A reconstructive procedure that reshapes pathological scars (hypertrophic, keloid, contracted) developing after trauma, burns, or previous surgery using surgical and supportive methods.
Indication
- Pain, itching, or functional limitation due to hypertrophic or keloid scar
- Contracted scar crossing a joint causing restricted movement (especially after burns)
- Wide, function-impairing scar tissue after burns
- Poorly healed surgical scar (dehiscence, widened scar)
- Mismatch between traumatic scar and surrounding skin quality (e.g., geometric scar on the face)
- Recurrent scar infection or ulceration
- Functional scar effects such as voice hoarseness or incomplete eyelid closure
Preparation
- Wait at least 12 months for scar maturation (optimal period for revision)
- Examination and photographic documentation of the scar and surrounding area
- Stop smoking 2 weeks before surgery (critical for wound healing)
- Preoperative assessment for silicone, pressure therapy, and steroid use in patients prone to keloid
- Antiseptic skin care before the procedure
How it's performed
- Most often performed under local anesthesia; sedation or general anesthesia for extensive scars
- The existing scar tissue is excised in a controlled manner
- A new incision pattern is created using Z-plasty, W-plasty, or geometric broken-line techniques
- Tissues are closed in layers without tension
- Intralesional steroid injection may be added when keloid risk is present
- Supported with silicone sheets, pressure therapy, and postoperative radiotherapy in high-risk keloid cases
Post-procedure
- Suture removal in 5-14 days depending on the area
- Use of silicone gel or sheets during the first 4-6 months
- Sun protection (high SPF) during the first 12 months
- Monthly intralesional steroid follow-up in patients at keloid risk
- Monitoring of scar maturation at 3, 6, and 12 month visits
Risks
- Healing of the new scar as hypertrophic or keloid (especially in keloid-prone individuals)
- Scar widening or pigmentation changes
- Wound dehiscence, infection
- Temporary numbness due to nerve endings
- Aesthetic outcome differing from expectations
- Recurrence of contracture (in joint scars)
FAQ
Will the scar disappear completely?
No. Surgery always leaves a new scar; the goal is to make the existing scar less prominent, more functionally comfortable, and aligned with natural skin lines.
I have keloid; I was told not to have surgery. Why?
Recurrence rates after simple surgical excision are high in keloid-prone individuals. In such cases, surgery is planned together with intralesional steroids, pressure therapy, and in selected cases postoperative radiotherapy.
Is scar revision covered by insurance?
Cases involving post-burn contracture, function-limiting scars, or trauma reconstruction are usually covered. Aesthetic-only applications are excluded. The decision depends on the payer's evaluation.
How long until results become final?
Maturation of the new scar takes 12-18 months. During this period, redness and firmness subside and the final appearance becomes clearer.
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