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.

Reviews

I recently received breast augmentation and am extremely happy with the results

I recently received breast augmentation and am extremely happy with the results! Dr. Shortt and his staff are wonderful and very talented. I definitely recommend this surgeon to anyone who is interested in cosmetic surgery.

Dr. Shortt is a very talented and compassionate doctor

Dr. Shortt is a very talented and compassionate doctor. He takes the time to listen to your concerns, and he lets you know what’s possible and what isn’t – he will never do something that will make you look fake or “done.” Dr. Shortt likes to say that he will make you into a better version of yourself, not someone else. He goes above and beyond to achieve your goals and truly cares about his patients.

I had a septorhinoplasty done to correct my breathing and the appearance of my nose. I have always been insecure about the size and shape of my nose – I had a bit of a bulbous tip and a prominent dorsal hump. I am so thrilled with the results of my surgery! In addition to breathing better, I am also feeling a lot more confident. I used to freak out if anyone took a photo of me from the side, but now I actually encourage it!

The support staff at Briarwood are wonderful, too. They make the experience comfortable and easy.

I am extremely happy that I finally took this step

I just want to say Thank you so much for doing such a wonderful job on my tummy tuck (abdominoplasty). I am very pleased! The care I received prior to, during, and after my surgery has been great. Dr. Shortt and the stuff at Briarwood cosmetic surgical centre have been very thorough and detail oriented when tending to my needs, concerns and questions. I am extremely happy that I finally took this step and LOVE my results. I wouldn’t have changed a thing and am glad I chose Dr. Shortt for my surgery.

Dr Shortt did an awesome job

I recently had a breast reduction and am so happy with the final result – Dr Shortt did an awesome job!

Dr Roger Shortt is a Genius, I am so happy with the result

I recently had a scar revision surgery to repair scars from a bilateral mastectomy. Dr Roger Shortt is a Genius, I am so happy with the result it is more than I could have hoped for. I am so grateful to Dr Shortt for his empathy kindness and professionalism. His staff reflected that image and were helpful, knowledgeable and efficient. Even though I had a bilateral I feel very happy when I see myself in the mirror. That says everything.

Best Choice I Made!

The stretch marks, loose skin and a deformed belly button from my twin pregnancy really affected my self confidence. Dr. Shortt helped me get that “old me” feeling back! He is patient, professional and truly cares for you during the recovery process. I always felt that Dr. Shortt and his team were there when I needed questions answered. Before I went for my surgery, I had no idea how important the weeks and months after would be. Now, I couldn’t be happier that I chose Dr. Shortt to be my doctor. He also makes sure that you know what to expect and that made the journey so much easier for me. Best choice I made! I finally feel like myself again.

Extremely pleased to share my recent experience with Dr. Shortt

Extremely pleased to share my recent experience with Dr. Shortt and his professional staff. The entire experience was more than I had hoped it would be. From beginning consultation to follow-up visits. Dr. Shortt and his staff are highly recommended for any results you are hoping to achieve. This team is the very best!

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