Scar Tissue - Part 4 The Surgical Treatments

Saturday, July 05, 2014


This is the last post in the scar tissue series. Please read parts 1 to 3 before choosing which route to take.

Part 1 - Scars and their classifications
Part 2 - The natural remedies
Part 3 - The medical at-home treatments
Part 4 - The surgical treatments for removal.

 Scar Removal Before and After Photos
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There are 4 popular surgical treatments.

These are skin grafts, excision, dermabrasion, or laser surgery. They are usually the go-to treatments for large scars caused by surgery and extensive burns. Please make sure you visit a qualified dermatologist or plastic surgeon for each of these as they may require anaesthesia or overnight stay at a hospital.

Surgery performed by a less skilled surgeon may result in a greater degree of scarring, but many times the skill of the surgeon has no effect on the amount of scarring that takes place, because your surgeon cannot control all the factors that determine how badly you will scar. Certain factors beyond your control influence your ability to heal without scarring. These risk factors cannot be changed, but help to determine if you will scar badly after your procedure.


Here's a list of the risk factors that may lead to scarring post procedure. Some may be beyond your control. Preventing scars means focusing on the factors that you can control. Some ways are simple, like following the instructions your surgeon gives you to the letter. Others are not so easy, like quitting smoking.

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  • Your age
  • Your race
  • A genetic tendency to scar
  • The size and depth of your incision
  • How quickly your skin heals
  • Smoking
  • Drinking alcohol
  • Nutrition
  • Hydration
  • Your weight
  • Rest
  • Proper wound care
  • Identifying infection quickly
  • Chronic illness
  • Stress on your incision
  • Exposure to sunlight

Skin Grafts

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To perform a skin graft, your surgeon removes healthy skin from your body and attaches it to the wounded area. Extensive scarring is inevitable and the healing process can be long and painful, but the majority of patients will survive the treatment and return to their normal lives, especially in the case of burn victims. 

Doctors prescribe a skin graft when an area of skin is so damaged that it may not be able to regenerate on its own. There are certain traumatic injuries, medical conditions and post-surgical procedures that may require skin grafts as part of the treatment process. 

This is a costly but effective procedure as it allows the receipient to live a relatively normal life afterwards.


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This basically means removal by cutting out tissue. The procedure is mainly used for raised scars and tumours,  but acne scars are also really responsive to this treatment. Excision surgery names often start with a name for the organ to be excised (cut out) and end in -ectomy. 

In excision, the doctor cuts into the skin to remove the acne scar and then closes the wound with stitches. In punch replacement grafting, the doctor uses a round sharp tool matched to the size of the scar to remove it. A skin graft, usually taken from behind the ear, is used to fill the open wound.

While no specific risks are associated with excision and punch replacement grafting, be aware that the procedure leaves behind scars that are much smaller and lighter than the original. If you have time and not prone to squeamishness, there are videos online that show excision surgeries. Because they are mainly classified as a cosmetic procedure some medical aid companies may not cover it. As usual depending on the severity and depth of your scar this may set you back a few thousand rands.
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Should you decide to have it done, please make sure you are not going to be out and about as this will likely worsen the initial scarring. Bandages need to be cleaned and changed often, with bruising being present for up to 2 or 3 weeks. 


Dermabrasion is a type of surgical skin planing, typically performed in a professional setting by a trained dermatologist or plastic surgeon. Dermabrasion has been practised for years (before the advent of lasers) and involves the controlled deeper abrasion of the upper to mid layers of the skin with any variety of strong abrasive devices including wire brushes, diamond wheels, sterilised sandpaper, salt crystals, or other mechanical means. 


Dermabrasion is not to be confused with microdermabrasion which is a newer and non-surgical cosmetic procedure performed by non-physician personnel, nurses, estheticians and most recently untrained individuals in their homes, with creams and tools available over-the-counter.

Be careful with dermabrasion. Make sure the doctor is certified to perform it and it is done in a sterilised environment. The procedure carries the risk of more scarring, skin discolouration, infections, and facial herpes virus (cold sore) reactivation, when performed incorrectly.
Depending on the level of skin removal with dermabrasion, it takes an average of 7–30 days for the skin to fully heal (re-epithelialise). Dermabrasion's rarely practised now and there are very few doctors who are trained and still perform this surgery. Dermabrasion has largely been replaced all over the world by newer and somewhat simpler technologies including lasers. This is because laser technologies carry the advantage of little to no bleeding and have a much shorter recovery time.

The purpose of surgical dermabrasion is to help diminish the appearance of deeper scars and skin imperfections. By smoothing the skin; small scars (for example pitted acne skin), an uneven skin tone from scars or birthmarks, sun damage, small tattoos, age spots, fine wrinkles would be corrected.

Laser Treatments 

Lasers are the current darling of the dermatology world. Quick, relatively painless, with a short recovery time and cost; laser scar revision is now the go-to scar revision therapy. High-energy light is used to treat damaged skin. Different lasers are available for treating a variety of scars. For example, a pulsed dye laser uses yellow light to remove scar redness and to flatten raised scars (hypertrophic scars or keloids). This is also very effective for tattoo removal.

Race can be a barrier to getting a laser treatment. Darker skin tones can't use any and all lasers. A soft pulse laser may be best. Please speak to your doctor or dermatologist about the options available to you.  

Laser resurfacing's done on an outpatient basis in a doctor's office or skin laser clinic, and usually takes one to two hours. You're given goggles to protect your eyes fro the laser's light during and you’ll be given a local anaesthetic for the pain and twilight sedation — you’re not out cold but you are sedated. The dermatologist will run the laser, which resembles a handheld wand, over the scar to remove the damaged skin cells. Each pass of the wand will remove more cells.

There are two types of lasers used for skin resurfacing, each with their own pros and cons:

CO2 laser is a powerful laser that penetrates deeply into the skin and is better at removing thicker and deeper scars. As a consequence, recovery time is long, usually about two weeks. The procedure also can be painful.

Erbium: YAG laser is less powerful than the CO2 laser and is most often used to treat shallow scars. You’ll need less anaesthetic and sedation when you undergo laser scar removal with this laser, and your recovery time is faster, about a week.

Good luck!

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