Who is a candidate?
Anyone who has a scar that can be improved in appearance. To be clear, scar revision involves surgically removing an old scar, and replacing it with a scar that is less noticeable (*There are also nonsurgical techniques to improve the appearance of a scar, such as Pixel laser resurfacing, “photofacial laser” to improve red/brown pigment from scars, or Micro-needling to help color and texture).
The most common reasons for scar revisions are to improve upon a scar that is raised or puffy (hypertrophic scar), discolored (pink/red/brown/purple), pulling on adjacent skin or underlying tissue, indented or depressed compared to adjacent tissue, or located or oriented in a poor position.
Bad scars can be the result of trauma or surgery. There are many reasons people form bad scars, and some of the causes can be controlled (how a wound is closed), and some cannot be controlled (your genetics and how well you heal).
The good thing is there is often a way to make scars better, and there are also measures you can take to give your scar the best chance at healing well (products to decrease tension such as Embrace, sun protection, silicone gels, etc).
Will insurance cover scar revision?
Insurance typically covers scar revision, but each case is evaluated on a case by case basis.
If the scar is hypertrophic, causing pain, or causing functional limitations, revision of the scar is often covered by insurance.
Dr. Patel will submit to insurance for preauthorization on your behalf.
Risks of scar revision
The standard surgical risks include pain; bleeding; infection; scarring; painful or hypertrophic scarring; hematoma; seroma; injury to vessels, nerves, surrounding structures; asymmetry; poor cosmetic result; contour irregularity; prolonged edema, numbness, parasthesias; need for further procedure and out of pocket costs; and risks of anesthesia.
Who is not a good candidate for scar revision
If a scar resulted from otherwise favorable conditions (appropriate surgical closure, lack of tension on the wound, good postoperative care), it is possible the resulting bad scar is simply a function of genetics and you just make bad scars.
If this is suspected, a scar revision may not be indicated. Also, even if conditions were not favorable, if a surgery is not expected to improve upon the current appearance, it would not be recommended.
During your consultation Dr. Patel will outline what would be the expected outcome of a scar revision in your particular case, and let you know whether scar revision is advised or not.
Postoperative follow-up visits
Visits following surgery typically occur the week after surgery, 2 weeks after that, and then spread out less frequently thereafter.
The schedule is adjusted based on doctor/patient preferences and needs. *For patients who use Embrace scar therapy after the scar revision, visits are weekly for 8 weeks.
If traveling or unable to come weekly, Dr. Patel may instruct you on how to apply Embrace at home and spread out the visits to every other week or as needed.
The time needed for recovery depends on the extent of the scar and scar revision.
If it is a small or minor scar that is revised, recovery time is minimal and does not require activity restrictions. The larger the incision or scar involved, the greater the change of having activity restrictions.
In general, to optimize healing, one must avoid any activity that puts tension or pulls on the scar.
What is Embrace therapy for scars?
Embrace is a scar therapy consisting of silicone sheets that have a mechanism to decrease the tension on the wound (not the same as regular silicone sheets).
Dr. Patel typically recommends starting the therapy 2 weeks after surgery, and applying weekly for 8 weeks (The sheets last anywhere from 5-9 days for most patients).
The thought behind this dressing is that by reducing tension on the wound, the incision is less likely to be hyperpigmented, raised, wide, etc. While it is considered optional (and not covered by insurance), Dr. Patel has noticed beneficial results in patients using Embrace.
Typically Dr. Patel or her Physician Assistant Nicole will personally apply the Embrace therapy at each visit during the duration of therapy, and can also instruct you on home application if needed.