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Vaishali B. Doolabh, M.D., F.A.C.S.
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Contemporary
Plastic Surgery |
4221
Southpoint Parkway
Jacksonville, Fl 32216 |
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Scar Revision |
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Scars - whether they're caused by
accidents or by surgery - are unpredictable. The way a
scar develops depends as much on how your body heals as
it does on the original injury. Many variables can
affect the severity of scarring, including the size and
depth of the wound, the blood supply to the area, the
thickness and color of your skin, and the direction of
the scar.
While no scar can be removed completely, Dr. Doolabh can
often improve the appearance of a scar, making it less
obvious through the injection or application of certain
steroid medications or through surgical procedures known
as scar revisions. Dr. Doolabh might perform Z-plasty,
Skin grafting or Flap surgery on: Keloid Scars,
Hypertrophic Scars, Contractures and Facial Scars. |
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Keloid Scars |
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Keloids are thick, puckered, itchy
clusters of scar tissue that grow beyond the edges of
the wound or incision. They are often red or darker in
color than the surrounding skin. Keloids occur when the
body continues to produce the tough, fibrous protein
known as collagen after a wound has healed.
Keloids can appear anywhere on the body, but they're
most common over the breastbone, on the earlobes, and on
the shoulder. They occur more often in dark-skinned
people than in those who are fair. The tendency to
develop keloids lessens with age.
Keloids are often treated by injecting a steroid
medication directly into the scar tissue to reduce
redness, itching and burning. In some cases, this will
also shrink the scar. If steroid treatment is
inadequate, the scar tissue can be cut out and the wound
closed with one or more layers of stitches. You should
be back at work in a day or two, and the stitches will
be removed in a few days. A skin graft is occasionally
used, although the site from which the graft was taken
may then develop a keloid.
No matter what approach is taken, keloids have a
stubborn tendency to recur, sometimes even larger than
before. To discourage this, Dr. Doolabh may combine the
scar removal with steroid injections, direct application
of steroids during surgery, or radiation therapy. Or you
may be asked to wear a pressure garment over the area
for as long as a year. Even so, the keloid may return,
requiring repeated procedures every few years. |
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Hypertrophic Scars |
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Hypertrophic scars are often
confused with keloids, since both tend to be thick, red
and raised.
Hypertrophic scars, however, remain within the
boundaries of the original incision or wound. They often
improve on their own - though it may take a year or more
- or with the help of steroid applications or
injections.
If a conservative approach doesn't appear to be
effective after approximately 9 months, hypertrophic
scars can often be improved surgically. Dr. Doolabh will
remove excess scar tissue, and may reposition the
incision so that it heals in a less visible pattern. You
may receive steroid injection during surgery and at
intervals for up to two years afterward to prevent the
thick scar from reforming. |
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Contractures |
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Burns or other injuries
resulting in the loss of a large area of skin may form a
scar that pulls the edges of the skin together, a
process called contraction. The resulting contracture
may affect the adjacent muscles and tendons, restricting
normal movement.
Correcting a contracture usually involves cutting out
the scar and replacing it with a skin graft or a flap.
In some cases a procedure known as Z-plasty may be used.
And techniques, such as tissue expansion, are playing an
increasingly important role. |
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Facial Scars |
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There are several ways
to make a facial scar less noticeable. Often it is
simply cut out and closed with tiny stitches, leaving a
thinner, less noticeable scar. If the scar lies across
the natural skin creases (or "lines of relaxation"), Dr.
Doolabh may be able to reposition it to run parallel to
these lines, where it will be less conspicuous.
Some facial scars can be softened using a technique
called dermabrasion, a controlled scraping of the top
layers of the skin using a handheld, high-speed rotary
wheel. Dermabrasion leaves a smoother surface to the
skin, but it won't completely erase the scar. |
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Z-plasty |
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This surgical technique
is used to reposition a scar so that it more closely
conforms to the natural lines and creases of the skin,
where it will be less noticeable. It can also relieve
the tension caused by contracture. Not all scars lend
themselves to Z-plasty; only Dr. Doolabh will be able to
judge. |
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The Procedure For Z-plasty
Scar Revision |
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In this procedure, the
old scar is removed and new incisions are made on each
side, creating small triangular flaps of skin. These
flaps are then rearranged to cover the wound at a
different angle, giving the scar a "Z" pattern. The
wound is closed with fine stitches, which are removed a
few days later.
While Z-plasty can make some scars less obvious, it
won't make them disappear. A portion of the scar will
still remain outside the lines of relaxation. |
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Skin Grafting and Flap
Surgery |
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Skin grafts and flaps
are more extensive than other forms of scar surgery. The
treated area may take several weeks or months to heal,
and a support garment or bandage may be necessary for up
to a year. |
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The Procedure For
Grafting |
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Grafting involves the
transfer of skin from a healthy part of the body (the
donor site) to cover the injured area. The graft is said
to "take" when new blood vessels and scar tissue form in
the injured area. While most grafts from a person's own
skin are successful, sometimes the graft doesn't take.
In addition, all grafts leave some scarring at the donor
and the recipient sites.
Flap surgery is a complex procedure in which skin, along
with the underlying fat, blood vessels, and sometimes
the muscle, is moved from a healthy part of the body to
the injured site. In some flaps, the blood supply
remains attached at one end to the donor site; in
others, the blood vessels in the flap are reattached to
vessels at the new site using microvascular surgery.
Skin grafting and flap surgery can greatly improve the
function of a scarred area. |
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After the Procedure For
Grafting |
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Keep in mind that no
scar can be removed completely; the degree of
improvement depends on the size and direction of your
scar, the nature and quality of your skin, and how well
you care for the wound after the operation. If your scar
looks worse at first, don't panic - the final results of
your surgery may not be apparent for a year or more. |
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If you have any questions, or wish to schedule a consultation with Dr. Doolabh, please call Contemporary Plastic Surgery today at
904.854.4800. |
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