Cosmetic suturing of wounds and scar revisions

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Scar is the method, by which human body closes wounds. Any full thickness skin wound will heal by formation of a scar.

If the cut involves full thickness of skin, there will always be a scar, though if operated by a Plastic Surgeon, it may be fine and difficult to see.

No two patients or injuries are similar. It is possible that your relative may have had a superficial injury, not involving full thickness of skin. Such wounds often heal without scar. Or he may have had a full thickness skin injury, but the scar may be difficult to see.

Yes. Plastic Surgeons employ gentle tissue handling, are used to working with fine sutures and under magnification. They are also experts in cosmetic surgery procedures. Therefore, they are the ones, often called to suture the cuts (lacerations) in cosmetically important areas such as face. After Plastic Surgery, the scars are often fine and difficult to see. However, Plastic Surgeons cannot alter the universal response of human body, of healing wounds with scar tissue. They also can�t change the position of the cut to a cosmetically less important area. As a result, the scar, though fine will always be there.

Yes. Plastic surgeons are aware of resting skin tension lines and direction of forces. They will often change the orientation of a scar to make it parallel with resting skin tension lines. They will also, sometimes introduce a break in scar such as z plasty, wherever the scar crosses joints, features, contours, so as to avoid straight line contractures of scars.

Once the suturing has been done, your Plastic Surgeon will advised you of followup schedule. Although variable, Plastic Surgeon remove most of the skin sutures by 3 to 4 days post surgery. Then there is a variable period of wound support with the help of steristrips/ tissue glue, followed by few weeks of massage and ointment applications.

Immediately after healing, most scars show up as a fine reddish line. In the few weeks afterwards, it becomes pale. Some scars however remain red or become darker, firm, rise above the surface of skin and start to itch. This is known as hypertrophy. Scars also become wider with time and this factor is dependent on muscle or joint forces, working across it. Scars which cross a joint or contour, often become raised, firm and may limit the movement of joint. This is known as contracture.

Scar hypertrophy can often be prevented by massage of various medicines, silicone gel or sheet application, use of pressure garments. For widening, besides the surgical technique, there is no practical long term solution as one cannot limit the movements of a joint for long time.

In Plastic and Cosmetic Surgery, whenever new procedures are done, the incisions are designed to be in cosmetically inconspicuous or hidden areas. For example, a cosmetic surgery of nose (cosmetic rhinoplasty) is carried out mainly with incisions inside the nose. Though, this makes the procedure more complex, the final scar remains in a hidden location. Similarly, a face lift surgery is carried out with incisions at junction of ear and face, extending behind the ear and up into hairline and not directly through cheek skin. This makes the resultant scar very difficult to see.

The procedure of improvement of pre existing scar is known as scar revision.

You will need to bring the relative for a consultation with Plastic Surgeon. If the scar is already a fine line, does not feel firm to finger, is not near any feature such as mouth or eye and is not near any contour such as jaw line, it often can’t be improved further surgically. It can be made slightly better by methods such as dermabrasion or laser resurfacing. However, your Plastic Surgeon is the best person to determine this.

In case of recent scars, it may be better to wait for a period of around 3 months in order for these to improve, without resorting to surgery. This waiting period can often be utilized to improve scars by non surgical means such as massage, ointment applications, silicone gel sheets and pressure garment therapy.

The scars can be revised by various methods. The scar can be surgically removed and surrounding skin edges advanced to close the defect. Fine sutures and cosmetic surgery techniques are utilized to produce a good result. This method is the best technique for scar revision. It can however be used only case of thin or small scars. In wide scars, use of this method may give rise to significant tension at edges or distortion of features, which are not acceptable. Sometimes, the direction of scar can be changed by methods such as a Z Plasty, to bring it in line with a natural skin crease. Other methods that can be used are, to bring in skin or tissue from adjacent or distant sites in the body. Another widely used method for scar revision is tissue expansion. In this technique, a silicone balloon (expander) is surgically implanted, next to the scar. It has a tubing, connecting it to a port, which is placed in an easily accessible subcutaneous location. After surgery, at interval of every few days, saline is injected in this port. This leads to expansion of the balloon, thus resulting in tissue expansion. After a period of few weeks, the tissue expands sufficiently, so that the scar and expander is removed and expanded flap advanced to cover the defect, without significant tension.

Other methods such as application of ointments, massage, pressure garments, silicone gel sheets, chemical peels, dermabrasion, laser resurfacing and steroid injections can also be used in selected cases to improve scars.

CASE 1 : Revision of chin scar

CASE 2 : Revision of left cheek scar

CASE 3 : Revision of forehead scar

CASE 4 : Revision of left temporal scar

CASE 5 : Revision of right cheek scar

CASE 6 : Revision of left cheek scar with tissue expansion

CASE 7 : Cosmetic Suturing of Laceration

CASE 8 : Cosmetic Suturing of Laceration

CASE 9 : Cosmetic Suturing of laceration