Information about the procedure
Improving the appearance and function of scars through surgical revision and subsequent treatment.
On this page
What it involves
Scar revision does not remove scars. Once a scar has formed, it is permanent. The aim is to make it narrower, flatter, closer in colour to the surrounding skin and oriented in a direction that makes it less noticeable.
Scars behave differently depending on their location. On the face they usually heal well; on the chest, shoulders and back they heal poorly and tend to thicken.
Some scars restrict movement or distort the surrounding structures. In these cases the revision is functional, not cosmetic.
Types and approaches
Excision and re-closure
The scar is excised and the wound is closed again, using a more precise technique and without tension. Suitable for wide or uneven scars.
Z-plasty
The scar is reoriented by transposing triangular flaps. It is used for scars that pull and restrict movement, or that lie in an unfavourable direction.
Treatment of hypertrophic and keloid scars
Corticosteroid injections, silicone products and compression. Surgery alone for a keloid often results in a larger keloid, so it is combined with other treatments.
Fat grafting beneath the scar
In depressed scars that are tethered to the underlying tissue, the grafted fat lifts the scar and improves the elasticity of the skin.
Who it is suitable for
Suitable for
- A wide, thickened or uneven scar
- A scar that restricts movement of a joint
- A scar lying in an unfavourable direction relative to the natural skin lines
- A depressed scar after trauma or surgery
- A scar that formed at least 12 months ago
Not suitable, or postponed, in cases of
- A recent scar, less than 12 months old — it is still changing on its own and revision would be premature
- Current smoking
- Active inflammation or infection in the scar
- A marked tendency to keloid formation without a treatment plan prepared in advance
- An expectation that the scar will be removed completely
Preparation
- Waiting for the scar to mature — usually at least 12 months
- Assessment of the scar type: atrophic, hypertrophic, keloid or contracted
- Planning an overall strategy, not just an operation
- Stopping smoking
- Strict sun protection before and after the revision
How it is performed
Most revisions are performed as day cases under local anaesthesia. Extensive scars may require sedation or general anaesthesia.
The procedure takes from 20 minutes to over an hour, depending on the size of the scar and the technique.
The wound is closed in layers so that there is no tension on the skin — tension is the main reason a scar widens.
Recovery
- The first weekStitches are removed between day 5 and day 14, depending on the area. The wound is kept clean and covered.
- 2–4 weeksThe scar is pink and slightly raised. Scar care with silicone gel or sheets begins.
- 1–3 monthsThe most active phase of maturation. The scar may temporarily look redder and firmer than before the revision — this is normal, although it worries many patients.
- 3–6 monthsThe scar begins to fade and flatten.
- 12–18 monthsFinal appearance. Only then does it make sense to assess the result.
Pain and discomfort
The revision itself is a minor procedure with minimal discomfort. Corticosteroid injections into a keloid are quite unpleasant for a short time. Standard painkillers are usually sufficient.
Risks and complications
Every intervention carries risks. Listing them does not mean they are expected to occur — it allows you to make an informed decision.
- The new scar may heal in the same way as the old one
- Recurrence of a keloid, sometimes larger than the original
- Change in pigmentation — lighter or darker than the surrounding skin
- Widening of the scar due to tension or strain too early on
- Thinning of the skin and dilated blood vessels after repeated corticosteroid injections
- Infection — rare
Results and longevity
The realistic expectation is improvement — usually significant — but not disappearance.
The result depends not only on the operation but above all on the aftercare — silicone products for at least three months and strict sun protection during the first year.
For keloids, treatment is a long process with several stages rather than a single intervention.