What Is Scar Revision?

Scar revision is a broad term that’s used to describe techniques that minimize or improve the appearance of scars. Simply put, scars are growths of fibrous tissue that form as part of your body’s healing response to an injury.

There are several different ways to perform scar revision, and sometimes doctors will combine methods. Your treatment options will depend on the type of scar you have, the severity of the scar, your desired outcome, and other factors. Some examples of scar revision include:

• Scar excision With this procedure, doctors remove the scar surgically and close the skin.
• Skin graft Surgeons remove the scar and take healthy skin from another area of the body to cover the affected spot.
• Skin flap This is similar to a skin graft, but the transferred skin has its own blood supply.
• Z-plasty With Z-plasty, surgeons make a Z-shaped incision through the scar tissue and some healthy skin. The Z-shape allows them to create pointed flaps that are used to reposition the scar or change its direction, so it’s less visible.
• Surface treatments Laser resurfacing, dermabrasion, light therapy, chemical peels, and bleaching agents are used to smooth the surface of the scar and lessen discoloration.
• Tissue expansion Tissue expansion involves helping the body grow new skin to cover a scar. Doctors place an inflatable balloon under the skin near the scar and gradually stretch the skin, which is redistributed to replace damaged areas.
• Cryotherapy With cryotherapy, doctors use a medication to freeze off the scar.
• Injectables Sometimes steroids or fillers made from natural or synthetic products are injected into the scar tissue to help improve its appearance.
• Pressure therapy This involves wearing a pressure appliance over the scar to help lessen its thickness.

Additionally, other nonsurgical treatments, such as topical medicines, may be used along with scar revision procedures to smooth out the skin’s surface and promote healing.

You might need scar revision if you would like to improve the appearance of a scar. Scars can result from injuries due to:

• Burns
• Surgery
• Accidents
• Illnesses
• Acne or other irritating skin conditions

Scars can vary in size, shape, color, and texture. There are different types of scars. They include:

• Hypertrophic scars These scars are usually raised, thick, and red. They can appear dark or light and often form right on the site of the wound.
• Keloids Keloids are thick, raised scars that can itch or cause pain. They may grow much larger than the wound that caused the scar. These scars usually affect the face, ears, neck, chest, or shoulders.
• Contractures Contractures cause skin to tighten and make it difficult to move. They often occur after a burn injury.
• Stretch marks They happen when skin stretches or shrinks rapidly and leads to damage in the connective tissues underneath. Stretch marks usually develop on the breasts, thighs, stomach, or upper arms.
• Atrophic scars These scars have a sunken appearance and look like small indentations in the skin. They usually result from acne or chickenpox.
• Flat scars This type of scar, which is usually pink or red, flattens as it heals.

A good candidate for scar revision is an individual who is physically healthy, doesn’t smoke, doesn’t have any active skin diseases, and has realistic expectations for their results.

There are many ways to perform scar revision. You and your doctor will choose the technique that will offer you the best outcome.

If you’re having a surgical procedure, your doctor might cut out your scar and stitch up the area. With Z-plasty, scars are repositioned so they’re not as noticeable. Doctors can also cover the scar with transplanted skin that’s taken from another area of your body with a skin graft or skin flap approach.

Or, you might have a tissue expansion procedure to slowly stretch the skin and replace the scar tissue. This procedure can sometimes be a complex process that involves multiple procedures to achieve the desired outcome.

If you’re having a surface treatment, doctors may use dermabrasion to smooth the skin, bleaching agents to lighten the skin, or chemical peels to improve texture and color. Laser therapy is another option that targets the surface of the skin and allows healthy skin to develop at the site of the scar.

Dermal fillers are often helpful for scars that are sunken or depressed.

Alternatively, steroid injections can improve the appearance of raised scar tissue.

With cryotherapy, doctors apply extreme cold to destroy scars.

Pressure therapy involves wearing a bandage or dressing that applies pressure to the wound while it heals. This extra tension may help lessen the size of a scar.

Your doctor will give you detailed instructions on how to best prepare for your procedure. You may have to wait to have the treatment if your scar hasn’t matured enough.

Before your surgery, you should tell your provider about all the medicines and supplements you take. Additionally, it’s important to let your doctor know about your existing medical conditions and any drug allergies you have.

Before undergoing scar revision surgery, you may have to:

• Stop taking certain medicines or adjust your dosages
• Stop smoking
• Get lab tests

If you’re receiving anesthesia for your scar revision, you may have to fast for a certain amount of time before your scheduled procedure.

On the day of your procedure, avoid applying any lotions or makeup to the area being treated.

It’s a good idea to ask your doctor if you can see before and after pictures of cases that are similar to yours. That way, you’ll know what kind of results to expect from your scar revision.

The risks associated with scar revision will depend on the type of procedure you have. You and your doctor should discuss all the potential negative outcomes before scheduling your surgery or treatment.

Some possible risks of scar revision surgery include:

• Bleeding
• Infection
• Problems associated with anesthesia
• Blood clots or cardiac problems
• Hematoma
• Asymmetry or poor results
• Fat necrosis (when fatty tissue deep in the skin dies)
• Seroma (an accumulation of fluid)
• Numbness
• Persistent pain
• Poor healing
• Keloid formation (thickened scar)
• Skin loss
• Skin discoloration or swelling
• Loose skin
• Recurrence of the scar

If you are having a surgical procedure, you’ll likely be given anesthesia to make you more comfortable. There are different anesthesia options. They include:

• Local anesthesia (an injection that numbs the area)
• Intravenous sedation (“twilight” sedation)
• General anesthesia (medicines that put you to sleep during surgery)

Your doctor will recommend the best way to ensure that you don’t feel pain during the surgery or treatment.

With surface procedures, such as lasers, you might feel warmth or discomfort. If so, doctors might apply a topical anesthetic, inject a numbing anesthetic, or give you an oral sedative, depending on the therapy that’s used.

After your procedure, you may notice skin discoloration, discomfort, or swelling that lasts one to two weeks.

Scar revision can cause complications, such as bleeding, infection, blood clots, hematomas, reactions to anesthesia, or cardiac issues.

You should seek medical attention right away if you develop the following symptoms:

• Shortness of breath
• Chest pain
• Irregular heartbeat
• A high fever, chills, or other signs of infection

You should let your doctor know if you’re having persistent pain, swelling, or numbness; your skin isn’t healing normally; or your results aren’t as expected.

Your aftercare routine will hinge on the type of procedure you had. You should follow any wound care instructions your doctor provides.

Healing from scar revision surgery can take several weeks, and it could take months before you see the final results.

If you have stitches, your doctor will probably remove them after three to four days if they’re on your face, or after five to seven days if they’re on another part of your body.

You may have to apply an elastic dressing or light dressing to the area after surgery.

Most people are able to resume normal activities shortly after their procedure, but it depends on the type of surgery you have. Your doctor will tell you what activities to avoid. You may have to be careful not to stretch the new scar.

You should apply sunscreen when outdoors and keep away from the sun while your scar is healing.

It’s possible to achieve desired results in one procedure, but you may require another scar revision surgery or treatment in the future.