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

You can tell the enthusiasm and passion Dr.Shortt has for his work

From the get go the professionalism and expertise I had received far surpassed those from other consultations I had done. I had gone in for a breast augmentation and am amazed from the results. You can tell the enthusiasm and passion Dr.Shortt has for his work. He had stated that afterwards my breast would look “perfect”, I figured anything would be better then what I had. Unbelieving then, here I am now absolutely thrilled with the results. I had a tattoo where the implant incision would be, to my surprise Dr. Shortt was able to work around it as well.

Breast Augmentation – What an Amazing Doctor !

From the get go the professionalism and expertise I had received far surpassed those from other consultations I had done. I had gone in for a breast augmentation and am amazed from the results. You can tell the enthusiasm and passion Dr.Shortt has for his work. He had stated that afterwards my breast would look “perfect”, I figured anything would be better then what I had. Unbelieving then, here I am now absolutely thrilled with the results.

I had a tattoo where the implant insission would be, to my surprise Dr. Shortt was able to work around it as well.

The day of my surgery Dr. Shortt and his team made me feel very comfortable and well taken care of. Thank you again !

Dr. Shortt has a great eye and is a creative visionary

Everyone reacts differently to a diagnosis / treatment of breast cancer. For me, after the mastectomy, I no longer felt whole. I decided reconstructive surgery was the answer which was very intense – but no regrets. The results were good but I still felt a little mismatched. My surgeon referred me to Dr. Shortt. Like so many others on this site, I felt like he knew exactly what I was looking for and how to get there. Dr. Shortt has a great eye and is a creative visionary that can determine what need to be done, coupled with the skill to do it. What really differentiates him from the rest though, is his empathy and understanding. You don’t often find doctors who are good at combining the science with compassion. This was a surprising and greatly appreciated aspect of my care. I am 4 weeks post op now and I have to say the results are spectacular. I feel like the sisters have been reunited and I am whole again. If you have had reconstructive surgery and feel you need a little more finessing, take my advice and make it happen. You will be glad you did. I would highly recommend Dr. Shortt to my closest friends and family and to anyone looking for cosmetic improvements.

Thank you again,

Susan

Amazing plastic surgeon

Amazing plastic surgeon who was initially referred to me by another plastic surgeon. From my first consultation, Dr Shortt immediately knew what surgical procedures were the best option for my situation. No hesitation in diagnosis and recommended plan of action. I’m a breast cancer survivor and I thought a breast reconstruction was a lost cause for me due to my extension radiation treatments and consequential skin damage. Dr Shortt was very methodical and professional throughout the entire 18 month process. Before each surgery, I witnessed assertiveness and confidence with a sure hand mapping my body with his sharpie pen. He made me feel at ease with his good sense of humour and music.
My breast cancer journey is at long last over and I am quite happy with the final results. I feel rejuvenated and have gained my confidence back. I am so glad that I didn’t hesitate with my initial decision to go forward with the breast reconstruction. Thank you so much Dr. Shortt.

Nicest doctor ever

Dr. Shortt made my experience so wonderful and easy, he listened to all my concerns and was so helpful with everything. I had small implants put in to correct my tuberous breast and didn’t want too much of a visible change in size, he did exactly that and was so helpful throughout the whole process and made things very easy. I can’t thank I’m enough!

Amazing Experience with Dr. Shortt

I had an amazing experience with Dr. Shortt and his staff. I am so thankful to have had such a skilled surgeon and I am extremely happy with the results and I am glad I went through with the procedure/ chose Dr. Shortt as my surgeon. When I went for my pre-op check-up with my GP he asked who my surgeon was and when I told him it was Dr. Shortt he said that Dr. Shortt is a very good surgeon/ “one of the best.” The consultation process was excellent, I had more questions than the average patient. I asked specific questions about the procedure and the techniques that he uses for the surgery and he was more than happy to answer all my questions and let me know that I could come back for further consultations if I had more questions etc.

I highly recommend Dr. Shortt

I highly recommend Dr. Shortt. I recently had laser surgery on my face and am very pleased with the results. Dr. Shortt was patient, understanding and answered all my questions during our consultation. I later had some concerns about the surgery and Dr. Shortt listened to them and modified the procedure for me. I felt completely confident in his skill, expertise and professionalism and am very glad I went ahead with the surgery.

Feel and look better than ever before.


LET’S DISCUSS YOUR OPTIONS CONTACT US TODAY.