Scar Revision
Scars are part of healing, but some remain raised, wide, tight, itchy, pigmented, or depressed. My approach blends precise facial surgery with evidence-based resurfacing and injectables to improve appearance and comfort—aiming for a scar that blends with surrounding skin and respects natural lines.
What scar revision can (and can’t) do
Can help with:
- Hypertrophic and keloid scars (thick, raised, itchy)
- Atrophic scars (acne/varicella pitting, surgical depressions)
- Wide or stretched scars across tension lines or joints
- Contractures limiting movement; tethered scars with pain/drag
- Colour or texture mismatch (dyschromia, irregular surface)
Cannot replace:
- True volume loss of an entire subunit (may need Dermal Fillers or structural surgery)
- Advanced laxity (consider Collagen Stimulators or Facelift & Neck Lift where appropriate)
Common scar types (and typical strategies)
- Hypertrophic / Keloid: intralesional steroids, silicone, staged excision with adjuvant therapy; careful tension management to reduce recurrence.
- Atrophic (acne, chickenpox, surgical)
- Rolling scars: subcision to release tethers, followed by collagen support (e.g., Collagen Stimulators/PN)
- Ice-pick scars: focal TCA CROSS; staged
- Boxcar scars: mesobotox, subcision ± resurfacing or targeted filler support
- Wide / mal-oriented scars: elliptical revision, Z-plasty/W-plasty to break up lines and redirect tension.
- Contracture scars (post-burn or joint lines): local flaps, Z-plasties, physiotherapy, and silicone/pressure protocols.
If your fullness is mainly along the jaw angle or under the chin, jawline implants or submental contouring may be more effective; I’ll guide you.
Candidacy & safety
Good candidates have a stable scar or clear symptoms (itch/tether/pain) and realistic expectations (improvement, not “erasure”).
We defer intervention with active infection, unstable medical conditions, or poor wound-healing risks until optimised.
Possible effects: bruising, swelling, infection, delayed healing, widened or pigmented scar, recurrence of hypertrophy/keloid. Recurrence risk is mitigated by tension-sparing design, adjuvant therapy, and strict aftercare.
Treatment options (tailored, often staged)
- Surgical revision: fusiform excision, Z/W-plasty, geometric broken-line closure; layered sutures to respect vectors
- Subcision: releases fibrous bands tethering atrophic scars
- Intralesional therapy: mesobotox, steroid injections for hypertrophic/keloid control
- Resurfacing: chemical (e.g., TCA, Jessner/glycolic programs) or device-based options (planned case-by-case)
- TCA CROSS: pinpoint chemical reconstruction for ice-pick scars
- Adjunct injectables: Dermal Fillers for contour blending; Collagen Stimulators / Polynucleotides for quality and firmness
- Silicone therapy & pressure: evidence-based support during maturation
- Scar care program: sun control (SPF 50+), taping, massage when indicated
The appointment, step by step
- Assessment & mapping (photos, vectors, tension lines)
- Plan discussion with staged options and realistic goals
- Procedure (local anaesthesia for most) with meticulous closure or focused intralesional work
- Aftercare instructions in writing; review schedule set
Time in clinic: ~20–60 minutes depending on the technique.
Back to routine: same day for injections/minor work; several days for surgical revisions/resurfacing.
Aftercare & downtime
- Keep dressing dry for 24–48 h (surgical); gentle cleansing thereafter
- Silicone gel during maturation; avoid friction and tension
- SPF 50+ daily for 12 months over the scar to minimise pigment change
- Resurfacing: expect pinkness/flaking 3–7 days (depth-dependent)
- Injections: mild swelling/tenderness 24–72 h
Scar maturation evolves over 3–12 months; results are reviewed and fine-tuned over time.
Smart combinations (case-by-case)
- Chemical Peels for colour/texture blending around the revision
- Collagen Stimulators / Polynucleotides to improve dermal quality and elasticity
- Dermal Fillers to smooth step-offs or depressions after subcision
- Mesobotox for surface sheen/pore look in adjacent skin (not for the scar itself)
FAQs
Will the scar disappear completely?
No. The aim is a finer, flatter, better-oriented scar that blends in. Think improvement, not deletion.
How long until I see the final result?
Most scars mature over 3–12 months. We schedule reviews and adjust care as needed.
What if my scar is keloid-prone?
We use a protocol (steroids, silicone/pressure, tension-sparing closure). Recurrence can happen; staged care reduces odds.
Do acne scars need surgery?
Often no. Many benefit from subcision, mesobotox, TCA CROSS, and collagen stimulation in a series.
Can you revise a fresh surgical scar?
Early on, we support with silicone/sun care. Formal revision is usually timed after partial maturation unless there’s a functional issue.
