Scar Revision

Scar revision is a surgical procedure that improves the appearance or function of a scar left behind after an injury, burn, or previous surgery.

When skin heals after damage, it forms scar tissue. Scar tissue is structurally different from normal skin — it is less flexible, may be raised, sunken, discoloured, or tightly bound to deeper layers beneath. Scar revision works by removing or reshaping this abnormal tissue and closing the skin in a way that encourages a flatter, less visible, and more flexible result. The exact technique depends on the size, location, type, and age of the scar.

Scar revision is considered when a scar causes significant cosmetic concern, physical discomfort, or limits movement. Plastic and reconstructive surgeons assess each scar individually before recommending this approach.

• Hypertrophic scars (thick, raised scars that stay within the original wound boundary) that have not improved with non-surgical treatments such as silicone sheets or steroid injections
• Keloids (an overgrowth of scar tissue that spreads beyond the original wound edge), particularly when they cause pain, itch, or significant disfigurement
• Contracture scars (tight scars that pull the skin and limit movement), commonly seen after burns over joints such as the elbow, knee, or neck
• Depressed or atrophic scars (sunken scars) that create an uneven skin surface
• Widened or stretched scars that formed because the wound was under tension during healing
• Scars in visible areas — such as the face or hands — that affect a person's confidence or daily life
• Scars that distort nearby structures, for example pulling on an eyelid, nostril, or lip

Scar revision is generally not recommended in the following situations:

• The scar is still maturing — most scars need at least 12 to 18 months to fully settle before surgery is useful
• Active skin infection or inflammation in or around the scar
• Uncontrolled medical conditions, such as poorly managed diabetes, that impair wound healing
• Strong tendency to form keloids without a plan to prevent recurrence after revision
• Unrealistic expectations — revision can improve a scar but cannot make it disappear entirely

Like any surgical procedure, scar revision carries recognised risks; your surgeon will discuss which of these apply most to your specific scar and skin type.

• Imperfect cosmetic result — the revised scar may still be noticeable, and outcomes vary between individuals and skin types
• Recurrence — the scar may widen, thicken, or reform, especially in people prone to keloids or hypertrophic scarring
• Wound infection — redness, warmth, or discharge at the surgical site
• Poor wound healing — more common in people who smoke, have diabetes, or poor blood circulation
• Altered skin sensation — numbness or increased sensitivity around the revised area, which often improves over time
• Skin discolouration — the revised area may appear lighter or darker than the surrounding skin
• Haematoma (a pocket of blood) or seroma (a pocket of fluid) collecting under the skin
• Anaesthesia-related reactions — depending on whether local or general anaesthesia is used
• Scarring from the revision itself — a new scar forms wherever skin is cut; the goal is to make it less troublesome than the original

Preparation for scar revision begins with a thorough consultation. The surgeon examines the scar closely — assessing its type, depth, location, and whether deeper structures such as tendons or joints are involved. Photographs are usually taken to document the baseline and plan the approach. It is important to share your full medical history, including any tendency to form keloids, all medications you take, and any previous treatments on the scar.

Before the procedure, your medical team will typically ask you to make the following adjustments:

• Stop smoking for several weeks beforehand if possible — smoking significantly reduces blood flow to the skin and slows healing
• Avoid alcohol for at least a few days before surgery
• Stop blood thinners (medications that reduce clotting, such as aspirin or anticoagulants) for a period advised by your surgeon — never stop these without medical guidance
• Fast (avoid eating and drinking) for the required period if general anaesthesia or sedation is planned — your team will give a specific instruction
• Keep the scar area clean and free from active skin infections before the procedure date

Pre-operative tests may include a blood count, clotting tests, and blood sugar checks, especially if there are underlying health conditions. For larger reconstructive cases, additional imaging may be requested.

On the day of the procedure, the steps generally follow this sequence — though the exact number and order vary with the technique chosen:

• 1. The surgical area is cleaned and marked by the surgeon to guide the incisions (cuts).
• 2. Anaesthesia is administered — local anaesthesia (numbing just the area) for small scars, or general anaesthesia (putting the patient fully to sleep) for larger or more complex cases.
• 3. The existing scar tissue is excised (removed) or reshaped. The technique varies: simple excision and re-closure for a straight scar; Z-plasty or W-plasty (geometric rearrangements of skin flaps) to reorient a contracture or irregular scar; skin grafting (moving skin from another part of the body) for very large scars; or flap surgery (moving a block of skin with its own blood supply) for deep or complex defects.
• 4. The wound is closed in layers using fine sutures (stitches) to minimise tension on the skin surface.
• 5. The area is dressed with appropriate wound coverings. Drains (thin tubes to remove fluid) may be placed if a larger area has been operated on.
• 6. The patient is moved to a recovery area to be monitored as the anaesthesia wears off.

Recovery after scar revision varies considerably depending on the technique used, the size of the area treated, and the individual's general health. Minor revisions done under local anaesthesia may allow the patient to go home the same day, while larger reconstructive procedures may require a hospital stay of several days. Your surgical team will provide a personalised recovery plan.

• Wound care: Keep the wound clean and dry as instructed. Dressings are usually changed on a schedule set by your nurse or surgeon. Do not remove sutures yourself — they are removed at a follow-up visit, or dissolve on their own if absorbable sutures were used.
• Activity restrictions: Avoid strenuous activity and heavy lifting for the period advised by your surgeon — physical strain can pull on the new wound and worsen the scar. Specific restrictions around joints (for example after contracture release) will be explained clearly.
• Sun protection: Keep the revised area out of direct sunlight and use high-protection sunscreen once the wound has closed — sun exposure can cause permanent discolouration of healing skin.
• Scar management: Once healing is sufficiently advanced, the surgeon may recommend silicone gel sheets, pressure garments (tight elastic covers that flatten the scar), or steroid injections to help the scar settle. These are usually continued for several months.
• Physiotherapy (exercise therapy guided by a specialist): If the revision involved a contracture over a joint, physiotherapy is often a critical part of recovery to regain full movement.
• Smoking and alcohol: Continuing to avoid smoking and excessive alcohol after surgery supports better healing and a better final result.
• Follow-up appointments: Regular check-ups allow the surgeon to monitor healing, remove sutures if needed, and adjust the scar management plan. Scar maturation is a slow process — the final appearance may not be clear for 12 months or more after surgery.
• Warning signs to report promptly: Increasing redness, swelling, warmth, discharge from the wound, fever, or sudden pain should be reported to your medical team without delay.