PATIENT RESOURCES / DR’s Blog

Scar Revision – Surgical and Non-Surgical Procedures

by | Breast Reduction, Plastic Surgery, Scar Revision

As a plastic surgeon I care a lot about scars. My reputation is on the line every time I make an incision in someone. Beyond my reputation, I really want people to be happy. It gives me great pleasure to see a scar heal and be barely visible; it is a competition with myself each time I operate. Although the nature of the surgery and a patient’s genetics influence the final result, it is really important to me that all my patients get the best possible scar they can. Sometimes when I speak to patients about having surgery they tell me that they don’t care what it looks like. I tell them I will care enough for both of us!

What is a scar?

A scar is your body’s way of healing after an injury. Scar tissue forms all through the body, not just the one that you see on your skin. Rather than replacing the injured tissue with the same type of tissue, a scar is a collection of collagen. It comes from a variety of injuries including surgery and trauma.

What is a perfect scar?

All skin heals with a scar after an injury, including a surgical incision. A “perfect” scar however will be very thin, soft, mobile from underlying tissue, and flesh toned. Ideally it will be placed in such a way that it hides in a fold, crease or a natural transition point from one area to another. Over time, you should have to struggle to find it.

What makes a scar look bad?

We all know what a crummy scar is when we see it. There are a number of different things that can make a scar look less than ideal. It can be thickened and raised (hypertrophic). It can grow beyond the confines of the original injury (keloid). It can be bright pink or even purple. It may have pigment and look darker than surrounding skin. Sometimes it is deformed and tethered, causing additional cosmetic or functional concerns. Other times, it may be flat and flesh coloured, but be thinned-out and wide.

How to ensure perfect scars?

There is no way to ensure perfect scars! However, as a plastic surgeon, I make it my mission to try. There are many things that I do during surgery, in the immediate post-operative stage, and in a more prolonged fashion to create the best possible scars:

  • During surgery it is important to handle the tissue very delicately. Pinching hard or stretching it too much with a retractor will affect the final quality.
  • Avoiding any injury from the cautery is also very important, and precise use is critical.
  • The next and possibly most important step is to prevent any tension on the skin. Skin tension leads to thick scars. This is probably the biggest difference between plastic surgeons and other doctors in terms of obtaining a perfect scar.
  • Whereas many doctors may put sutures in the skin to close a wound, the plastic surgeon rarely would. Instead we usually use a deeper layer of closure to take tension off the wound before we close the skin.
  • For some surgery, such as an abdominoplasty, I use up to 4 separate layers of sutures so that by the time I get to the outer skin layer there is virtually no tension at all.
  • At the end of the case and for the next several weeks, I apply and reapply a dressing that keeps the tension off the incision. This is also very different, than what many doctors would do, who do not recognize the importance of minimal tension during the early healing process.
  • After about 3 weeks, I start patients on silicone strips and a prescription scar cream that I created with my pharmacist. It has 4 different medications that all help limit excessive scarring. I also show them techniques of scar massage to improve the feel and appearance of a scar.
What can be done if a scar is still not ideal?

There are several things that I do to try and fix a scar, depending on the problem:

  • This includes lasers such as IPL or BBL to lighten the colour of the scar. Different wavelengths can be used for this depending on whether it a pink/purple scar or a pigmented scar.
  • I may use Profractional to ablate the scar and soften it.
  • Sometimes I will use a combination of all the above and some topical steroid that I rub into the scar following laser treatment.
  • If this doesn’t work, there is always the option of steroid injections into the scar or a scar revision.
  • I also make sure that patients continue to use silicone, the prescription scar cream and massage techniques.
  • In extreme cases, a scar revision may be followed with a mild dose of radiation treatment to prevent keloid recurrence.
What is a scar revision?

A scar revision can be done under local anaesthetic or general anaesthesia, depending on the nature of the problem. The scar is excised. The tissue is then freed-up so that it is no longer tethered to underlying muscle or bone. Releasing the skin and deep tethering allows the tissue to be brought together with less tension. A multi-layered closure is then performed to minimize any scar tension and maximize the chances for a great scar.

Sometimes I see scars that were placed in the wrong location or direction. I will often re-orient a scar to better hide it in a crease or wrinkle. Other times, I will reposition it to hide it under clothing as in patients that have an unsightly C-section scar. I then proceed to care for the scar the same way I mentioned above.

What is the most common scar revision I do?

The most common scar reason I see people in my office is for scars on the abdomen or breasts. The abdominal scars may be from past surgeries or a C-section. Often the C-section scar will tether the above skin creating an odd looking shelf of redundant skin. Sometimes this scar can be excised and re-closed to give a smoother contour and a finer scar. Other times the amount of scar can be better treated with an abdominoplasty. This is an especially good option if someone has excess skin and fat and is interested in overall cosmetic enhancement to the area, not just the scar. It is a personal choice that I help patients come to after explaining the pros and cons of their different options.

The breast scars I see are usually in patients whom had past surgeries including breast reductions and breast lifts. I also commonly see patients after a lumpectomy or breast reconstruction that does not look ideal.

Are scar revisions covered by OHIP?

Oftentimes OHIP sees scars as a cosmetic concern and does not cover the cost. With that being said, there are times that scars are covered; this may require a letter from me to the Ministry of Health asking for funding.

How do I book an appointment?

If you feel your scar is cosmetic in nature, you can call directly to the office to arrange a consultation at 905-849-4282. A fee will apply. If however, you feel strongly that it should be covered by OHIP, then see your own doctor who will send a referral on your behalf.

If you are interested in discussing a scar revision, please contact Dr. Rodger Shortt to arrange an appointment at 905-849-4282 or info(at)drshortt.com.

Dr Rodger Shortt is a plastic surgeon servicing Toronto, Oakville, Mississauga, Burlington, Milton, Hamilton and Georgetown. He strives to provide his patients the best care and excellent plastic surgery results. He is one of only a few plastic surgeons in Canada with a top rating on RateMD, RealSelf and Ontario Doctor Review. Dr Rodger Shortt is a specialist plastic surgeon trained in cosmetic surgery and reconstructive surgery. He specializes in breast surgery, breast augmentation, breast fat transfer, mommy makeover, tummy tuck, body contouring, breast reconstruction and cosmetic surgery of the face. He is the Director of Cosmetic Surgery Training at McMaster University and an Assistant Clinical Professor.

Testimonials

Huge Breasts Be Gone!

Absolutely hands down the best! Dr Shortt is very skilled and has a warm, caring personality along with a sense of humour:) You are in the best hands should you choose Dr. Shortt. Thank you Dr Shortt and Joanne for making this a great experience!

He is a masterful surgeon and he has exceeded my expectations.

Dr. Shortt performed breast reduction/tummy tuck surgery and I am very happy with the results. He is a masterful surgeon and he has exceeded my expectations. I’m a 64 yr. old woman who has lived with shoulder and back pain for years. I decided to have a breast reduction in the hope of easing this discomfort and improving my quality of life in retirement. I was able to discuss questions and concerns easily with Dr. Shortt. He has a quiet, kind manner , complemented by a good sense of humour. I would not hesitate to recommend Dr. Shortt to my family and friends. The office staff are also very professional, friendly and helpful.

Dr Shortt is talented, trustworthy, and kind.

Dr Shortt was has been incredible! I went to him in search of options for correctly my breast asymmetry. I read a lot of reviews for plastic surgeons in and around Toronto and I chose Dr Shortt because his reviews were overwhelmingly positive. Initially, I was interested in fat grafting because I feared an implant would be obvious. At my consultation, Dr Shortt explained the advantages and disadvantages of both options. His opinion was that an implant would actually be the better choice because breast augmentation with an implant is much more predictable and due to the difference in my breasts, I would probably need multiple sessions of fat grafting, which would get quite expensive. After the consultation, I understood why an implant would be the better choice for me and my body. He wrote a letter on my behalf advocating that my surgery be covered by OHIP, the Ontario Health Insurance Plan, and they agreed to cover it! I really appreciated that Dr Shortt was honest about what he thought would make me the most happy (an implant in one side), not what would make him the most money (multiple sessions of fat grafting). Throughout the whole process, he was patient, understanding, and confident. His sense of humour put me at ease on surgery day and I couldn’t be happier with the results of my surgery. I didn’t want bigger breasts, just more symmetrical ones and he managed to balance me out beautifully without even touching my bigger left breast. My surgery was three weeks ago and except for the scar (which is healing beautifully) you can’t even tell I had surgery. My new breast looks and feels great and I can’t stop buying pretty new bras now that any bra will work for me. I can’t wait for bikini season! Dr Shortt is talented, trustworthy, and kind. As soon as you meet him, you’ll see that he truly cares about your happiness. Thank you, Dr Shortt!

I would 100% recommend Dr. Shortt and his staff to anyone who is considering breast reconstruction surgery.

I would 100% recommend Dr. Shortt and his staff to anyone who is considering breast reconstruction surgery. Dr. Shortt is a very knowledgeable, thorough and compassionate surgeon. i
felt comfortable with him from the first consultation appointment. He answered every question we had and was never in a rush. I am very grateful to Dr. Shortt for his expertise and his skills for making me feel like a whole woman again
Thank you so much !!

My experience with Dr. Shortt was great.

My experience with Dr. Shortt was great. I highly recommend Dr Shortt if you are considering any surgery. He did my breast reconstruction twice and each was very professional . He also took care of me after that so no concerns.

He was thorough, professional and clearly is the expert in his field.

I had the great pleasure of meeting Dr. Shortt for my initial assessment this week. My appointment was not only on time, but they were able to accommodate my early arrival. Dr. Shortt was a delight. He immediately put me at ease and was not in a rush. He was thorough, professional and clearly is the expert in his field. This is my second assessment and and I very happy that I held out for this referral.

Thank You Dr. Shortt

I wish I had had a breast reduction sooner; the improvement in how I feel physically and mentally is simply amazing. I could repeat so much of what others have said about Dr. Shortt; he is professional, knowleable and is quick with a funny quip when needed. I appreciate and am so grateful for his skill as a surgeon/artist. Joanne is always friendly and helpful and I appreciate her time in scheduling my surgery. Most definately recommend this Dr. Shortt and his team!

Feel and look better than ever before.


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