What the procedure is
Scar revision covers a range of approaches aimed at improving the appearance of an existing scar: from topical treatment and injections, to re-excision and resuture, to reorienting a scar so that it lies in a better direction relative to the natural lines of the skin.
Expectations must be precise: the aim is to improve a scar, not to remove it. Every wound heals with a scar; what can be changed is its width, direction, colour and level.
A hypertrophic scar stays within the boundary of the original wound, whereas a keloid extends beyond it, and the two are managed differently.
Correcting the result of previous surgery is assessed cautiously; it is usually preferable to wait until the tissues have matured and stabilised, which commonly takes several months to a year.
Who is a suitable candidate
- People with a mature scar whose appearance has stabilised, or a scar causing tightness or restricting movement.
- People whose tissues have settled after previous surgery and who want to assess options for correction.
- Non-smokers.
- People who understand that improvement is gradual and may need more than one session or approach.
How it is performed
The approach varies considerably with the scar: it may be an injection in clinic, excision and resuture under local anaesthesia, or a more extensive procedure under general anaesthesia for large or tethering scars.
Techniques may be used to reorient a scar so that it is redistributed along directions following the natural lines of the skin, making it less conspicuous.
In some cases skin grafts or tissue flaps are used where there is a tissue deficit.
Recovery
- This varies with the extent of the procedure, from immediate return to activity after an injection, to two weeks or more after more extensive surgery.
- Aftercare is an essential part of the result, including sun protection and adherence to any preparations or dressings advised.
- Improvement appears gradually over months rather than weeks.
Scars
Any scar-revision procedure produces a new scar; the aim is for it to be better than the previous one in width, direction or level.
In people predisposed to keloid, the likelihood of recurrence is higher, so treatment is usually planned in stages and with adjunctive measures.
Risks and complications
Every operation carries risk. This is an educational list, not an exhaustive one; the risks specific to your case are discussed during consultation.
- Recurrence of hypertrophic or keloid scarring.
- A difference in colour from the surrounding skin, either lighter or darker.
- Infection.
- Delayed healing.
- A result less than expected, or the need for further sessions.
- In correction after previous surgery, the tissues may be less elastic and less well perfused, making the result less predictable.
Combining with other procedures
More than one approach is often combined in the same case, such as excision followed by injections or supportive topical treatment over months.
Common questions
Can a scar be removed completely?
No. Every wound heals with a scar. The aim is to improve its appearance in width, direction, colour and level, not to erase it.
When should treatment of a recent scar begin?
Supportive care begins early once the wound has healed, while surgical intervention is usually deferred until the scar has matured and its colour and thickness have stabilised — commonly six to twelve months — because many scars improve on their own during that period.