Scar Revisions

Scar revision surgery involves techniques aimed at minimizing a scar’s prominence and making it blend more naturally with the surrounding skin. While scars cannot be entirely erased, modern dermatologic, laser and surgical approaches can significantly improve their appearance, helping patients regain confidence and comfort.

Scar revision surgery may be recommended for individuals with scars that:

• Are raised, thickened, or discolored (hypertrophic or keloid scars).
• Cause physical discomfort or limit movement due to tension on the surrounding tissues.
• Are red, pink, purple or darker in pigmentation that surrounding skin
• Are recessed or appear as depressions in the skin (atrophic scars).
• Result from acne, surgical incisions, burns, or traumatic injuries.
• Affect self-esteem or confidence due to their visibility.

Scar revision surgery is highly individualized. During your consultation your Palo Alto Dermatology Institute dermatologic surgeon will want to know why you desire surgery, your expectations and desired outcome. They will review your medical history including your medications and previous surgeries.

Your dermatologic surgeon will evaluate your general health including risk factors. They will examine your scar in detail, take photos and discuss your options and recommend your treatment options, likely outcomes, potential risks and complications.

Patients who are bothered by a scar, do not smoke, are physically healthy, and have realistic expectations and generally have healthy skin are typically good candidates for scar revision procedures.

There is a broad range of scar revision techniques. All are performed with local anesthesia. Treatment options are based on the type and degree of scarring.

1. Surgical Scar Revision: Surgical excision is often used for larger or irregular scars. This process involves removing the old scar and re-closing the wound with meticulous, multilayered suturing techniques to create a smoother and less noticeable line. In some cases, techniques like Z-plasty or W-plasty may be used to reorient the scar along natural skin folds.
2. Laser Scar Revision: Laser treatments are a non-invasive option to reduce the redness, size, or irregular texture of scars. Vascular lasers can reduce the scar redness and pigment lasers can reduce pigmentation. Fractional laser resurfacing, such as CO2 lasers, stimulates collagen production, smooths the skin, and improves scar pigmentation. This approach is particularly effective for acne scars or hypertrophic scars. The Ultrapulseâ and Fractional CO2 lasers are widely used to improve skin texture, suppleness and pigmentation for certain types of scars where there is a background of aging skin or history of severe acne scarring.
3. Subcision: Subcision for depressed scars and acne scars is a minimally invasive cosmetic procedure to improve the appearance of the scar. It is particularly effective for rolling scars or other types of depressed scars tethered to the underlying tissue, which create an uneven skin surface.
4. Dermabrasion: Manual dermabrasion can blend the scars with the surrounding skin and is most useful for facial scars.
5. Dermal Fillers: Atrophic scars, such as those caused by acne, can benefit from dermal filler injections. These fillers restore volume to depressed areas, creating a smoother skin surface.
6. Steroid Injections: For thick, raised scars like keloids or hypertrophic scars, intralesional corticosteroid injections can reduce inflammation and flatten the scar over time.
7. Microneedling: Microneedling creates controlled micro-injuries to the skin, stimulating natural healing and collagen production. This technique is particularly effective for fine lines and atrophic scars.
8. Chemical Peels: For mild surface-level scars, chemical peels can improve skin texture and pigmentation by removing damaged outer layers of skin.
9. Skin Grafting or Flap Surgery: In cases of severe scarring, such as large burn scars, skin grafts or flap surgery may be necessary to restore function and appearance.