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THE PROCEDURE

Medications are administered for your comfort during the surgical procedures. The options include local sedation, intravenous sedation and general anesthesia. Your doctor will recommend the best option for you.
Topical treatments, such as gels, tapes or external compression, can help in wound closure and healing, or to reduce the ability of skin to produce irregular pigment. These products may be used to treat existing surface scars and discoloration, and to aid in healing of scar revision procedures.
Injectable treatments are often used to fill depressed or concave scars. Depending on the injectable substance used and your particular scar conditions, results may last from three months to several years. Therapy must be repeated to maintain results. One form of injection therapy uses steroidal-based compounds to reduce collagen formation and can alter the appearance, size and texture of raised scar tissue.
Surface treatments are most often used for cosmetic improvement of scars. These methods can soften surface irregularities and reduce uneven pigmentation. Surface treatments are a controlled means of either mechanically removing the top layers of skin or changing the nature of tissue. 
These treatment options include:
• Dermabrasion is a mechanical polishing of the skin.
• Laser resurfacing changes the surface of the skin that allow new, healthy skin to form at the scar site.
• Chemical peel solutions penetrate the skin's surface to soften irregularities in texture and color.
• Excisiion Surgically removes a scar. Closure of the resulting surface wound is referred to as “simple” closure. Layered closure is used where excision extends to tissue below the skin surface or in areas with a high degree of movement. The first step, or layer, requires sub-dermal closure (below the skin surface) with absorbable or non-removable sutures. Layers of closure continue to build, concluding with closure of the remaining surface wound.
Advanced techniques in scar revision include complex flap closure to reposition a scar so that it is less conspicuous, or improve flexibility where contracture has restricted mobility.
Z- plasty is a flap technique that involves a “Z” pattern incision with multiple angles. This creates angled flaps on either side of the original scar site that can completely reposition or change scar direction, interrupt scar tension, or improve scar flexibility.
 Skin grafts or pharmaceutical tissue substances are used if there is not enough healthy tissue present for closure of a scar excision. This is more likely with revision of severe burn scars. The graft may consist of healthy skin from other areas of your body, such as the abdomen or thigh.
Tissue expansion can be a substitute for skin grafts. In this procedure, an inflatable balloon called a tissue expander is placed under the skin near the scar site. The balloon is slowly filled with sterile solution to expand the area of healthy skin. Once the skin has been stretched sufficiently, the expander is removed and new skin replaces the adjacent scarred tissue. 

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