Improving your appearance with scar revision surgery

Scars are visible signs that remain after a wound has healed. They are unavoidable results of injury or surgery, and their development can be unpredictable. Poor healing may contribute to scars that are obvious, unsightly, or disfiguring. Still, even a wound that heals well can result in a scar that affects a normal skin appearance. Scars may be raised or recessed, different in color or texture from surrounding healthy tissue, or particularly noticeable due to their size, shape, or location.

Scar revision surgery is meant to minimize the scar so that it is more consistent with your surrounding skin tone and texture. Although scar revision can provide a more pleasing cosmetic result or improve a scar that has healed poorly, a scar cannot typically be completely erased.

Is scar reduction right for me?

Scar revision is a highly individualized procedure and you should do it for yourself, not to fulfill someone else’s desires or to try to fit any sort of ideal image. Scar revision can be performed on people of any age and is a good option for you if:

  • You are bothered by a scar anywhere on your body
  • You are physically healthy
  • You do not smoke
  • You have a positive outlook and realistic goals for your scar revision surgery
  • You do not have active acne or other skin diseases in the area to be treated

The type of scar you have will determine the appropriate techniques your plastic surgeon will use to improve your scar.

What happens during scar revision surgery?

Step 1 – Anesthesia

Medications are administered for your comfort during the surgical procedure. The choices include local anesthesia, intravenous sedation, and general anesthesia. Your doctor will recommend the best choice for you.

Step 2 – The treatment

The degree of improvement that can be achieved with scar revision will depend on the severity of your scarring, as well as the type, size, and location of the scar. Each patient is different. In some cases, a single technique may provide significant improvement. However, your plastic surgeon may recommend a combination of scar revision techniques to achieve the best results.

Topical treatments, such as gels, tapes, or external compression, can help in wound closure and healing, or reduce the ability of skin to produce irregular pigment. These scar care products may be used to treat existing surface scars and discoloration and to aid in the healing of scar revision procedures.

Injectable treatments could include fat grafting (fat transfer), steroid injection, or other adjunctive treatments such as 5-FU. They are often used to fill depressed or concave scars, such as with fat injections transferred from another area of the body. 

Depending on the injectable substance used and your particular scar conditions, results may last from three months to several years. Therapy may need to be repeated to maintain results. 

One form of injection therapy uses steroidal-based compounds to reduce collagen formation and can alter the appearance, size, and texture of raised scar tissue.

Surface treatments are most often used for the cosmetic improvement of scars. These methods can soften surface irregularities and reduce uneven pigmentation. Surface treatments are a controlled means of either mechanically removing the top layers of skin or remodeling the tissue. These treatment options include:

  • Laser or light therapy causes changes to the surface of the skin that allow new, healthy skin to form at the scar site.
  • Chemical peel solutions penetrate the skin’s surface to soften irregularities in texture and color.
  • Skin bleaching agents are medications applied topically to lighten the skin.

Step 3 – Incisions

Sometimes for deeper scars, an incision is needed to surgically remove the old scar. 

In cases where there is an area of a tethered or tight scar at a prior surgical site, skin grafting will be used as an adjunct.

Step 4 – Closing the incisions

Some scars require layered closure. Layered closure is often used where excision extends to tissue below the skin’s surface or in areas with a high degree of movement. The first step, or layer, requires sub-dermal closure (below the skin’s surface) with absorbable or non-removable sutures. Layers of closure continue to build, concluding with the closure of the remaining surface wound.

Key Benefits
  • Creates a smoother, more even skin texture or tone as needed
  • Reduces scars’ appearance to be less noticeable
  • Improves functionality and comfort for scars that restrict movement or cause pain & discomfort
Glossary

Acne Scars: Permanent indentations or protrusions on the skin caused by severe acne. These can be improved with scar revision treatments.

ASPS Member Surgeons: Surgeons who are members of the American Society of Plastic Surgeons.

Blood Vessels: Tubular structures, such as arteries, veins, and capillaries, that carry blood throughout the body. In the context of scar revision, blood vessels play a crucial role in the healing process. Adequate blood supply to the affected area is essential for delivering oxygen and nutrients needed for tissue repair and regeneration.

Burn: A type of injury that can result in scars, requiring specialized revision techniques.

Contractures: Scars that restrict movement due to skin and underlying tissues that pull together during healing. They can occur when there is a large amount of tissue loss, such as after a burn. Contractures also can form where a wound crosses a joint, restricting the movement of the fingers, elbows, knees, or neck.

Discoloration, surface irregularities, and other more subtle scars: These types of scars can be cosmetically improved by surgery or other treatments recommended by your plastic surgeon. These types of scars do not impair function or cause physical discomfort and include acne scars as well as scars resulting from minor injury and prior surgical incisions.

Facial Plastic: A sub-specialty of plastic and reconstructive surgery focusing on the face, often involved in scar revision for facial scars.

Flap Surgery: A surgical procedure that moves healthy, live tissue from one part of the body to another to cover a scarred area.

Flaps: Tissue sections used in flap surgery to repair and revise scars.

Function: The ability of a body part to move or perform normally, which can be improved with scar revision.

General Anesthesia: Medication used to induce unconsciousness during extensive scar revision procedures.

Hypertrophic scars: Thick clusters of scar tissue that develop directly at a wound site. They are often raised, red, and/or uncomfortable, and they may become wider over time. They can be hyperpigmented (darker in color) or hypopigmented (lighter in color).

Injections: A method used to administer medication directly into a scar to reduce its appearance.

Insurance Coverage: The extent to which health insurance will pay for scar revision procedures.

Keloid Revision: Specific treatment for keloid scars to reduce their size and improve their appearance.

Keloid Scars, Keliods: Scars that are larger than hypertrophic scars. They can be painful or itchy, and may also pucker. They extend beyond the edges of an original wound or incision. Keloids can occur anywhere on your body, but they develop more commonly where there is little underlying fatty tissue, such as on the face, neck, ears, chest, or shoulders.

Laser: A tool used in scar revision to resurface the skin and improve the appearance of scars.

Laser Treatments: Procedures that use laser technology to reduce the visibility of scars.

Local Anesthesia: Medication used to numb a specific area during minor scar revision procedures.

Physical Therapy: Rehabilitation that may be recommended after scar revision surgery to improve function and appearance.

Pigmentation: The color of a scar, which can vary and may be addressed during scar revision.

Plastic Surgeon: A doctor who specializes in performing surgeries to repair and improve the appearance of scars.

Plastic Surgery: A medical specialty focused on reconstructive and cosmetic procedures, including scar revision.

Raised Scars: Scars that are elevated above the skin surface, often treated with scar revision.

Results: The outcomes of scar revision procedures, aiming to improve the appearance and function of scars.

Revision Surgery: Procedures aimed at altering and improving the appearance of existing scars.

Risks: Potential complications associated with scar revision surgery, which patients should be aware of.

Scar Removal: The process of reducing or eliminating the appearance of scars through various treatments.

Scar Revision Surgery: Operations performed to revise and enhance the appearance of scars.

Scar Tissue: Fibrous tissue that forms over a healed wound, often targeted in scar revision procedures.

Scar Tissue Pain: Discomfort or pain associated with the formation of scar tissue. Scar tissue can develop after an injury or surgery, leading to tightness, reduced flexibility, and sensitivity in the affected area. This pain can be a result of nerve entrapment or tension within the scar tissue and surrounding skin. Treatments for scar tissue pain may include physical therapy, massage, injections, and surgical revision.

Scarring: The process of scar formation, which can be addressed with scar revision procedures.

Skin Graft: A surgical procedure where skin is transplanted to cover a scarred area.

Skin Grafts: Sections of skin used in grafting procedures to repair and revise scars.

Skin Irritation: A possible symptom of scarring that may be relieved with revision techniques.

Skin Tone: The natural color of a person’s skin, which can be matched during scar revision for uniformity.

Surgeons: A surgeon is a medical professional specialized in performing surgeries, including those for scar revision.

Surgical Procedure: Operations performed to correct or improve the appearance of scars.

Therapy: Treatments, such as physical therapy, that support healing and recovery after scar revision.

Tissue Expansion: A surgical procedure used to stretch the skin and other tissues to create additional tissue for reconstruction. This method involves inserting an expander (a balloon-like device) under the skin near the area to be repaired.

Topical Treatments: Creams or ointments applied directly to scars to improve their appearance.

Wound: An injury to the body that can result in scarring, potentially necessitating revision.

Wound Healing: The body’s natural process of repairing tissue after an injury.

Z-Plasty: A surgical technique used in scar revision to improve the functional and cosmetic appearance of scars.

FAQs

The initial healing phase of a surgical scar revision may include localized swelling, discoloration, or discomfort for about 1 to 2 weeks. When you can return to your normal activities depends on the details of your surgical plan and the location and size of your scar. Healing will continue for several weeks, and as the new scar heals, it will slowly refine and fade. With chemical peels or laser resurfacing (surface treatments), you will experience similar conditions in the treated area as well as overall sensitivity.

The final results of your scar revision surgery will be long-lasting. However, it may take several months for your final results to become apparent, and in some cases, it may take a year for the new scar to fully heal and fade.

The practice of medicine and surgery is not an exact science. Although good results are expected, there is no guarantee. In some situations, it may not be possible to achieve optimal results with a single surgical procedure and another surgery may be necessary.

In the consultation, your surgeon will review your medical history and how you got your prior scar. It is important to review your expectations of the outcome with your healthcare provider, who will review with you what is achievable with a scar revision.

The success and safety of your scar revision procedure depends very much on your complete candidness during your consultation. You’ll be asked a number of questions about your health, desires, and lifestyle. Be prepared to discuss:

  • Why you want the surgery, your expectations, and desired outcome
  • Medical conditions, drug allergies, and medical treatments
  • Use of current medications, vitamins, herbal supplements, alcohol, tobacco and drugs
  • Previous surgeries

Your surgeon may also:

  • Evaluate your general health status and any pre-existing health conditions or risk factors
  • Examine your scar in detail
  • Take photographs for your medical record
  • Discuss your options and recommend a course of treatment
  • Discuss likely outcomes and any risks or potential complications
References »

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Ward RE, Sklar LR, Eisen DB. Surgical and Noninvasive Modalities for Scar Revision. Dermatol Clin. 2019 Jul;37(3):375-386. doi: 10.1016/j.det.2019.03.007. 

Lupton JR, Alster TS. Laser scar revision. Dermatol Clin. 2002 Jan;20(1):55-65. doi: 10.1016/s0733-8635(03)00045-7. 

Khatri KA, Mahoney DL, McCartney MJ. Laser scar revision: A review. J Cosmet Laser Ther. 2011 Apr;13(2):54-62. doi: 10.3109/14764172.2011.564625. 

Xiao A, Ettefagh L. Laser Revision of Scars. 2022 Oct 3. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. 

Wu DC, Goldman MP, Wat H, Chan HHL. A Systematic Review of Picosecond Laser in Dermatology: Evidence and Recommendations. Lasers Surg Med. 2021 Jan;53(1):9-49. doi: 10.1002/lsm.23244. 

Lee Peng G, Kerolus JL. Management of Surgical Scars. Facial Plast Surg Clin North Am. 2019 Nov;27(4):513-517. doi: 10.1016/j.fsc.2019.07.013. 

Ziolkowski NI, Behman R, Klassen AF, Fish JS, Mundy LR, She RW, Forrest CR, Hollenbeck S, Arriagada C, Greenhalgh D, Pusic AL. Determining the Independent Risk Factors for Worse SCAR-Q Scores and Future Scar Revision Surgery. Plast Reconstr Surg. 2021 Jul 1;148(1):203-212. doi: 10.1097/PRS.0000000000008095.

Kontochristopoulos G, Platsidaki E. Chemical peels in active acne and acne scars. Clinics in Dermatology. 2017 Mar-Apr;35(2):179-182. doi: 10.1016/j.clindermatol.2016.10.011.

Chandrashekar BS, Sriram R, Mysore R, Bhaskar S, Shetty A. Evaluation of microneedling fractional radiofrequency device for treatment of acne scars. J Cutan Aesthet Surg. 2014 Apr;7(2):93-7. doi: 10.4103/0974-2077.138328.

Juhasz MLW, Cohen JL. Microneedling for the Treatment of Scars: An Update for Clinicians. Clinical, Cosmetic and Investigational Dermatology. 2020 Dec 22;13:997-1003. doi: 10.2147/CCID.S267192.

Claytor RB, Sheck CG, Chopra V. Microneedling Outcomes in Early Postsurgical Scars. Plast Reconstr Surg. 2022. doi: 10.1097/PRS.0000000000009466. 

El-Domyati M, Barakat M, Awad S, Medhat W, El-Fakahany H, Farag H. Microneedling Therapy for Atrophic Acne Scars: An Objective Evaluation. Journal of Clinical and Aesthetic Dermatology. 2015 Jul;8(7):36-42.

Bellafill for acne scars. The Medical Letter on Drugs and Therapeutics. 2015 Jun 22;57(1471):93-4.

Schedule a consultation with Alannah Phelan, MD at Boston Plastic Surgery to learn about your scar revision surgery options. Dr. Phelan is an expert scar revision surgeon, and she is here to help guide you with the ideal treatment plan to meet your goals. We invite you to call our practice at 617-786-7600.

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