he appearance of unsightly or disfiguring scars or blemishes may be improved by carefully executed cosmetic surgery, but there are important facts that patients must understand. The surgeon's goal is to replace an unsightly or disfiguring scar with a better scar; one which is a fine line, level with the surrounding surface, about the same color as the adjacent skin, and which causes little or no distortion of the surrounding area. The surgeon wants to produce a scar that is as inconspicuous as possible.

Initially, a freshly repaired scar usually looks very good. Then it becomes hard, red, and slightly raised above the surrounding skin. Gradually, the hardness and redness lessen and disappear, leaving a soft scar level with, and somewhat paler than, the adjacent skin. Maturation of scars takes anywhere from 6 to 18 months.

Patients seeking scar or blemish removal should realize that scar removal will result in another less noticeable scar, since there can be no complete removal of all traces of a scar. The final appearance of the revised scar or blemish will not be evident for many months.

Scar revision is usually performed after one year or more has elapsed since the scar was initially created. This gives the healing tissues time to mature, and gives the patient a better, more predictable result than earlier reconstruction. Occasionally, scar edges are sanded down, or dermabraded, using a high speed rotating diamond burr and topical skin refrigerant, in order to blend the area with surrounding skin.

When removing a scar or blemish, the surgeon makes every effort to place the incision as nearly as possible in, or parallel to, a normal crease of the face. Sometimes, the direction of a scar is changed, so that it will approximate these lines. Removal of large scars or blemishes may require multiple operations over a period of time, shifting surrounding tissue to fill the defect, or even skin grafting.