgical site at these visits.
Risks & Complications
Every surgery carries risks, and therefore one must consider if risks outweigh the benefits for your own personal situation. If they do then the surgery may be well worth it. Dr Aggarwal will discuss the pros and cons of surgery with you during your consultation.
- Risks of anaesthetic – some scar surgeries are performed with local anaesthetic while others are performed with assisted local anaesthetic (with sedation) or under general anaesthetic. There is a small chance of a reaction to the local anaesthetic or with general anaesthesia.
- Bleeding – the risk is higher in those on blood thinning medication. Dr Aggarwal will discuss with you what you need to do with blood thinners and discuss the pros and cons of ceasing or continuing your medication. Dr Aggarwal may need to consult with your GP, cardiologist or other physicians involved in your care before a decision to change your medication is made. Any bleeding is controlled during surgery however unexpected bleeding can occur in the immediate postoperative period. If this occurs it can usually be controlled through direct sustained pressure.
- Infection– this is rare. You may be given a course of oral antibiotics after your surgery, depending on your surgery, to keep this risk to a minimum.
- Poor scarring: in general people with bad scars are at risk of the same thing happening after surgery. Therefore we often combine surgery with other scar management techniques including scar massage, silicone, pressure therapy, steroid medication, and in extreme cases radiation (reserved for the worst of keloid scarring).
- Regular follow up therefore is important in scar revision
- It is also paramount to be religious with scar management as this can be as important as the surgery itself in achieving a good long term scar.
Procedure FAQs
- Yes, firstly it is possible to claim a Medicare rebate of approximately $73 for the consultation if you have a referral
- Furthermore, scar revision surgery is associated with Medicare Item Numbers – therefore rebates will be available from Medicare if the surgery is performed in rooms, or from both Medicare and health fund if it is performed in a day surgery or hospital.
- You can see us at our main practice at Gordon, or at one of our other location at Hornsby, Hunters Hill or Camperdown.
- Please scroll to the bottom of the page to find out more information about these locations.
- Surgery may be performed in our Gordon rooms
- It can also be performed at any of the hospitals where Dr Aggarwal works – Sydney Adventist Hospital, SAN Day Surgery, Hunters Hill Private Hospital or Chris O’Brien Lifehouse.
- Cease fish oil, and other supplements such as Ginkgo, Ginseng.
- Please discuss with Dr Aggarwal if you are on blood thinning medications as he will discuss with you if these should be continued or temporarily stopped or altered.
- Stop smoking around the time of surgery and recovery.
- You will be given written instructions regarding these.
- It is common to use Chlrosig ointment for scar revisions on the face (in the first week).
- Dr Aggarwal will give you instructions on scar management to improve the cosmetic results once wounds have healed.
- In general it is best to avoid any activity that raises blood pressure for 48-72 hours after surgery.
- If surgery is performed on your lower limb (leg or foot) it is best to avoid walking as much as possible and elevate the leg whenever you are still to the level of the hip.
- Dr Aggarwal will provide you with the necessary scripts for antibiotics and pain relief.
- Yes
- However we always encourage patients not to be away overseas shortly after having a procedure, and you are best to advise Dr Aggarwal of this preoperatively so the best timing of surgery can be planned.
- You may do gentle swimming in a pool or beach after 2 weeks once all wounds have healed.
- It is best to not drive for the first 1-2 days after sedation or general anaesthetic (if this was used in your mole removal treatment).
- You may be restricted from driving for longer if your surgery was on your legs.
- Yes absolutely.
- This can be performed in our Gordon rooms or in a day surgery setting. However if the procedure is too large for local anaesthesia alone then you will be offered the option of going to a private hospital
- Yes scar management techniques involving scar massage, silicone, pressure therapy are essential to good scar formation. These are just as, if not more important, than surgery itself.
- In general scars that are less than 12 months old, should not have repeat surgery but instead employ maximum use of scar management techniques. As the scar matures it remodels and the scar may improve over this period. In some cases steroid medication may be used to as a non-surgical means to improve the symptoms and appearance of bad scars.
Procedure Pricing
- The cost for scar revision surgery is completely dependent on the nature of the initial scar, the location, extent of surgery required as well as if complex reconstruction using local flaps or grafts is needed.
- In general at Mode Plastic Surgery, we follow the guidelines for fees set out by the Australian Medical Association.
- If the procedure is performed in our Gordon rooms, there will be a facility fee ($250) charged for coverage of our sutures, sterilising, and nursing staff.
- We will provide you with a written quote before proceeding with surgery.
Meet Dr Aggarwal
Dr Aggarwal is a well regarded, respected, highly skilled and experienced Specialist Plastic Surgeon. Graduating at the top of his class throughout his training, Dr Aggarwal has completed fellowship training at some of the world’s most prestigious reconstructive and cosmetic plastic surgery institutions. He continues to publish research is prestigious plastic surgery journals, and is actively involved in the training of future plastic surgeons.
What sets Dr Aggarwal apart from others is his personal, affable and warm nature. Not only does he pay attention to detail, to producing natural, beautiful results but he ensures that the patient’s journey is just as special as their outcome. Dr Aggarwal looks after patients at two of Sydney’s most prestigious public hospital campuses (RPA and POWH/RHW), and operates privately on the North Shore.
Why Choose Us
Highly Skilled
Highly skilled Fellowship Trained Plastic surgeon – know you are in the safest of hands with a Plastic Surgeon who is experienced, highly respected, and appointed at premier Sydney hospitals- including the SAN, RPA, POWH and RHW.
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Suite 13, 924 Pacific Highway
Gordon NSW 2072, Australia
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