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

Dr. Shortt preformed a gynecomastia gland removal on me

Dr. Shortt preformed a gynecomastia gland removal on me, I am 20 years old and have been dealing with gynecomastia my whole life, it has caused me alot of pain and discomfort. I am very athletic and fitness is my passion, having these glands affected how I looked cosmetically as well. I was recommended by my doctor to have Dr. Shortt as my surgeon, and I am so happy I was recommended to him. Throughout the process getting ready for my surgery he was extremely knowledgeable and professional providing all the information I needed to know. His staff were very helpful as well and I sent several emails asking questions and always got a reply right away. The surgery itself went really well and I was surprised that there was very little pain following the surgery, I didn’t really need any painkillers. He removed both glands which happened to be quite large from my chest. I saw Dr Shortt for follow up appointments for the first 3 weeks after, we were both extremely happy with how I was healing and the results. In fact, I am blown away by how much better I look, there is no scar at all and no soreness and discomfort like I had before I got the surgery done. I’m impressed, and I haven’t even healed fully yet since I am only 3 weeks out, I am looking forward to the final results because it’s only going to get better from here. This was a life changing surgery for me, I am so pleased I was able to get the opportunity to have such a great surgeon perform it. If you are a male that is looking for a good surgeon to perform this type of surgery, I am confident that you will be beyond happy with what Dr. Shortt can do, I know I was. Thank you.

I highly recommend dr. Shortt, he is very honest.

I highly recommend dr. Shortt, he is very honest. I had a consultation for my son to do his nose he explained everything to us thoroughly and spend enough time with us and answered all our questions.

I had sought a breast reduction to ease the back and neck pain

I had sought a breast reduction to ease the back and neck pain I had endured for years. I had met a few other plastic surgeons over a year period. I had never been comfortable or confident enough to make the decision to have surgery…not until I met with Dr Shortt. I had been afraid of surgery and never felt convinced it was worth it. After my consultation with Dr Shortt , I was excited about how he could help. He made me feel very comfortable. During the initial examination we also spoke about the large deposits of skin and fat under my arms – a constant source of embarrassment and discomfort. I had not worn anything sleeveless in years as they spilled out. He spoke to me about “auxiliary breast tissue removal”. I was thrilled there was something that could be done and both surgeries could be performed together When explaining what the procedure would entail and the recovery time, he spoke with me not at me. He acknowledged my fears and concerns. All my questions had been answered and I knew that surgery was the right decision and he was the right surgeon for me! ( I was so excited about the prospect now that I shared with my daughter now amazing he was – she had also meet other plastic surgeons for implants for herself – she met him and was also so impressed – she had her surgery performed by him as well!) The surgery went well. At all the follow up appointments, he was always timely. You would think being exposed and examined would be uncomfortable, but is wasn’t. He is such a professional and put you at such ease with him that I never had the chance to feel uncomfortable He would exam the areas and scars and instruct how to best take care of them. He shared in my joy and excitement for the difference this had made! I feel better and look better I also want to mention what an amazing team he has as well. Everyone I came into contact with at his office were amazing! I can’t come up with one thing that I feel he could have improved on. Without any hesitation I would, and do, recommend him!

I selected Dr Shortt based on his credentials and experience

At 51 years of age and many, many years of pain, I sought out a Surgeon who would perform for me an OHIP covered Breast Reduction and after a great deal of research, I selected Dr Shortt based on his credentials and experience. Reviewing his past surgery accomplishments, I soon wanted the “Mommy Makeover”. At my first appointment, I was pleasantly surprised by the Dr Shortt’s demeanor. He was found to be very approachable and empathetic. He took the time to explain everything that I needed to know and also answered all of my questions without making it seem a burden. He went through step by step what I would go through during and after my surgery. As a very self-conscious person, he was able to make me feel very comfortable being fully exposed and was professional every step of the way. His Support Staff are all so very courteous and professional. As far as the surgery itself, I would have to say I think that not only is he an excellent Surgeon, he is a Sculptor. I am extremely pleased with the results. The few people that I have shown my stomach and newly formed belly button are astounded at the results. Currently I am 9 weeks post op and feel wonderful and able to go back to the gym. Dr Shortt being a Perfectionist wants another 6mth appt to ensure that I remain am as happy as I am today and that the scarring is as minimal as possible. He has changed my life and I am very grateful. I would and have recommended him to several people already.

I am currently 5 weeks post op and am extremely pleased with my results

I am currently 5 weeks post op and am extremely pleased with my results so far and Dr.Shortt told me if I’m happy with the results so far, wait until I’m finally healed. Dr Shortt is an amazing doctor, his bedside manner is impeccable and at every step of the way he made me feel comfortable and you could tell he genuinely really cared. He took his time to listen to me and my concerns and reassured me he would do his very best, and the results so far are amazing, I am extremely happy and feel amazing. With any big surgery it can be scarey and nervous but Dr.Shortt is very knowledgeable and most of the time had already answered all my questions I had for him and he put me at ease. His staff are amazing to work with too, especially Joanne. Thank you guys, from my very first consult to today you have made this whole experience absolutely amazing. I would highly recommend you definitely go see Dr.Shortt his professionalism and the fact that he actually treats you like a person first shows he really cares.

I am very pleased with the excellent work of Dr. Rodger Shortt

I am very pleased with the excellent work of Dr. Rodger Shortt. His expertise and great manners helped me a lot through the difficult times and multiple operations I went through. As a cancer breast patient, I had two mastectomies for my right and left breasts. Dr. Short joined the surgeon on my second mastectomy and started his wonderful work of inserting the breast tissue expanders. I visited Dr. Shortt’s clinic several times to inject the saline into the breast expanders. During these visits, I appreciated the staff pleasant attitudes and Dr. Shortt recommendations. At the last stage of the process, Dr. Shortt removed the breast expanders and inserted the breast implants and he reconstructed my nipples from my breast skin. I am very pleased with the wonderful job Dr. Shortt has completed. I highly recommend Dr. Shortt and wish him every success with all the patients.

I am so very grateful for all the hard work he did

About 8 years ago I had a lumpectomy leaving my breasts very unbalanced. It has made super uncomfortable about my appearance especially in a bathing suite. Dr. Shortt did an amazing job fixing this. I am so very grateful for all the hard work he did. My girls look like twins instead of cousins. Also, his staff is excellent and caring. I am so happy and recommend him to anyone who needs a good Plastic Surgeon who listens and get the best possible results for his patient.

The above statements are from third party sites.
Dr. Shortt does not control any third party websites and is therefore not responsible for the content of third party sites.
They are provided as a source for your review and discretion.

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