Excision "W Plasty"
Throughout history, people who have been distressed and embarrassed by disfigurement of their facial skin have searched for ways to improve these imperfections. Today, because of modern technology, there are several excellent procedures available to improve facial scarring, such as, dermabrasion, excision, and laser.
Dermabrasion, first introduced in the 1940's, has been perfected over the last few decades. Used on both men and women, facial dermabrasion is a surgical procedure in which skin, scarred from acne, pox or other causes, is "sanded" with a rotary abrasive instrument. The abrasive or planing action evens out the skin to give it a smoother, more pleasing contour. When the technique of dermabrasion was first developed, it was used primarily to improve acne, pox marks and scars resulting from accidents or disease. Today, it is used to treat other conditions as well. These include tattoos, age (liver) spots, wrinkles and certain kinds of skin lesions.
Dermabrasion can be done successfully on patients with active acne. It is better, of course, to obtain the greatest amount of acne control prior to the surgery, but more extensive damage can occur if the procedure is delayed.
Prior to surgery, a complete medical history is taken in order to evaluate the general health of the patient. A careful examination is also conducted. The physician describes the type of anesthesia to be used, the procedure, what results might realistically be expected and possible risks and complications. Photographs are taken before and after surgery to evaluate the amount of improvement. Preoperative instructions might include the elimination of certain drugs which contain aspirin in order to minimize the possibility of excessive bleeding. Antibiotics may be prescribed to prevent infection. The patient may be advised to cleanse the face and hair with antiseptic soap the day before surgery.
There are several excellent methods of scar removal available, today. The method that the physician chooses will depend upon the size of the scar and the length of time it has been on the skin. How the patient heals may also be a factor in the decision.
Dermabrasion can be performed in a physician's office, an outpatient surgical facility or a hospital depending upon the physician's and patient's preference. Medication to relax the patient may be administered prior to surgery. The face is thoroughly cleansed with an antiseptic cleansing agent. Eyes and hair are covered, and the area to be treated is sprayed with a spray that freezes the skin. Cold packs to numb the area may be applied before it is sprayed.
Superficial skin is then "sanded" with an abrasive wire brush or other appliance attached to a high speed rotary instrument. Some patients require bandaging after treatment, others do not. The procedure lasts from thirty to sixty minutes, depending upon the condition of the skin and extent of the area involved.
With dermabrasion bumps and other irregularities of the skin can be corrected.
The irregular area is abraded and then allowed to heel.
This is a great procedure to remove wrinkles and other facial scarring.
Many physicians consider excision one of the best methods of scar removal. The advantage of this method is that the entire scar can be removed and hidden by a less noticeable scar. W Plasty, is a very common excision method which can remove an unsightly scar. The old scar is removed by making a zig/zag incision. This incision is then closed and is left looking like a "W" shape. This technique hides the scar by changing the direction of the scar and increasing scar length, which adds greater surface tension to prevent widening.
Excision involves an injection of a local anesthetic to numb the area after which the scar is removed surgically. The edges are then brought together and sutured. With this procedure, there is minimal bleeding which is easily controlled with electocautery. In some cases involving large scars, a skin graft taken from another part of the body may be necessary.
In recent times, lasers have been used to remove unwanted scars. The argon and carbon dioxide lasers, the two most frequently used today, are employed in a similar manner. After the local anesthetic is applied, pulses of light from the laser are directed on the scar. Using a special solution the area is scrubbed and the process is repeated until the scar has been removed.
For a few days, the skin feels as though it has been severely sunburned. Medication alleviates any discomfort the patient may have. Antibiotics may be prescribed to prevent infection.
If bandages are used, they are removed within a few days. Some swelling is to be expected 24 to 48 hours after surgery. Swelling can be reduced by keeping the head in a slightly elevated position when reclining.
A crust which loosens and falls in several days begins to form a few days after dermabrasion. At this time, the planned area is moist. The patient may be instructed to wash the crust with a mild soap and tap water but is cautioned not to pull off crusts that slightly adhere to the skin as this can result in scarring.
After the crusts fall off, the skin appears quite pink, but this coloration fades in three to six weeks. During this period, special soaps and cosmetics mat be recommended and men are allowed to shave with mild shaving creams. Patients are instructed to avoid medicated or scented cosmetics and hair sprays which might be harmful to the skin.
For several weeks following dermabrasion, pimples resembling acne may appear. These disappear in time. Directed and reflected sunlight must be avoided for several weeks, and sunscreen should always be worn when out of doors. Strenuous activities should be avoided for ten days to two weeks following surgery. The physician advises when normal activities can be resumed.
Thousands of patients who undergo dermabrasions each year are delighted with results. Occasionally, hyperpigmentation or deepening of skin color occurs, but this can be treated. Infection of the treated area is rare as is scarring. Additional planings may be necessary. Although complications are rare, there are certain inherent risks connected with every surgical procedure which should be thoroughly discussed with the physician. Patients can minimize complications by carefully following directions given by the physician.
Regardless of which method of scar removal is used, some scarring or color variations may remain. Healing time varies depending upon the size and depth of the scar, the procedure used and the patient's healing process. It is important for the patient to discuss with the physician the various procedures, how they are performed, and the probable results. Care of the treated area must also be discussed.
If you are interested in learning more about scar revisions, please call our office at 570-674-6525 and we will be happy to answer your questions.
The Renaissance Center for Plastic
113 North Memorial Highway
Shavertown, PA 18708