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SCAR REMOVAL     When the skin is in the process of recovering from an injury, whether the result of an accident, surgery, a burn, or acne, scarring will occur wherever multiple layers of the skin have been affected. Once a scar forms, it is permanent but may be made less visible or relocated surgically.   With very few exceptions most people are self – conscious about facial scars. Some people may also experience diminished functioning of eyes, mouth or nose due to scarring. If you’ve wondered how facial scar revision could improve your appearance, your self – confidence, or your level of facial functioning, you need to know how scar revision works and what you can expect from this procedure.   FACIAL SCARS   Because of its location, a facial scar is frequently considered a cosmetic problem, whether or not it is hypertrophic. There are several ways to make a facial scar less noticeable. Often it is simply cut out and closed with tiny stitches, leaving a thinner, less noticeable scar. If the scar lies across the natural skin creases (or “lines of relaxation”), the surgeon may be able to reposition it to run parallel to these lines, where it will be less conspicuous.   Some facial scars can be softened using a technique called dermabrasion, a controlled scrapping of the top layers of the skin using a hand – held, high – speed rotary wheel. Dermabrasion leaves a smoother surface to the skin, but it won’t completely erase the scar.   Z – Plasty is a surgical technique used to reposition a scar so that it more closely conforms to the natural lines and creases of the skin, where it will be less noticeable. It can also relieve the tension caused by contracture. Not all scars lend themselves to Z- plasty, and it requires an experienced plastic surgeon to make such judgments.   Skin grafting, flaps, low- dose steroid injections can also help in selected cases. Scars that are well settled and not very prominent can be concealed with cover- up make up too.   KELOID SCAR   Keloids are thick, puckered, itchy clusters of scar tissue that grow beyond the edges of the wound or incision. They are often red or darker in color than the surrounding skin. Keloids occur when the body continues to produce the tough, fibrous protein known as collagen after a wound has healed.   Keloids can appear anywhere on the body, but they’re most common over the breast bone, on the earlobes, and on the shoulders. They occur more often in dark – skinned than in those who are fair. The tendency to develop Keloids lessens with age. Keloids are often treated by injecting a steroid medication directly into the scar tissue to reduce redness, itching and burning. In some cases, this will also shrink the scar.   If steroid treatment is inadequate the scar tissue can be cut out and the wound closed with one more layers of stitches. This is generally an outpatient procedure, performed under local anesthesia. You should be back to work in a day or two, and the stitches will be removed in a day or two, and the stitches will be removed in a few days. A skin graft is occasionally used, although the site from which the graft was taken may then develop a Keloid.   No matter what approach is taken, Keloids have a stubborn tendency to recur, sometimes even larger than before. To discourage this, the surgeon may combine the scar removal with steroid injections, direct application of steroids during surgery, or radiation therapy or you may be asked to wear a pressure garment over the area for as long as a year. Even so, the keloid may return, acquiring repeated procedures every few years.   IS FACIAL SCAR REVISION FOR YOU?   The most basic requirement for, all surgery is good health. Other requirements are more subtle and should be carefully considered in discussion with your surgeon. Expectations of the surgery and of the surgeon must be realistic. A person considering facial scar revision must understand that there, is no way to remove scars completely. The goal is to remove the appearance of the scar either by disguising it or relocating it, or minimizing its prominence. Skin color and type, age, and type of scarring, are all important factors that must be part of the discussion prior to surgery.   MAKING THE DECISION FOR SCAR REVISION   Whether the surgery is desired for functional or cosmetic reasons, your choice of a facial plastic surgeon is of paramount importance. Your surgeon will examine the scar in order to decide upon the proper treatment and inform you of outcomes that can be expected from facial scar revision surgery.   Different scars require different treatments. For example, severe burns that destroy large sections of skin cause the skin to heal in a puckered way. As the skin heals, muscles and tendons may be affected in this “contracting” movement. Keloid scars are a result of the skin’s overproduction of collagen after a wound has healed. These scars generally appear as growth in the scar site. Hypertrophic scars, unlike keloids, do not grow out of the boundaries of the scar area, but because of their thick, raised texture, can be unsightly and may also restrict the natural movement of muscles and tendons.   Some facial scars are unattractive simply because of where they appear on the face, while others affect facial expressions. All surgical possibilities will be discussed in the initial consultation along with risks involved for each type of scarring . The agreement between you and the surgeon on how to proceed is a prerequisite for successful surgery. After you both decide to proceed with scar revision, he will inform about the anesthesia, the surgical facility, any secondary surgeon, options and costs.   Because scars are highly individualistic and the patient’s attitude towards scar is personal, maximum improvement in facial scars may require more than one procedure, and more than one technique may be employed.   AFTER SCAR REVISION   As you heal, keep in mind that no scar can be removed completely; the degree of improvement depends on the size and direction of your scar, the nature and quality of your skin, and how well you care for the wound after the operation. If your scar looks worse at first, don’t panic – the final results of your surgery may not be apparent for a year or more.