Excision: There are various forms of excisional surgery. Fusiform elliptical excision or punch excision are the most common facial scar removal surgery for revising a mature depressed or spread scar.
- In fusiform elliptical excision technique, an ellipse-shaped skin incision is created to excise the scar. This is a useful technique for removal of scar that is bigger than 5mm.
- In punch excision technique, a round-shaped skin incision is created to excise the scar. This is a useful technique for removal of scar that is smaller than 5mm.
- Extramarginal scar excision involves excision of small margin of the normal tissue along with the scar in order to get normal tissue at the wound margins.
- Intramarginal scar excision uses serial excisions done at intervals of 6-12 weeks. This technique is used for revising a wide and/or rounded scar (such as those caused by burn or ulcer) that cannot be excised completely in one sitting. This method is also useful for facial scars where aim is to preserve normal skin as much as possible.
- Geometric broken line closure is an advanced scar irregularisation technique that provides maximum camouflage of longer scars. The irregularly irregular pattern of the incision line has random twists and turns which makes it difficult for the eyes to follow. However, it is more time consuming and technically more difficult than other closure methods. Geometric broken line closure is typically reserved for a revision of relatively longer scars involving a convex or a concave surface.
Subcision: is a minimally invasive minor surgical procedure useful for treating certain rolling scars (a type of depressed skin scar). Subcision may be performed using a special needle (e.g. BD Nokor needle), cannula, Enerjet device (Buckshot subcision technique), or wire scalpel. The needle, cannula, or wire scalpel is inserted through an entry point on the skin surface, then is used to break fibrotic strands that tether down the scar to the underlying tissue. The release of the fibrotic strands and new collagen deposition caused by wound healing lead to cosmetic improvement of the scar.
- Enerjet subcision (Buckshot subcision): Enerjet device produces a powerful stream of liquid (liquid projectile) that penetrates the scar and explode underneath the skin creating a small subcision effect of approximately 10mm in diameter. Enerjet’s liquid projectile consists of skin healing compounds which prevents collapse (re-adherence) of subcised scar and promote healing. Enerjet subcision is particularly useful for treating certain rolling scars on the face.
- Nokor needle subcision: is most commonly used for subcision of small scars, typically no less than 5mm, and no bigger than a few centimeters.
- Wire scalpel subcision: is most commonly used for larger rolling scars such as linear surgical scars (e.g. C-section scar)
Punch graft: A specialized tool called ‘biopsy punch’ is used to remove skin from both recipient site and donor site located on the skin. The harvested donor skin plugs into the recipient site like a cork in wine bottle. The plug is glued, sutured, or taped flush with the surrounding skin for about 7 days to promote healing. While the procedure produces new scarring, the new scar is generally smoother and less conspicuous than the old depressed scar. In some cases, color and texture difference may be noticeable, but a skin resurfacing technique can be performed several weeks after the grafting to reduce such differences.