What is scar revision surgery?

Scar revision surgery improves the appearance of a scar. Scar revision surgery may involve  relocating a scar. Most people seek scar revision surgery for cosmetic reasons. Scar revision surgery is sometimes medically necessary to restore function of the affected body part or to relieve symptoms, such as pain.

Scar revision surgery has risks and potential complications. You may have less invasive treatment options. Consider getting a second opinion about all of your treatment choices before having scar revision surgery.

Types of scar revision surgeries

The types of scar revision surgeries include:

  • Punch graft involves punching out a core of skin containing the scar and filling it with a core of unscarred skin from another area. Punch grafts are especially useful for small, deep scars such as acne scars.
  • Scar excision involves cutting out the scar and closing the incision. A new scar will form, but it should be less visible than the original scar. 
  • Z or W-plasty involves cutting a series of triangular flaps through the scar in a “Z” or “W” pattern. This can reposition the new scar into natural creases or relieve a contracted scar by cutting across fibrous tissue.

Other procedures that may be performed 

Your doctor may perform other procedures in addition to scar revision surgery. These include: 

  • Autologous fat transfer or collagen injection to fill in sunken or depressed scars
  • Dermabrasion and laser resurfacing to improve the surface appearance of the scar by treating the top skin layers
  • Skin grafting or skin flaps to take healthy skin from one area and transplant it to cover the area where the scar was surgically removed
  • Tissue expansion to create extra skin near the scar that will cover the area once the scar is surgically removed

Why is scar revision surgery performed?

All scars are permanent, but scar revision surgery can minimize a scar’s appearance. Your doctor may recommend scar revision surgery if you want to improve the look of your scar for cosmetic reasons. Your doctor may also recommend it to restore function or to relieve symptoms, such as pain, contracture and recurrent infections. 

Your doctor may only consider scar revision surgery for you if other options that involve less risk of complications are not appropriate for you or have not worked. You should also be physically healthy, not smoke, and have realistic expectations of improvement, not perfection. Ask your doctor about all of your options and consider getting a second opinion before deciding on scar revision surgery. 

Your doctor may recommend scar revision surgery to treat:

  • Contractures are large scars that pull areas of skin, causing tightness. Contractures can also affect the underlying muscles, joints and tendons, limiting function and movement of the affected body part.
  • Burn scars that heal as a wide scar or in a puckered manner, possibly causing contractures
  • Facial scars that are unattractive or that affect your facial expressions
  • Ice pick or pitted scars that usually result from acne or blistering diseases such as chickenpox
  • Long or irregular scars as a result of trauma or prior surgery
  • Keloid scars that grow beyond the boundaries of the original wound or incision. They are often discolored, thick, elevated, and irregular scars that can be painful.
  • Hypertrophic scars are similar to keloid scars except that they are confined to the original boundaries of the wound or incision.

Who performs scar revision surgery?

The following specialists can perform your scar revision surgery:

  • Plastic surgeons specialize in correcting physical defects that affect a person's appearance or ability to function. 
  • Dermatologists specialize in the medical and surgical care of the skin, hair and nails.
  • Pediatric dermatologists specialize in the medical and surgical care of the skin, hair and nails in infants, children and adolescents.

How is scar revision surgery performed?

Your scar revision surgery will be performed in a hospital, surgeon's office, or outpatient surgery setting. All surgical incisions create scars, but the goal is to create a new, less noticeable scar. Your surgeon will take specific steps to close your incision to minimize the appearance of the new scar. This often involves closing each layer of skin tissue separately using very fine stitches.