Scar tissue is the body’s natural attempt to repair a deep injury, consisting primarily of collagen fibers laid down rapidly to close the wound. The central question for anyone considering scar revision is whether removing the old scar will simply create a new, potentially worse, one. The answer depends entirely on the type of scar being treated and the specific revision method used. For many scars, revision offers significant improvement, but for certain types, the risk of recurrence is notably high.
The Biology of Scar Formation
The formation of a scar is a complex, multi-stage biological process initiated immediately after tissue injury. The healing process begins with the inflammatory phase, where the body stops bleeding and cleans the wound site. This prepares the damaged area for the subsequent stage of repair.
The proliferative phase follows, marked by the creation of new tissue. Specialized cells called fibroblasts move into the area and rapidly deposit new collagen, a protein that provides structural support. This hastily deposited collagen is disorganized and structurally different from the basket-weave pattern found in healthy skin, forming the bulk of scar tissue.
The final stage is the remodeling or maturation phase, which can last for many months or even years. In this phase, the body attempts to break down some of the excess, disorganized collagen while strengthening the remaining fibers. However, the scar tissue will never regain the full strength or perfect structure of the original, undamaged skin.
Scar Revision Techniques
Practitioners use various techniques aimed at minimizing a scar’s appearance by replacing the existing tissue with a cleaner wound that heals more favorably. Surgical excision is a common approach, involving cutting out the old scar and closing the resulting incision with meticulous, tension-free suturing. The goal is to orient the new scar along natural skin tension lines, making it less noticeable.
Surface treatments address the texture and color irregularities of the scar tissue. Procedures like laser resurfacing and dermabrasion remove or vaporize the outer layers of the skin, promoting collagen reorganization and stimulating the growth of smoother skin. Different lasers can also target redness or pigmentation within the scar.
Injectable treatments offer another pathway to revision, often used to address the height or depth of a scar. Corticosteroid injections are frequently used for raised scars, working to slow down excessive collagen production and flatten the tissue. Dermal fillers, conversely, can be injected beneath depressed or pitted scars to raise them to the level of the surrounding skin.
Assessing the Risk of Recurrence
The risk of generating a worse scar is highest for individuals prone to pathological scarring, specifically keloids and hypertrophic scars, which result from an overzealous healing response producing excessive collagen. A hypertrophic scar remains confined to the boundaries of the original wound, while a keloid grows aggressively beyond the injury site.
When a surgeon excises a keloid, the new incision is interpreted by the body as another injury, triggering the same biological mechanism that caused the original scar. Surgical removal of keloids alone can have a recurrence rate exceeding 50%, often resulting in a larger scar than the first. For this reason, surgical excision of a keloid is almost always paired with adjunctive therapies, such as post-operative steroid injections or radiation therapy.
Risk factors for recurrence include genetic predisposition, younger age, and the scar’s location on the body. Areas with high skin tension, such as the chest wall, shoulders, and earlobes, are particularly susceptible to forming pathological scars due to constant pulling force. For most normal scars, which are flat or atrophic, revision techniques generally succeed in improving the appearance, provided careful surgical technique and post-procedure care are employed.
Minimizing Scarring After Treatment
Preventing a new scar from becoming prominent requires diligent care during the first few months of healing, focusing on controlling inflammation and minimizing tension. Tension minimization is managed through careful layered closure during surgery and the use of paper tape or steri-strips to support the healing incision afterward. The goal is to reduce the mechanical stress that stimulates excessive collagen production.
Topical treatments like silicone gel sheets or silicone ointments are highly recommended and should be applied once the wound has fully closed. Silicone works by hydrating the scar site and regulating the signals that lead to collagen overproduction during the remodeling phase. Pressure therapy, using specialized garments or dressings, is also utilized for high-risk areas to physically flatten the scar as it matures.
Sun protection is a primary component of post-revision care, as ultraviolet radiation can cause a healing scar to darken permanently. Applying a broad-spectrum sunscreen with an SPF of 30 or higher is necessary for the first year. Consistent adherence to these instructions determines the final, long-term outcome of the scar revision.