Scar revision surgery is a procedure designed to alter a scar’s appearance, size, or shape, not to remove it entirely. The goal of this treatment is to make a noticeable mark less conspicuous by improving its color, texture, or blending it more favorably with the surrounding skin. Individuals often seek this option when a scar causes physical discomfort, restricts movement, or significantly impacts their self-esteem. Deciding if scar revision is worthwhile involves weighing the potential for improvement against the commitment required for the process.
Defining the Scope of Scar Revision
A factor in determining suitability for scar revision is the scar’s maturity; most surgeons recommend waiting 12 to 18 months after the initial injury or surgery. This allows the natural remodeling phase of wound healing to complete, as many scars fade and flatten significantly on their own. Good candidates for surgery are generally healthy non-smokers who have realistic goals for the outcome.
Specific scar types are amenable to revision, including hypertrophic scars, keloids, contractures, and wide or depressed scars. Hypertrophic scars are raised and confined within the boundaries of the original wound. Keloids are more complex, extending aggressively beyond the edges of the initial injury. Keloids are prone to recurrence and may require a combination of surgery and post-procedure injections to manage the risk of them reforming.
Surgical Techniques Used in Revision
When a scar is severe, affects function, or has not responded to less invasive methods, surgical revision is considered. The most straightforward technique is simple excision, where the surgeon removes the entire scar and meticulously closes the wound to create a thinner, less noticeable line. This is often used for scars that are wide or depressed and located along the natural skin tension lines.
More geometrically complex methods are employed to change a scar’s direction or relieve tension that could cause widening. Z-plasty and W-plasty involve making small, angled incisions to reorient the scar so that it aligns more closely with the skin’s natural creases. Z-plasty is effective for releasing scar contractures, which are tight scars that restrict movement over joints. For large defects or severe burn scars, skin grafting or flap surgery may be necessary, involving transplanting healthy skin from another area of the body.
Non-Surgical and Minimally Invasive Alternatives
Less invasive approaches can be used before or instead of surgery, especially for newer or less severe marks. Intralesional steroid injections, often using corticosteroids, are a common treatment for raised scars like keloids and hypertrophic scars. These injections reduce inflammation and decrease the production of collagen, which helps to flatten the elevated tissue.
Surface treatments are helpful for improving texture and discoloration. Laser therapy can smooth the scar’s texture, minimize redness, and stimulate new collagen growth. For depressed scars, soft tissue fillers can be used to raise the sunken area to the level of the surrounding skin. Silicone sheeting and gels are also widely recommended post-procedure or as an early intervention, as they apply pressure and hydration that can help prevent and treat raised scars.
Setting Realistic Post-Procedure Expectations
The most important expectation is that scar revision improves appearance; it does not guarantee complete erasure. The goal is to make the mark blend more seamlessly with the surrounding skin, reducing the scar’s color, thickness, or size. Immediately following surgery, patients can expect localized swelling, discoloration, and mild discomfort for the first one to two weeks.
The new scar will go through a maturation process that can take up to a full year before the final results are visible. Sun protection is advised during this time, as ultraviolet exposure can cause the developing scar to darken permanently. Financial considerations are important, as most insurance plans will not cover the procedure unless it addresses a functional impairment. Risks, though uncommon, include infection, poor healing, changes in skin sensation, or the possibility that the scar may not improve as anticipated.