MED0001860545
Read more here This website contains imagery which is only suitable for audiences 18+. All surgery contains risks.
This website contains imagery which is only suitable for audiences 18+. All surgery contains risks.
MED0001860545: This website contains imagery which is only suitable for audiences 18+. All surgery contains risks.
Read more here
Scar revision is the term for surgery performed to improve the appearance or function of an existing scar. It’s an area where realistic expectations matter more than in most other procedures, because no scar revision can remove a scar completely.
At a Glance
Scar Revision
Introduction
Scar revision is the term for surgery performed to improve the appearance or function of an existing scar. It’s an area where realistic expectations matter more than in most other procedures, because no scar revision can remove a scar completely. The goal of scar revision is improvement, not disappearance, and patients considering revision should understand that the outcome is an altered scar rather than no scar at all.
Different scars respond to different approaches, and not every problematic scar benefits from surgery. Some scars improve significantly with non-surgical management, and this is often tried before surgery is considered. Some scars are best left alone, because the risk of the revision producing an equally problematic or worse result is significant. The role of assessment at consultation is to work out which scars are likely to benefit from revision, which are best managed non-surgically, and which are best left as they are.
Types of problematic scars
Scars can be problematic in different ways, and the specific problem affects which approach is most appropriate.
These have spread wider than the original incision. This is typically related to tension across the wound during healing and to individual factors including body site, age, and skin characteristics. Revision involves excision of the widened scar and closure under less tension where possible.
Raised, red, firm scars that stay within the original incision line. These often develop in the first few months after injury or surgery and can improve over time with or without treatment. Non-surgical management including silicone sheeting or gels and pressure therapy is often tried first. Surgical revision is considered where non-surgical measures haven’t produced adequate improvement.
Keloids extend beyond the original incision line and can continue to grow over time. They’re more common in certain skin types and body sites, and they have a high rate of recurrence after surgical excision alone. Management often involves a combination of approaches, and the risk of the revised scar becoming another keloid needs to be considered before surgery is planned.
These limit movement or function, most commonly across a joint or on the face. Surgical revision aims to release the contracture and reconstruct the area to restore movement or function. Contracture revision is often performed for functional rather than cosmetic reasons.
Tethered to the underlying tissue, adherent scars produce a depressed or pulled-in appearance. Revision involves releasing the tethering and, in some cases, adding volume beneath the scar to restore contour.
Some scars don’t have a specific structural problem but are more visible than the patient would like. This includes scars that cross natural skin lines, scars that are in prominent locations, and scars that are simply thicker or more noticeable than the surrounding tissue. Revision aims to place the resulting scar in a more inconspicuous position or pattern.
Non-surgical management first
Many scars improve with non-surgical management, either alone or in combination with surgical revision. Silicone sheeting or gels applied over the scar for several months has evidence of benefit for hypertrophic and keloid scars. Pressure therapy using specialised garments can help certain scar types. Massage of the scar during the maturation phase can improve softness and appearance in some cases.
For scars that are still in the maturation phase (within the first 12 to 18 months after injury or surgery), waiting to see how the scar settles is often the right approach, since scars typically improve during this period. Revising a scar that’s still maturing risks producing a new scar that goes through the same maturation phase.
Non-surgical measures are generally tried before surgical revision is considered, particularly for hypertrophic and keloid scars. Where non-surgical measures haven’t produced adequate improvement and the scar is affecting the patient significantly, surgical revision becomes an option to consider.
Surgical techniques
Several different techniques are used in scar revision, chosen based on the type and location of the scar and what's realistic to achieve.
The scar is excised and the resulting wound is closed with the aim of producing a narrower, less visible scar. This works well for widened scars in areas with sufficient tissue laxity to allow closure without tension. The resulting scar is initially red and firm and settles over 12 to 18 months.
A technique that changes the direction of a scar by cutting a Z-shaped pattern and rearranging the tissue. This is used to change the orientation of a scar so that it lies within natural skin creases, or to release the tension of a contracture scar across a joint. The resulting scar is longer than the original but in a more favourable direction or with less tension.
A technique that breaks a long straight scar into a series of small angled segments in a W pattern. This changes the appearance of the scar so that it doesn’t read as a single line, which can make it less visible on the face and other areas. W-plasty produces a longer total scar length but often a less noticeable overall appearance.
Techniques that treat the surface of a scar to blend it with the surrounding skin. These are sometimes used alone for certain scar types and sometimes as a secondary treatment after surgical revision. Dermabrasion mechanically abrades the skin surface; laser resurfacing uses focused light energy to achieve similar effects.
For larger or more complex scars, revision may involve local flaps or skin grafts, particularly where the scar itself is extensive or where underlying tissue needs to be replaced. This overlaps with the reconstruction techniques used after skin cancer surgery.
The choice between techniques depends on the type and location of the scar, the skin characteristics, and what’s realistic to achieve. Dr Shepherd will explain which technique is most appropriate for your situation and the reasoning behind the recommendation.
Realistic expectations
The single most important part of scar revision is understanding what it can and can’t achieve. Scar revision produces a different scar, which is often better than the original but is never no scar at all. Patients who go into revision expecting the scar to disappear are almost always disappointed.
Realistic improvements from scar revision include making the scar narrower, changing its direction so it sits within natural skin lines, breaking up a long straight scar into a less visible pattern, releasing a contracture that limits movement, and reducing the height of a raised scar. The revised scar is initially red and firm, similar to any fresh surgical scar, and settles over 12 to 18 months. The final appearance can typically be assessed once this maturation phase is complete.
Certain scars have a higher risk of the revision producing a similar or worse result. Keloids in particular have a high recurrence rate after excision alone. Scars in areas of high tension (across joints, on the chest and shoulders) can widen again after revision. Patients whose original scar is in one of these higher-risk categories need to weigh the potential benefits carefully against the risk of ending up with a scar that isn’t any better or is worse than the original.
The procedure
Scar revision can be performed under local anaesthesia, local anaesthesia with sedation, or general anaesthesia, depending on the size and complexity of the revision. Smaller revisions are typically performed as day procedures under local anaesthesia. Larger revisions or those involving multiple areas may require general anaesthesia. Operating time depends on the specifics.
Sutures are typically removed within one to two weeks depending on the location. Post-operative care often includes measures to optimise scar healing, such as silicone sheeting or gel, sun protection, and taping. These measures are generally applied for several months after surgery to give the revised scar the best chance of maturing well.
Recovery
Recovery depends on the size and location of the revision. Small revisions have short recovery periods, with most patients back to normal activity within a few days. Larger revisions may involve activity restrictions for several weeks. Sutures are typically removed within one to two weeks. The revised scar goes through its own maturation process over 12 to 18 months, initially appearing red and firm before gradually fading.
Sun protection over the revised scar is important during healing and for at least the first year afterwards, because sun exposure during maturation can cause the scar to become darker permanently. Silicone gel or sheeting applied over the scar for several months is often recommended to optimise the result.
Risks
The recognised risks include:
Cost
Scar revision may attract a Medicare rebate where the scar is causing functional problems (for example, contracture scars limiting movement, or scars associated with previous cancer surgery where revision is indicated). Cosmetic scar revision (where the scar isn’t causing functional problems and revision is being performed for cosmetic reasons) generally isn’t covered by Medicare or by private health funds. We’ll assess your likely eligibility at consultation and provide a written quote covering all costs.
Results vary
Final appearance of the revised scar depends on the type of scar being revised, the location, the technique used, individual healing characteristics, and factors including sun protection and post-operative scar care. Some patients see significant improvement; others see a change that’s less pronounced than they hoped. The revised scar continues to mature over 12 to 18 months. There’s no guaranteed cosmetic result, and we discuss realistic expectations carefully at consultation before proceeding.
FAQs
No. Any surgery leaves a scar, and scar revision replaces the original scar with a new one. The goal is improvement rather than disappearance. Realistic improvements include making the scar narrower, changing its direction, breaking up a long straight line, or releasing a contracture. Patients expecting the scar to disappear are almost always disappointed.
Generally at least 12 to 18 months. Scars go through a maturation phase over this period, during which they typically improve. Revising a scar that’s still maturing risks producing a new scar that goes through the same phase. Waiting until the original scar has matured allows you to see what the scar has settled to and whether revision is still indicated.
Sometimes. Silicone sheeting or gel, pressure therapy, and scar massage can produce improvement in certain scar types, particularly hypertrophic and keloid scars. These are often tried before surgical revision is considered. Non-surgical measures are generally more effective in scars that are still maturing than in scars that have already fully matured.
A rebate may apply where the scar is causing functional problems (for example, contracture scars limiting movement). Cosmetic scar revision isn’t generally covered. We’ll assess your likely eligibility at consultation.
Yes, but with the important caveat that keloids have a high recurrence rate after surgical excision alone. Management often involves a combination of approaches. The risk of the revised scar becoming another keloid needs to be weighed carefully before surgery is planned, particularly in patients with a history of multiple keloids.
The initial healing takes one to two weeks, with sutures typically removed at that point. The revised scar goes through its own maturation over 12 to 18 months, initially appearing red and firm before gradually fading. Sun protection and, in many cases, silicone gel or sheeting are recommended during this maturation phase.
Practitioner
Dr Henry Shepherd, BMed MD MS (Plast.) FRACS (Plast.) | Specialist Plastic Surgeon | AHPRA registration: MED 0001860545