Scar revision — not surgery that removes a scar, surgery that changes one

Scar revision cuts out an existing scar and closes it again. A wide scar becomes narrow, a pulling direction becomes a less pulling one, an uneven edge becomes even.

The first thing to write on this page is this: a new scar is made in order to deal with a scar.

Which is why the scarring field in this layer says 'visible'. There is no border of colour to hide it in, as on areola reduction, and no hairline to tuck it behind, as on a facelift. The new scar appears where the old one was.

Why changing one is still worth something. What a scar is like comes from its width, its direction, its height and its colour together. Of those, direction is what surgery can change, and set along the lines the skin pulls on, a scar of the same length shows less. Closing a widened scar narrow is the same kind of gain.

But surgery is often not the first choice. The non-surgical options on this site.

• silicone scar products — the most used of all, and Cochrane rated all of the evidence 'low' or 'very low'
• intralesional corticosteroid — used as first-line for keloids and hypertrophic scars
• intralesional 5-fluorouracil — combined with a steroid it ranked first across 24 trials. Not alone
• cryotherapy, fractional laser and subcision — each sits in a different place depending on the scar

Which scar it is decides that choice. Keloid or hypertrophic, atrophic or widened, pulling or not. That distinction belongs in a clinic, and this site does not make it for you.

Timing matters too. A scar matures over months. While it is red and firm it is changing on its own, so there is a period in which waiting beats operating. How long to wait is settled in a clinic.

This site does not deal in prices, clinics or reviews.

The new scar can turn out worse. The first sentence to accept about this operation. The reclosed line can widen again, or become a hypertrophic scar or a keloid.

If you tend to keloid, surgery itself can raise the risk. A keloid has a way of growing back out of the cut. In that case the usual approach is not surgery alone but surgery with adjuvant treatment planned alongside, and you should hear that plan before the operation. See the intralesional corticosteroid and 5-fluorouracil pages.

Material on recurrence is thin on this site. The 66-patient trial on the 5-FU page wrote that recurrence could not be assessed. In keloids, 'flat now' and 'flat a year from now' are different stories.

Sensation can change. The skin where it was cut can feel duller, or feel tight.

Colour stays for a while. A new scar goes through a red period too, and pigment change is more visible on darker skin.

Wounds can open, the more so where there is tension.

Not smoking matters. Healing decides most of the result here.

It is not always one operation. A wide scar is sometimes reduced in stages.

First ask whether all the non-surgical options have been tried. It is the most useful question in this operation. Depending on the scar, injections, silicone or laser often come first.

Ask for the name of your scar. Keloid, hypertrophic, atrophic, widened and contracting scars have different plans. Hearing the name also tells you which page on this site to read.

Ask whether the plan is to change direction or to narrow. Simple excision, Z-plasty, W-plasty, a local flap, staged reduction — ask to see which is proposed and why, drawn out.

Hear the aftercare plan before the surgery. When pressure, silicone, injections and sun protection start, and for how long, is a large part of the result. Having the operation and leaving that empty can take you back to where you were.

Say if you tend to keloid. A history in you or your family changes the plan.

Ask whether this is a period for waiting. A red, firm scar is changing on its own.

Block the sun. A new scar holds colour long in sunlight. See sunscreen.

Ask in advance when to judge the result. It takes 6 to 12 months. Do not judge from a red line a month later.

It cannot be undone. And the scar does not go away. Whether you can accept both sentences together is the central question of this operation.

Be clear about what bothers you — the width, the direction, the height or the colour. If it is the colour, surgery may not be the answer: colour is the territory of time, sun protection and other methods.

If it is a keloid, there are places to read before this page: the scars page and the injection pages. In keloids, surgery is an option that goes in when adjuvant treatment is planned with it.

Set the size of your expectation beforehand. What this operation changes is what the scar is like, not whether it is there. A good result still has a line.

Whether to have it is decided in consultation, and it is better not to decide from one clinic's account.