As a wound heals, tissue begins to grow over the wound, protecting it and replacing the damaged skin. As this fibrous tissue settles in, you develop a scar. Essentially, scars are nature’s way of reminding you of past injuries.
Some people don’t mind these badges of history, but others are eager to erase the evidence. The goal of a scar revision procedure is to improve or minimize the appearance of the scar. This can help you feel less self-conscious about it.
In other circumstances, a scar revision surgery can restore some function to an area where scar tissue has grown up and inhibited your usual range of motion.
It’s best to discuss your options with a doctor before deciding. You have many options to choose from when it comes to changing your scar’s appearance.
Minimally invasive procedures
Your doctor might suggest starting out with one of several available minimally invasive procedures to see if that improves the appearance of your scar. Options include:
- Corticosteroid injections. Corticosteroid injections into the scars are a common first-line treatment for certain kinds of scars, according to a
small 2015 study, including hypertrophic and keloid scars.
- Bleomycin injections. These injections are also considered a safe way to help improve the appearance of hypertrophic scars, although
researchsuggests that people with darker skin may run the risk of developing hyperpigmentation at the site. Some 2019 researchalso suggests that injecting a keloid scar with bleomycin is safe and effective, although it’s pretty common for the scar to come back after treatment.
- Laser treatment. Laser treatment is sometimes used to resurface some types of scars and make them smoother, flatter, and less noticeable. Multiple sessions may be required.
- Other resurfacing procedures. Procedures like chemical peeling, microdermabrasion, and dermabrasion are sometimes used to address acne scars. These remove the top layer of skin, smoothing it out. According to the American Academy of Dermatology (AAD), resurfacing usually works best on scars that are already flat.
- Microneedling. Microneedling is sometimes used for acne and other scars. This entails rolling a device with small needles over the skin. The needles prick the skin and stimulate collagen growth to make the skin look smoother. A variation of the procedure, radiation microneedling, involves sending radiofrequency waves through the needle to enhance the process.
- Cryosurgery. Cryosurgery is one option for some types of scars. Also known as cryotherapy, it involves swabbing or spraying liquid nitrogen on the scar to “freeze it off.” However, the AAD does not recommend it for people with darker skin.
Surgical revision with advanced techniques in wound closure
Your surgeon will use one of several possible techniques to revise the scar. They may use a skin graft or skin flap to close the wound. After making the appropriate incisions, your surgeon will close the wound with sutures.
In some complex cases, a surgeon may choose to suture together the tissue in layers. If they suture the tissue in layers, they will start with the tissue below the skin surface and work their way up. Multilayer repair can make it stronger, according to a
You can start out treating some scars with topical treatments or injections. But if you don’t get the results you’re seeking, surgery may be the next step.
If you have one of these types of scars, speak with a doctor about what kind of surgery could be effective.
Discoloration or surface irregularities
If you’ve ever had surgery, you might have some scars remaining from the surgical incisions. Or you might have some acne scars that are fading too slowly for you.
Hypertrophic scars tend to be wider or thicker raised scars at the site of a wound. They’re often red or pink, but they can vary in color and sometimes appear darker or lighter.
A keloid scar is fibrous scar tissue. It forms a smooth, hard growth after a wound has healed.
Keloid scars tend to be larger and more raised than hypertrophic scars. They often grow beyond the borders of the original injury site. Keloid scars have a higher recurrence rate than hypertrophic scars, too.
Doctors often first treat these types of scars with corticosteroid injections, then possibly cutting out the scar. The process of cutting out the scar is known as excision.
If the keloid recurs after excision, the last line of treatment is to cut it out again. This is followed by immediate radiation therapy to the scar.
When a burn or other type of serious wound heals, fibrous tissue sometimes replaces the elastic tissue that was there before the injury. This inelastic tissue is known as a contracture.
A contracture feels stiff. It can restrict the usual movement of the tendons, muscles, and joints in the affected area.
Some dermatologists will suggest a cosmetic treatment like laser treatment, microneedling, or chemical peels for acne scars. If that doesn’t quite do the job, you could follow up with dermal fillers. However, minor surgery is also a treatment you might want to consider.
Depressed acne scars
A depressed acne scar is one that’s sunken into the skin. If you have a depressed acne scar, your doctor can surgically “lift” the scar up to make it flush with the rest of your skin. This can make the scar less noticeable.
Raised acne scars
If you have raised acne scars, you might start with a nonsurgical treatment like corticosteroid injections. If those don’t do the job, a doctor might recommend surgery.
Your doctor may recommend additional corticosteroid treatments, or other treatments such as radiation therapy, after surgically removing the raised scar. Cryosurgery can be a good option for people with lighter colored skin who have raised scars.
You can have an injury on just about any part of your body, so you can develop a scar on just about any part, too. The type of plastic surgery that’s most appropriate for your scar can vary.
Your face is the most visible part of your body, when you get down to it. Your doctor will speak with you about the procedures that are available for scars on your face. Much will depend on the type of scar that you have on your face.
Your doctor may recommend starting out with a process like dermabrasion or laser resurfacing to smooth down a raised or rough scar. If you have a keloid or hypertrophic scar, they might suggest injections of medication to reduce the size. Then, they’ll move on to excision of the scar, according to the American Academy of Facial Plastic and Reconstructive Surgery.
Your neck is also quite visible, so your doctor may speak with you about scar revision surgery that will minimize the appearance of the scar. A surgeon may be able to work with the natural tension lines in your neck. Again, the procedure will depend on the type of scar, including the size.
Trunk and limbs
You may be most concerned about function in other parts of your body. For example, if you have a contracture from a burn on your hand or leg, you may want to pursue a scar revision to ease some tension and restore some lost movement. According to a
Here’s what you can expect from a typical scar revision surgery. Your results may vary.
One of the biggest risks of scar revision surgery is that you may not get the exact results you want. Every scar is different, and a procedure that worked on one scar might not be as effective on another.
You may want to consider other potential risks of undergoing surgery. They include:
- reaction to the anesthesia used for the process
- bleeding, swelling, or skin discoloration at the surgical site
- deep vein thrombosis
- numbness at the surgical site
- incision that doesn’t heal properly
- possible need for additional revision surgeries
Consider your budget and the cost of scar revision surgery carefully before you make a final decision. If you have insurance, there’s a good chance that your policy may not pay for a scar revision surgery if it’s for aesthetic purposes. However, if your scar is the result of trauma like a burn or accident, it’s possible that your insurance may cover some of the cost.
In the meantime, speak with your doctor about the estimated price of a scar revision procedure. The price can vary, depending on:
- how extensive the surgery will be
- where the surgery will be performed
- what kind of anesthesia you’ll need
Before any scar revision procedure, your doctor will want to meet with you to assess your scar. They’ll look for a variety of characteristics, including its:
- vascularity (the blood vessels involved)
They’ll also note the area where the scar is located and any tissue stiffness. Then, your doctor will discuss your options with you, including the benefits and risks.
Once you decide upon a specific procedure, your doctor will discuss the actual surgery including the techniques. They will also give you some pre-op instructions to help you prepare. Typically, these will outline behaviors you may want to avoid before your surgery, such as smoking or drinking alcohol.
Before your surgeon begins the scar revision procedure, you will need to receive anesthesia. Depending on the procedure, you may only need local anesthesia and can be awake during the procedure. But sedated anesthesia or general anesthesia may be appropriate in other situations. Then the procedure can begin.
There are several types of scar revision surgery, and one of them may be appropriate for you.
The surgeon will remove the scar and carefully sew the remaining edges together.
Not every scar revision surgery will require a skin graft, but sometimes, it’s necessary. If so, your surgeon will remove the scarred area. Then, they’ll place a piece of skin taken from another part of the body to replace the removed skin. Finally, they’ll sew it into place. This procedure is often used for burn scars.
This surgery is similar to a skin graft surgery. Your surgeon will move a flap of skin from another area of the body to replace the skin removed when the scar is excised.
During this procedure, the surgeon repositions the scar so it falls more along the natural lines of your skin. According to a
The W-plasty is a fairly versatile procedure with minimal risk. It can be particularly useful when revising hypertrophic scars. The downsides: it may not be appropriate on scars in the eyelid area and can result in a longer scar, according to a
With a Z-plasty, your surgeon moves or redirects the lines of the scar to make it less noticeable. The surgeon creates pointed flaps of skin, which can lessen the tension or pressure from skin tightness of some scars.
The recovery process can vary, too, depending on how extensive the surgery was. Typically, your doctor will go over how to take care of your surgical site. For example, they may tell you to take it easy for a few days or weeks to avoid putting any strain or stress on the wound as it heals.
You may also notice some swelling or bruising around the site during the first 1 or 2 weeks after the surgery. You can use cold compresses to keep the swelling down. Let your doctor know if the swelling or discoloration doesn’t eventually go away.
Be sure to visit your doctor for any scheduled follow-up visits, even if your surgical site seems to be healing up just fine.
Another key piece of advice: Protect your scar or scar revision from the sun as much as possible. A broad-spectrum sunscreen or protective clothing should do the trick.
It’s also important to be patient. Penn Cosmetic Surgery cautions that the healing time may be longer for a scar removal on your leg than for a scar removal on your face. And it may take months for you to fully realize the improvement to your scar’s appearance.
You may be a good candidate for scar revision surgery if you:
- are in good overall health
- do not smoke
- have no active skin conditions, especially in the affected areas
- have realistic expectations for a scar revision procedure
Also, make sure you know why you’re considering scar revision surgery. According to the American Society of Plastic Surgeons, the key is that you’re doing it for yourself, not to please someone else.
Your best choice for a doctor to perform your scar revision procedure is a board certified plastic surgeon or dermatologist. These are physicians who have completed medical school and a residency program, then voluntarily pursued extra medical education in their specialty area and passed rigorous exams to demonstrate their mastery. They must also keep up their education to maintain their certification.
Wondering where to find a highly qualified doctor or surgeon? You can search for a plastic surgeon or dermatologist through search tools provided by the:
- American Society of Plastic Surgeons
- American Board of Plastic Surgery
- American Academy of Dermatology
- American Board of Dermatology
When you find a doctor, you may want to ask them some questions to make sure they’re a good fit for you. Those questions might include:
- What kind of training and certification do you have?
- What kind of scar revision procedures have you done?
- Which scar revision procedures do you perform the most frequently?
- Do you think I’m a good candidate for scar revision surgery?
- What kind of procedure would you recommend for me?
- What are the potential risks from the procedure you’re recommending?
- How long will the procedure take, and what will the recovery be like?
- Can you show me some before-and-after photos of other patients who’ve undergone scar revision surgery in your practice?
- How much will this surgery cost?
- What should I do if I develop any complications from surgery?
- How will you handle a situation if I’m not pleased with the results of the revision?
You might also want to bring along your own medical history, including your family medical history and information about any previous surgeries you’ve undergone.
Scars can vary in size, shape, and thickness. Some are barely noticeable, while others are impossible to miss. Your available treatment options will depend on the location and type of your scar, as well as your budget. In some cases, a surgical procedure may be the right solution for you, but consult your doctor about all your options first.