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Procedure guide · Reconstructive Plastic Surgery
Scar RevisionScar revision exchanges an existing scar for a better one; no operation removes a scar entirely. It improves scars that are wide, raised, tethered, discoloured or running across the natural lines of the skin, and it can release a scar that restricts movement. Scars keep improving on their own for a full year, so revising earlier than that usually means operating on something that was still going to get better.
Scar revision is surgery to improve an existing scar, and the most useful thing to establish before anything else is what it can achieve. It cannot remove a scar. Skin cut through its full thickness always heals with a scar, so revision replaces the existing one with a new one that is narrower, better positioned, better oriented, less tethered or less obviously a straight line. Patients who understood that are consistently satisfied with a good result; patients who expected the scar to disappear are disappointed however well the operation went.
Timing matters more than technique, and it is the commonest avoidable mistake in this area. A scar continues remodelling for a full year and sometimes 18 months, becoming paler, flatter and softer with no intervention at all. Revising at 3 or 6 months means operating on something that was still going to improve, and frequently produces a new scar no better than the one it replaced. The exception is a contracture restricting movement or distorting a structure such as an eyelid or a lip, where waiting causes harm that cannot be undone and early release is correct.
What actually determines whether a scar looks good is direction and tension rather than the fineness of the stitching. A scar lying along the natural lines of the skin, under no tension, heals to a fine pale line. One crossing those lines, or pulled apart by movement every time a joint bends or an expression forms, widens however carefully it was closed. Site matters too: eyelids and the face heal beautifully, while the chest, shoulders and upper back scar badly in almost everyone. A surgeon who talks about direction and tension is describing the thing that decides the outcome.
That is why the geometric techniques exist. A Z-plasty cuts two triangular flaps and swaps them, which reorients a scar into the natural lines of the skin, lengthens the tissue and breaks a straight line into segments. It is the standard answer to a scar running in the wrong direction or one that has tightened across a joint. A W-plasty or geometric broken line excises the scar along an irregular pattern so the eye cannot follow a continuous line, which is very effective for long straight facial scars. Neither removes more scar than a simple excision does; they rearrange it.
Non-surgical treatment deserves trying first for almost any scar under a year old. Silicone gel or sheeting has the best evidence of anything available and needs months rather than weeks of consistent use. Intralesional steroid flattens and softens a raised, firm, itchy scar and relieves the itching, which is frequently the worst symptom. Vascular laser reduces redness and resurfacing laser improves texture, particularly in burn scars. None of these can narrow a wide scar, reposition one or release a contracture, but they resolve a great many scars that would otherwise reach a surgeon.
One risk deserves singling out because it converts a modest problem into a significant one. Anyone who has previously formed a keloid, or who has a family history of them, is at real risk of a revision producing a worse scar than the original. Keloids are commoner in people of African, Caribbean and East Asian descent and at certain sites regardless of skin type, particularly the chest, shoulders and earlobes. Revising a scar in someone with that tendency without planning adjuvant treatment is how a small scar becomes a large one.
Where a contracture has been released, the aftercare is the operation. Splinting and stretching for months are what stop the released tissue tightening again, and a released contracture that is not stretched contracts back and wastes the surgery. Arranging therapy before the operation rather than afterwards is the most useful preparation for anyone having a functional release rather than a cosmetic refinement.
Scar revision is, with keloid surgery and fat grafting, one of the few procedures in this category that genuinely suits travelling. It is short, usually under local anaesthetic, and the aftercare is silicone, sun protection and massage that patients apply themselves. The one caveat is that the result cannot be judged for a year, so any dissatisfaction arises long after the trip, which makes the revision policy worth agreeing in writing beforehand.
Scar revision has a maturation timetable that governs almost everything else about it. A scar is at its reddest and most raised between 6 weeks and 4 months, then remodels for a year or more, gradually flattening and fading. Operating during the inflammatory phase means operating on tissue that is actively laying down collagen, and the new scar frequently behaves exactly as the first one did. Most surgeons therefore decline to revise anything before 12 months unless it is causing a functional problem such as an eyelid being pulled out of position. Patients find this wait difficult precisely because the scar looks worst during it.
Scar revision is measured by the patient rather than by the surgeon, and the two frequently disagree. Validated scar scales such as the Patient and Observer Scar Assessment Scale exist because observers consistently rate scars as better than the people who have them. A revision that halves the width of a scar is a clear technical success and can still disappoint someone whose expectation was that it would disappear. The most useful preparation is a frank conversation about what a realistic result looks like, ideally with photographs of the surgeon’s own revisions rather than selected best cases.
Scar revision is frequently combined with non-surgical treatment rather than used alone, and the combination generally outperforms either. Silicone gel or sheeting applied for several months has the best evidence of the self-applied options. Steroid injection flattens a thick scar. Vascular laser reduces redness, and fractional laser improves texture and pliability. A common plan is a surgical revision followed by silicone from 2 weeks, then laser from 8 weeks if the scar remains red. Setting out that whole sequence at the start prevents the disappointment of judging a revision at 6 weeks, when it has barely started.
Scar revision technique is chosen by what is wrong with the scar rather than by preference. A scar that is simply wide is excised and closed carefully in layers to take tension off the skin. A scar running across the natural tension lines is broken up and redirected with a series of Z-plasties. A scar pulling a structure out of position is released and the gap filled with a graft or a local flap. A depressed scar is undermined and supported from beneath, sometimes with fat. Naming the specific problem is what makes the right technique obvious.
Scar revision has a small number of situations where it should be declined rather than attempted. An active keloid is one, because excision alone reliably makes it worse. A scar less than 12 months old is another, unless it is causing a functional problem. A scar in a patient who is smoking is a third, since the healing that a revision depends on is measurably impaired. A surgeon who declines on any of these grounds is giving good advice rather than turning away work.
Scar revision costs are unusually variable because the procedures themselves vary so widely. A small facial revision under local anaesthetic is among the least expensive operations in plastic surgery, while a contracture release with a flap under general anaesthetic sits in a different bracket entirely. Where scarring is functional rather than cosmetic, many health systems and insurers will contribute, so it is worth establishing coverage before paying privately.
Surgeons look for these points at the consultation.
Scar revision suits people with a scar at least 12 months old that is wide, raised, depressed, discoloured, tethered to deeper tissue, restricting movement, or running across the natural lines of the skin, who do not smoke, and who understand that the result is a different scar rather than no scar.
Reasons a good surgeon will ask you to wait or choose something else.
Scar revision is avoided in scars less than 12 months old that are still remodelling, in active infection or inflammation, in current smokers, in anyone with a keloid tendency unless adjuvant treatment is planned, during isotretinoin treatment and for some months afterwards, and where the expectation is that the scar will disappear.
Ask your surgeon which technique they recommend for you and why.
The old scar is cut out and the wound closed in layers with fine sutures, trading a wide or poorly healed scar for a narrow, well-placed one.
Two triangular flaps are transposed, which reorients a scar into the natural lines of the skin, lengthens it and breaks a straight line into segments.
The scar is excised along an irregular zig-zag or randomised pattern, so the eye cannot follow a continuous line.
Silicone gel or sheeting, steroid injection into a raised scar, pressure, massage, and laser for redness or texture.
Step by step, from arrival to discharge.
Scar revision starts with the surgeon assessing which way the scar runs relative to the natural lines of the skin, whether it is tethered to deeper tissue, and whether it restricts movement.
Simple excision for a wide scar in a good direction, Z-plasty to reorient or lengthen, W-plasty or a broken line to disguise a straight facial scar.
The planned incisions are drawn out, which for geometric techniques is most of the operation, since poor planning makes a Z-plasty worse than doing nothing.
The old scar is removed and the wound closed in layers without tension, using fine sutures placed to evert the edges.
Sutures out at 5 to 7 days on the face and 10 to 14 days elsewhere. Silicone and sun protection begin once the wound is fully closed.
Silicone, massage and sun protection for months, with splinting and stretching where a contracture was released.
Frequencies follow published guidance; your personal risk depends on your health and the surgeon.
The most useful thing to understand about scar revision is what it can and cannot do. It cannot remove a scar. Skin that has been cut through its full thickness always heals with a scar, and surgery replaces the existing one with a new one that is narrower, better positioned, better oriented or less tethered. Patients who understood that are consistently satisfied; patients who expected the scar to disappear are not, however well the operation went.
Timing matters more here than technique. A scar continues remodelling for a full year and sometimes 18 months, becoming paler, flatter and softer without anyone doing anything. Revising at 3 or 6 months means operating on something that was still improving, and it is the commonest avoidable mistake in this field. The exception is a contracture restricting movement or distorting a feature such as an eyelid or a lip, where waiting causes harm and early release is correct.
What actually decides whether a scar looks good is direction and tension. A scar lying along the natural lines of the skin, under no tension, heals to a fine pale line. A scar crossing those lines, or pulled apart by movement, widens however carefully it was stitched. That is why Z-plasty and its relatives exist: they do not remove more scar than a simple excision does, they reorient it. A surgeon who talks about direction and tension rather than about stitching technique is describing the thing that determines the outcome.
One risk deserves singling out. Anyone who has previously formed a keloid, or who has a family history of them, is at real risk of the revision producing a worse scar than the original. Keloids are commoner in darker skin and in certain sites, particularly the chest, shoulders and earlobes. Revising a scar in someone with that tendency without planning adjuvant treatment is how a modest problem becomes a significant one.
Scar revision exchanges one scar for another, and how the new one heals depends on the same biology that produced the first. A proportion of revisions are no improvement.
Z-plasty and W-plasty techniques deliberately trade a single line for a longer broken one, which is less visible overall but covers more skin.
The new scar healing lighter or darker than surrounding skin. Darker skin types are more likely to develop lasting hyperpigmentation.
Reduced sensation along and around the new scar, usually improving over months and occasionally permanent in a narrow band.
The new scar heals worse than the old one, particularly where tension is high, in smokers, or where a keloid tendency was not recognised.
Wound infection after scar revision, treated with antibiotics, which can itself worsen the resulting scar.
A released scar tightening again, particularly across a joint or in a growing child, which is why splinting and therapy follow contracture release.
Recovery from scar revision is short and the surgery is usually the easy part. Most revisions are done under local anaesthetic as a day case, discomfort is mild, and people return to desk work within a few days. What takes time is the scar itself, which behaves exactly like the original did: it reddens and firms over the first 2 months before slowly fading over a year or more.
That reddening catches people out. A revision looks worse at 6 weeks than the scar it replaced, which is disconcerting if nobody explained the sequence. It is the normal course of wound healing rather than a sign that the operation failed, and judging the result before 6 months tells you almost nothing useful.
Three things genuinely help during that year. Silicone gel or sheeting, used consistently once the wound has closed, has the best evidence of anything available and needs months rather than weeks of use. Sun protection, because ultraviolet light darkens a healing scar and that darkening can be permanent. And massage, which softens a firm scar and is worth doing daily.
Where a contracture was released across a joint, splinting and stretching matter more than any of that, and they continue for months. A released contracture that is not stretched tightens again, which wastes the operation. Arranging therapy before the surgery rather than afterwards is the single most useful preparation in those cases.
Days 1-3
Mild discomfort managed with simple painkillers. Dressings kept clean and dry. Swelling and bruising around the site, more on the face.
Days 4-14
Non-absorbable sutures removed at 5 to 7 days on the face and 10 to 14 days elsewhere. Flying is usually cleared at around day 3.
Weeks 2-8
The new scar reddens and firms as it heals, which is normal and alarming to patients who were not warned. Silicone and sun protection start once healed.
Months 3-6
Redness begins to fade and the scar softens. Massage continues. This is too early to judge the result.
Months 12-18
The scar reaches its settled colour and texture. Any further revision is considered only from this point.
A revised scar looks worse before it looks better. It reddens and firms over the first 2 months exactly as the original did, which disconcerts patients who were not told the sequence, then fades and softens over a year or more.
Judging the result before 6 months tells you almost nothing useful, and the honest assessment point is 12 to 18 months. Patients who look at a revision at 6 weeks and conclude it failed are looking at normal wound healing.
Outcomes are good where direction and tension were the problem and the revision addressed them. They are less good where the underlying biology produced a poor scar in the first place, because the same biology heals the new wound.
A proportion of revisions are no improvement, and a smaller proportion are worse, particularly in high-tension sites and in anyone with a keloid tendency. That is worth knowing before rather than discovering afterwards.
Scar revision is among the least expensive procedures in this category, because it is usually short and performed under local anaesthetic as a day case. The prices on this site come from verified clinic records rather than a published tariff, and they vary mainly with the length of the scar and the complexity of the technique.
A geometric technique such as a Z-plasty or a series of them takes considerably longer than a simple excision and is priced accordingly. Contracture release with grafting is a larger operation again, frequently under general anaesthesia, and may need a hospital stay.
The cost most worth establishing in advance is revision, because this is the procedure where dissatisfaction typically arises 12 months later. Agree what happens if the new scar heals no better, what it would cost, and whether it would mean travelling again.
Why quotes for the same procedure differ, so you can compare packages fairly.
Options to weigh before deciding, surgical and non-surgical.
The right first step for almost any scar under a year old, with the best evidence of any non-surgical treatment and no new wound.
For a raised, firm, itchy scar, flattening and softening it and relieving the itch, frequently enough to avoid surgery entirely.
Vascular laser for redness and resurfacing laser for texture, particularly effective in burn scars. Cannot narrow or reposition a scar.
Where the scar has grown beyond the original wound, it is a keloid and needs a different plan, since plain revision will make it worse.
Reasonable where the scar is mature, causes no functional problem and the trade for a different scar is not obviously worth making.
Ask the same questions at every consultation so you can compare answers.
No. Skin cut through its full thickness always heals with a scar, so scar revision exchanges an existing scar for a better one rather than removing it. The new scar may be narrower, flatter, better oriented or less tethered, but it exists.
That expectation is the single largest determinant of satisfaction. Patients who understood it are consistently pleased with a good result; patients who expected the scar to disappear are disappointed however well the surgery went.
At least 12 months, and sometimes 18. Scars remodel on their own for that long, becoming paler, flatter and softer without any intervention, so revising earlier means operating on something that was still improving.
The exception is a contracture that restricts movement or distorts a feature such as an eyelid or the corner of the mouth. Waiting there causes harm, so release is done early and the scar refined later.
Two triangular flaps of skin are cut and swapped, which reorients the scar into the natural lines of the skin, lengthens the tissue and breaks a straight line into segments the eye cannot follow.
It is the standard answer to a scar running in the wrong direction or one that has tightened across a joint. The trade is a zig-zag of greater total length than the original straight line, which is nonetheless usually less visible.
Direction and tension decide most of it. A scar lying along the natural lines of the skin and under no tension heals to a fine pale line. One crossing those lines, or pulled apart by movement, widens however carefully it was closed.
Site matters too: the chest, shoulders and upper back scar badly in almost everyone, while eyelids and the face heal beautifully. Age, skin type, genetics and smoking all contribute as well.
Silicone gel or sheeting has the best evidence of any non-surgical treatment for raised or red scars, and it is worth using for months rather than weeks. It is also the right first step for almost any scar under a year old.
Vitamin E and most proprietary scar creams have little evidence behind them. Sun protection genuinely matters, because ultraviolet light darkens a healing scar and that darkening can be permanent.
For raised, firm, itchy scars, yes. Intralesional steroid flattens and softens a hypertrophic scar and relieves itching, and it is frequently tried before any surgery is considered.
It is given as a course of injections weeks apart, and it can thin the surrounding skin or lighten it if overused. For keloids specifically it is a mainstay of treatment rather than an adjunct.
If it has grown beyond the boundaries of the original wound and shows no sign of settling, it may be. A hypertrophic scar stays within the original wound and usually improves over a year; a keloid spreads into normal skin and does not.
The distinction matters because excising a keloid without adjuvant treatment has a very high recurrence rate. Anyone with a keloid tendency needs a different plan from ordinary scar revision.
For redness and for texture, frequently yes. Vascular lasers reduce the redness of an immature scar and resurfacing lasers improve texture and pliability, particularly in burn scars.
Laser cannot narrow a wide scar, reposition one or release a contracture. It is a useful adjunct alongside surgery or non-surgical management rather than an alternative for a structural problem.
Usually not. Most scar revisions are done under local anaesthetic as a day case. General anaesthesia is used for long scars, for contracture releases involving grafts, and for children.
A longer or more complex revision may use local anaesthetic with sedation. Ask which is planned, since it affects the cost, the setting and how long you spend at the clinic.
Only where a contracture was released, and then it matters a great deal. Splinting and stretching for months are what stop the released tissue tightening again, and skipping them wastes the operation.
For a straightforward revision, scar massage and silicone are all that is needed, and those you do yourself. Arrange any therapy before the surgery rather than afterwards.
Yes, more so than almost anything else in this category. It is short, usually under local anaesthetic, the aftercare is light and largely self-administered, and flying is cleared within a few days.
The one caveat is that the result cannot be judged for a year, so any dissatisfaction arises long after you are home. Establish what the revision policy is and what it would cost before booking.
A plastic surgeon who discusses direction and tension rather than stitching technique, and who explains which method they propose and why. Those are the things that decide whether a scar heals well.
Ask to see their own results at 12 months rather than at 6 weeks, since a scar at 6 weeks is red and firm regardless of how well it was done. Ask also what they would do if the revision healed no better.
The natural lines along which skin is least under tension, which on the face largely correspond to expression creases. A scar lying along them heals to a fine line; one crossing them is pulled apart with every movement.
It is why an identical wound on the forehead and on the chest heals so differently, and why a surgeon planning a revision talks about direction before technique. Where a scar runs the wrong way, a Z-plasty reorients it.
Because the skin there is under constant tension from movement of the arms and chest, and because those sites have a genuine biological tendency to hypertrophic and keloid scarring in almost everyone.
That is why surgeons are cautious about elective incisions there and why a revision on the chest is less likely to improve matters than the same revision on a face. Expectations should be set accordingly.
Dermabrasion can blend the edges of a scar and improve an uneven surface, particularly for facial scars, and is sometimes done a few weeks after a revision rather than instead of one.
Microneedling has some evidence for improving texture in atrophic scarring. Neither narrows a wide scar, repositions one or releases a contracture, so they are refinements rather than alternatives.
Around 5 days for a facial revision under local anaesthetic, and longer where a contracture has been released or a graft used. Physical work involving the treated area waits until tension on the scar is safe, usually 6 weeks.
The visible part matters too: a fresh facial scar is red and obvious for weeks, which some people would rather not take to work immediately. That is a personal calculation rather than a medical restriction.
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