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

Absolutely hands down the best!

Absolutely hands down the best! Dr Shortt is very skilled surgeon and has a warm, caring personality along with a sense of humour which will keep you at ease throughout the whole process. You are in the best hands should you choose Dr. Shortt. Thank you Dr Shortt and Joanne for making my surgical journey a great experience!

It’s Been 28 Years …

I was reviewing breast transfer procedures on real self. Dr. Shorrt had comment on a previous post. I checked out his profile/website and decided to go for a consultation. I was glad that he actually conducted the consultation. I’ve been to one where the Dr.’s assistant did the initial one. He was very easy to talk , to express your concerns. He was very knowledge. Some doctors are in rush to explain things. “You don’t get a second chance to make a first impression” . I felt very comfortable right away. I knew I wanted him to be my surgeon.

All in all I can not say enough good things about my experience with both Dr. Shortt and his staff

Dr Short t was my surgeon for breast reduction, tummy tuck, bra-line back lift and panniculectomy. I was at ease upon our first meeting. I felt he genuinely was on my side and interested in my well being. Although the surgeries I have undergone have been major , the pain was surprisingly minor. I have had excellent recoveries and shockingly minimal scaring. I could not be more satisfied with having been his patient. I did some research about plastic surgery and costs were in line with others. All in all I can not say enough good things about my experience with both Dr. Shortt and his staff

Thankful for High Standards

I had lost an excessive amount of weight. After success in living a healthier lifestyle I found that the extra skin impacted my health in other ways. Dr Short completed a Belt Lipectomy.
My experience through the consultation visits and pre and post surgery was very positive!
Dr. Shortt was detailed with my questions leaving nothing to my imagination, defining the realities I would experience throughout the process. He was specific through the preparatory work that needed to happen and made me feel connected and comfortable with the procedure.
Dr. Shortt is professional, extremely knowledgeable as a plastic surgeon, and has the ability to communicate to people with clarity during each appointment!
I have also appreciated the office environment and connections with Joanne as she answered my questions with efficiency and genuine care.
Dr. Shortt is highly skilled in what he does, and he has the character of caring and valuing as he speaks with you. Dr. Shortt wants great results for each person and sets a very high standard, in which I am grateful!
I am really happy with the whole process from start to finish and excited about the outcome of having this surgery!
Thank you Dr. Shortt!

I had a bump on my thumb removed by Dr Shortt a few years ago.

I had a bump on my thumb removed by Dr Shortt a few years ago. It was e third time I’d had it removed, as it kept growing back, but since Dr Shortt removed it, it hasn’t returned!

I’m very pleased with the results of my explant surgery.

Dr Shortt was recommended to me for my explant surgery. I was informed he was the best surgeon for the job and that I would be very happy with the results.
We met on a couple of occasions before the surgery and discussed the options of new implants, fat grafting or just an explant. He was courteous, respectful and very knowledgeable.
He respected my decision to just have the explant surgery and didn’t try to sell me on other procedures. He is all about what’s best for his patients. When I had my pre-op at the hospital, the intake nurse couldn’t say enough wonderful things about him and his skills. That solidified it for me.
I’m very pleased with the results of my explant surgery. It was a unique case in that the implants had completely liquified. They were done 8 years ago by another recommended surgeon in Burlington, not Dr Shortt himself. It seems they were just defective.
Dr. Shortt noted that he had never seen any implants come out in that condition. I appreciate that he is following up with the manufacturer to inform them of the situation.
if you are choosing implants, please do your research and educate yourself and if you choose to have them done, Dr. Shortt is your guy.

Dr. Shortt is a true professional, with an amazing bedside manner.

Recently I had Dr Shortt remove a large lump from the back of my leg. His genuinely friendly manner immediately put me at ease.
In the hospital, he explained how the procedure was going to work, which made me feel comfortable. The actual procedure took less than 5 minutes, with no pain. I was completely relaxed, knowing I was in good hands. Dr. Shortt is a true professional, with an amazing bedside manner. I’d trust him to do absolutely any surgical procedure and would feel confident that the outcome would be very successful.

Feel and look better than ever before.


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