Scars -whether they’re caused by accidents or by surgery- are unpredictable. The way a
scar develops depends as much on how your body heals as it does on the original injury or
on the surgeon’s skills.
Many variables can affect the severity of scarring, including the size and depth of the
wound, the blood supply to the area, the thickness and color of your skin, and the direction
of the scar. How much the appearance of a scar bothers you is, of course, a personal matter.
No scar can be removed completely. However, plastic surgeons can often by
various techniques, improve the appearance of a scar; making it less obvious.
MAKING THE DECISION:
Many scars that appear large and unattractive at first may become less noticeable with
time. Some can be treated with steroids to relieve symptoms such as tenderness and itching.
For these reasons, we recommend waiting as long as a year or more after an injury or
surgery before you decide to have scar revision.
We will examine you and discuss the possible methods of treating your scar, the risks and
benefits involved and the possible outcomes. Be frank in discussing your expectations with
us, and make sure they’re realistic. Don’t hesitate to ask any questions or express any
concerns you may have.
Insurance usually doesn’t cover cosmetic procedures. However, if scar revision is
performed to minimize scarring from an injury or to improve your ability to function, it may
be at least partially covered. Check your policy or call your carrier to be sure.
RISK & COMPLICATIONS:
While scar revision is normally safe, there is always the possibility of complications. These
may include infection, bleeding, a reaction to the anesthesia, or the recurrence of an
You can reduce your risks by choosing a qualified plastic surgeon and closely following his
or her advice, both before surgery and in follow-up care.
Keloids are thick, puckered, itchy clusters of scar tissue that grow beyond the edges of the
wound or incision. They are often red or darker in color than the surrounding skin. Keloids
occur when the body continues to produce the tough, fibrous protein known as collagen after
a wound has healed.
Keloids can appear anywhere on the body, but they’re most common over the breastbone,
on the earlobes, and on the shoulders. They occur more often in dark-skinned people than in
those who are fair. The tendency to develop keloids lessens with age.
Treatment: Keloids are often treated by injecting a steroid medication directly into the
scar tissue to reduce redness, itching, and burning. In some cases, this will also shrink the
scar. This treatment is repeated several times with intervals of 4 weeks in between
If steroid treatment is inadequate, the scar tissue can be cut out and the wound closed with
one or more layers of stitches. This is generally an outpatient procedure, performed under
local anesthesia. You should be back at work in a day or two, and the stitches will be
removed in a few days. A skin graft (see the section on skin grafting) is occasionally used,
however the site from which the graft was taken may then develop a keloid.
No matter what approach is taken, keloids have a stubborn tendency to recur, sometimes
even larger than before. To discourage this, the surgeon may combine the scar removal with
steroid injections, direct application of steroids during surgery. Or you may be asked to
wear a pressure garment over the area for as long as a year. Even so, the keloid may
return, requiring repeated procedures every few years.
Hypertrophic scars are often confused with keloids, since both tend to be thick, red, and
raised. Hypertrophic scars, however, remain within the boundaries of the original incision or
wound. They often improve on their own-though it may take a year or more-or with the help
of steroid applications or injections.
Treatment: If a conservative approach doesn’t appear to be effective, hypertrophic scars
can often be improved surgically. The plastic surgeon will remove excess scar tissue, and
may reposition the incision so that it heals in a less visible pattern. This surgery may be
done under local or general anesthesia, depending on the scar’s location. You may receive
steroid injections during surgery and at intervals for up to two years afterward to prevent
the thick scar from reforming.
Because of its location, a facial scar is frequently considered a cosmetic problem, whether
or not it is hypertrophic.
Treatment: There are several ways to make a facial scar less noticeable. Often it is simply
cut out and closed with tiny stitches (primary closure), leaving a thinner, less noticeable scar.
If the scar lies across the natural skin creases (or “lines of relaxation”) the surgeon may be
able to reposition it to run parallel to these lines, where it will be less conspicuous. (See
Some facial scars can be softened using a technique called dermabrasion, a controlled
scraping of the top layers of the skin using a hand-held, high-speed rotary wheel.
Dermabrasion leaves a smoother surface to the skin, but it won’t completely erase the scar.
Z-plasty is a surgical technique used to reposition a scar so that it more closely conforms to
the natural lines and creases of the skin, where it will be less noticeable. It can also relieve
the tension caused by contracture. Not all scars lend themselves to Z-plasty, however, and it
requires an experienced plastic surgeon to make such judgments.
This procedure is performed under local anaesthesia, the old scar is removed and new
incisions are made on each side, creating small triangular flaps of skin. These flaps are then
rearranged to cover the wound at a different angle, giving the scar a “Z”pattern. While
Z-plasty can make some scars less obvious, it won’t make them disappear. A portion of the
scar will still remain outside the lines of relaxation.
AFTER SCAR REVISION:
With any kind or scar revision, it’s very important to follow our instructions after surgery to
make sure the wound heals properly. Although you may be up and about very quickly, one
should gradually resume normal activities.
As you heal, keep in mind that no scar can be removed completely; the degree of
improvement depends on the size and direction of your scar, the nature and quality of your
skin, and how well you care for the wound after the operation.
If your scar looks worse at first, don’t panic-the final results of your surgery may
not be apparent for a year or more.