Scar Revision SurgeryBy
Sarah Lewis, PharmD
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
Looking for a Doctor?
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.
Your surgeon will tell you which techniques are best for you and how long you need to stay in the hospital based on your diagnosis, age, medical history, general health, and possibly your personal preference. Learn about the different techniques and ask why your surgeon will use a particular type for you.
Types of anesthesia that may be used
Your surgeon will perform your scar revision using either general anesthesia or regional anesthesia.
General anesthesia is a combination of intravenous (IV) medications and gases that put you in a deep sleep. You are unaware of the procedure and will not feel any pain.
Regional anesthesia is also known as a nerve block. It involves injecting an anesthetic around certain nerves to numb a large area of the body. For small scar revisions, your doctor will inject the anesthetic in the skin and tissues around the procedure area (local anesthesia). You will likely have sedation with regional anesthesia to keep you relaxed and comfortable.
What to expect the day of your scar revision surgery
The day of your surgery, you can expect to:
Talk with a preoperative nurse. The nurse will perform an exam and ensure that all needed tests are in order. The nurse can also answer questions and will make sure you understand and sign the surgical consent form.
Remove all clothing and jewelry and dress in a hospital gown. It is a good idea to leave all jewelry and valuables at home or with a family member. Your care team will give you blankets for modesty and warmth.
Talk with the anesthesiologist or nurse anesthetist about your medical history and the type of anesthesia you will receive.
A surgical team member will start an IV.
The anesthesiologist or nurse anesthetist will start your anesthesia.
A tube may be placed in your windpipe to protect and control breathing during general anesthesia. You will not feel or remember this or the surgery as they happen.
The surgical team will monitor your vital signs and other critical body functions. This occurs throughout the procedure and your recovery until you are alert, breathing effectively, and your vital signs are stable.
What are the risks and potential complications of scar revision surgery?
As with all surgeries, scar revision surgery involves risks and possible complications. Most scar revision surgeries are successful, but complications may become serious and life threatening in some cases. Complications can develop during surgery or recovery.
General risks of surgery
The general risks of surgery include:
Anesthesia reaction, such as an allergic reaction and problems with breathing
Bleeding, which can lead to shock
Blood clot, in particular a deep vein thrombosis
Potential complications of scar revision surgery
Most scar revision surgeries are successful procedures with few complications. However, complications of scar revision surgery can occur and become serious. Potential complications of scar revision surgery include:
Changes in skin sensation or color
Damage to nerves, blood vessels, and muscles
Keloid formation or recurrence
Poor wound healing or separation of the incision
Unfavorable scar recurrence
Reducing your risk of complications
You can reduce the risk of certain complications by following your treatment plan and:
Following activity, dietary and lifestyle restrictions and recommendations before your procedure and during recovery
Informing your doctor if you are nursing or if there is any possibility of pregnancy
Inspecting the surgical site for proper healing as instructed by your care team
Notifying your doctor immediately of any concerns, such as bleeding, fever, or increase in pain
Protecting the surgical site from injury, stretching, infection and sunlight by following all instructions for bandaging, cleaning and dressing the site
Taking your medications exactly as directed
Telling all members of your care team if you have any allergies
How do I prepare for my scar revision surgery?
You are an important member of your own healthcare team. The steps you take before surgery can improve your comfort and outcome.
You can prepare for scar revision surgery by:
Answering all questions about your medical history, allergies, and medications. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.
Getting preoperative testing as directed. Testing will vary depending on your age, health, and specific procedure. Preoperative testing may include a chest X-ray, EKG (electrocardiogram), blood tests, and other tests as needed.
Losing excess weight before the surgery through a healthy diet and exercise plan
Not eating or drinking before surgery as directed. Your surgery may be cancelled if you eat or drink too close to the start of surgery because you can choke on stomach contents during anesthesia.
Stopping smoking as soon as possible. Even quitting for just a few days can be beneficial and help the healing process.
Taking or stopping medications exactly as directed. This may include not taking aspirin, ibuprofen (Advil, Motrin), and blood thinners. Your doctor will give you instructions for taking your medications and supplements.
Questions to ask your doctor
Facing surgery can be stressful. It is common for patients to forget some of their questions during a doctor’s office visit. You may also think of other questions after your appointment. Contact your doctor with concerns and questions before surgery and between appointments.
It is also a good idea to bring a list of questions to your appointments. Questions can include:
Am I a good candidate for scar revision surgery? Are there any other options for improving the appearance of my scar?
What type of scar revision procedure do I need?
How long will the surgery take? When can I go home?
What restrictions will I have after surgery? When can I return to work and other activities?
When can I shower after scar revision surgery? How should I care for my incisions?
How will my scar look after surgery?
What kind of assistance will I need at home?
How should I take my medications?
How will you treat my pain?
When should I follow up with you?
How should I contact you? Ask for numbers to call during and after regular hours.
What can I expect after my scar revision surgery?
Knowing what to expect after scar revision surgery can help make your road to recovery as smooth as possible.
How long will it take to recover?
You will stay in the recovery room after surgery until you are alert, breathing effectively, and your vital signs are stable. You will still be drowsy from sedation or anesthesia. Scar revision surgeries are usually outpatient procedures, so you will need a friend or family member to drive you home and stay with you the first night.
You may have a sore throat if a tube was placed in your windpipe during surgery. This is usually temporary, but tell your care team if you are uncomfortable.
You may have an elastic dressing around your incision. The elastic dressing will help prevent keloid scars from forming or recurring. Otherwise, you will only have a light dressing over your incision. You will likely have swelling, redness and bruising following scar revision surgery. Your doctor will treat your discomfort. Bruising and swelling should go away within a few weeks.
Recovery after scar revision surgery is a gradual process. Recovery time varies depending on the procedure, type of anesthesia, your general health, age, and other factors. Your doctor will give you specific instructions about returning to activities based on the location and size of your scar. Full recovery and maximal scar improvement takes a year or more.
Will I feel pain?
Pain control is important for healing and a smooth recovery. There will be discomfort after your surgery. Your doctor will treat your pain so you are comfortable and can get the rest you need. Call your doctor if your pain gets worse or changes because it may be a sign of a complication.
When should I call my doctor?
It is important to keep your follow-up appointments after scar revision surgery. Contact your doctor for questions and concerns between appointments. Call your doctor right away or seek immediate medical care if you have:
Breathing problems, such as shortness of breath, difficulty breathing, labored breathing, or wheezing
Change in alertness, such as passing out, unresponsiveness, or confusion
Chest pain, chest tightness, chest pressure, or palpitations
Fever. A low-grade fever (lower than 101 degrees Fahrenheit) is common for a couple of days after surgery. It is not necessarily a sign of a surgical infection. However, you should follow your doctor's specific instructions about when to call for a fever.
Inability to urinate or have a bowel movement
Leg pain, redness or swelling, especially in the calf, which may indicate a blood clot
Pain that is not controlled by your pain medication
Unexpected drainage, pus, redness or swelling of your incision
How might scar revision surgery affect my everyday life?
The new appearance of your scar may give you increased satisfaction with your appearance and increase your self-confidence. Surgeons caution that it is important to be realistic about how much scar revision may improve your self-image. As a result, you should be aware of what scar revision surgery can and cannot do for your overall appearance.
You should protect your scar revision site from sunlight by using sunscreen or a dressing for a year or longer. This prevents discoloration of the new scar.
If your scar revision surgery was medically necessary, it may relieve your symptoms so you can lead a healthier, normal life. Physical therapy is sometimes necessary to regain movement and function of a body part. This is especially true for contracture scar revision surgery.
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