Scar Revision

Many patients who have a caesarean section develop tethering of their scar causing a bulge above the scar which, even in slim people, is visible through clothing.  At Cadogan Clinic we have a simple procedure to correct or improve C Section Scars under local anaesthesia: Cadogan Caesar Correction (CCS).

From £4,150 (Fellowship led £2,698)

From £1,900 (Fellowship led £1,235).

Some people produce better scars than others, for example ‘poor scars’ such as hypertrophic or keloid scars stay visible and cause skin irritation for a number of months or years after formation. When these ‘visible’ scars fade they tend to whiten and remain equally visible – unlike a ‘good scar’ which will fade significantly and blend with the tone of the surrounding skin.

We offer both superficial and more invasive treatment options (e.g. surgical, dermatological and aesthetic) to combat bad scars. All scar cases are unique, and as such we can guide you in arranging a consultation with the very best suited specialist for your needs. Whatever your personal requirements, Scar Revision Surgery at the Cadogan Clinic can provide you with the leading experts and techniques for your treatment.

Scar revision surgery is performed to improve the appearance of a scar wherever on the face or body, but it is also often carried out to improve functioning as the formation of a scar can interfere with the movement of muscles and joints. A shortening or tightening of the skin and underlying muscles can accompany severe scars and this is known as contracture. Contractures may interfere with a range of motion and other aspects of joint functioning, as well as deform the shape of the scarred body part or affect the muscles in the face responsible for controlling facial expressions.

AT A GLANCE

• SURGERY TIME: 1 hour (although depends on the complexity of the scar)

• HOSPITAL STAY: Day case

• REASONABLY MOBILE: Immediately

• WASHING: Shower after 1 week, bath after 2 weeks.

• DRIVING: 1 week

• EXERCISE: INCLUDING GYM 2-6 weeks (again depends on the complexity and position of the scar)

• FULL RECOVERY: 2 weeks

• TIME OFF WORK: None

The operation is carried out as a Day case, usually with you asleep, although the occasional patient might prefer local anaesthesia. We use TIVA at the Cadogan Clinic, which is safe and reliable.

Before surgery, the surgeon will mark up the skin with you awake and take standard photographs for the records.

Liposuction alone may be adequate, but if there is floppy skin, it will need be reduced. The markings will determine the amount to be removed and the position of the final scar. This may stretch from the back of the elbow to the armpit. Simply reducing skin in the armpit is rarely adequate. Any surplus fat around the front of the arm or adjacent back or shoulder will be removed by liposuction.

Most of the stitches are likely to be dissolving, but some in the armpit will need to be removed at 10 to 14 days after surgery. Surgeons have their preferences.

SURGICAL EXCISION - This is a procedure in which the surgeon shaves down and cuts out scar tissue to reduce the size of the scar. This technique is most commonly used on large scars that cannot be treated adequately with medications or other nonsurgical means. When excision is done in stages, it is referred to as "serial excision." This is performed if the area of the scar is too large to remove at one time without distorting nearby skin.

FLAPS, GRAFTS, AND ARTIFICIAL SKIN.- Flaps, grafts, and artificial skin are used to treat contractures and large areas of scarring resulting from burns and other traumatic injuries. When there is not enough skin at the site of the injury to cover the incision made to cut out and remove the scar tissue, a skin graft (thin layer of skin) from another part of the body carefully matching colour and texture is placed over the excision site. The graft tissue itself is harvested preserving its own blood supply so that the donor tissue can successfully ‘bed in’ to its new location.

Z-PLASTY AND W-PLASTY. Z-plasty and W-plasty are surgical techniques used to treat scarring contractures and help to minimize the visibility of scars by repositioning them along the natural lines and creases of the skin. They are not usually used to treat keloids or hypertrophic scars. With a Z-plasty, your surgeon makes a Z-shaped incision with the middle line of the Z running along the scar tissue - the flaps of skin formed by the other lines of the Z are rotated and sewn into a new position that reorients the scar about 90 degrees. In effect, the Z-plasty minimizes the appearance of the scar by breaking up the straight line of the scar into smaller units. A W-plasty is similar to a Z-plasty in that the aim is to minimize the visibility of the scar by turning a straight line into an irregular one. The surgeon makes a series of short incisions to form a zigzag pattern to replace the straight line of the scar. The primary difference between a Z-plasty and a W-plasty is that a W-plasty does not involve the formation and repositioning of skin flaps. 

The incision sites are usually very discreet indeed but this does again depend on the complexity of the scar to begin with and the surrounding tissue and the technique employed – in all cases the aim of a scar revision treatment is to minimise the existing wound site, so your surgeon will discuss in detail their preferred techniques during consultation.

It is not uncommon to experience altered sensation following your treatment, this may either manifest in increased sensitivity (apart from the early discomfort of surgery), or the reduction in feeling around the treated area. These changes in sensation usually last for a month or so following surgery.

It іѕ соmmоn to еxреrіеnсе dіmіnіѕhеd (оr lоѕѕ оf) ѕkіn sensation after any ѕurgеrу, not just an arm lift. It іѕ rаrе to еxреrіеnсе permanent changes in sensation аftеr brасhіорlаѕtу, but іt is роѕѕіblе. Liposuction stretches nerves, which recover. Tiny nerves are severed with any skin incision, but they either repair naturally or other nerves nearby take over.

The skin may feel tight, particularly early on, after arm lifting (Brachioplasty), there. This should not last.. Thеrе соuld роtеntіаllу bе lоѕѕ оf rаngе of mоtіоn оf thе ѕhоuldеr. You can avoid this by exercising from early on to maintain this movement.

Most patients can return to work on the third day after surgery. Although it is recommended that you take a few days off work – exact instructions will be provided by your surgeon depending on the complexity of your treatment.

The most important aspect of long-term aftercare is protecting the affected area from the sun because the surgical scar will take about a year to mature and is only about 80% as strong as undamaged skin. Sunlight can cause burns, permanent redness, loss of pigment in the skin, and breakdown of the collagen that maintains the skin's elasticity.

Aftercare following the use of skin grafts or flaps is slightly more ridged. You will be scheduled to return to the clinic at regular intervals so that your graft sites can be monitored. If artificial skin has been used you must keep the site(s) completely dry until advised otherwise – this may require specific restrictions around bathing or showering as well as clothing choice, i.e. wearing loose comfortable clothing can help reduce the disturbance to the treated area.

Massaging the treated areas after surgery when comfortable enough to do so (usually 2 weeks following surgery) is a very important part of the healing process and helps to soften your skin, adjacent tissue, and helps accelerate healing - you will be given exact instructions about aftercare and which movements when massaging would be best.

You will experience discomfort over the first few days following surgery, however, the degree of pain does vary from person to person.

If you have young children, babies or pets, please ensure that the area(s) treated are not pushed, kicked or disturbed for at least 1 week. Your tissues have been agitated and require a period to heal without further disturbance. It is recommended that you organise help with caring for young children (lifting/carrying) during the first few days of recovery.

Wounds must be kept completely dry for the first week. If you have had surgical treatment you may be able to shower after this first week. After your first post-operative check with the nurse at the end of week 1, you will be advised that you can shower or bath as usual.

Do not sit out in strong sunlight for the first 2 weeks after surgery. Once fully recovered and the scars are matured you may expose areas on the body or face that have been treated (this is usually after 12 months).