Scar revision is a surgical procedure to improve or reduce the appearance of scars. It also restores function, and corrects skin changes (disfigurement) caused by an injury, wound, or previous surgery.

Scar tissue forms as skin heals after an injury (such as an accident) or surgery. The amount of scarring may be determined by the wound size, depth, and location; the person's age; heredity; and skin characteristics including color (pigmentation).

Surgery to revise scars is done while you are awake (local anesthesia), sleeping (sedated), or deep asleep and pain-free (general anesthesia).

Medications (topical corticosteroids, anesthetic ointments, and antihistamine creams) can reduce the symptoms of itching and tenderness. Scars shrink and become less noticeable as they age. You may be able to wait for surgical revision until the scar lightens in color, which can be several months or even a year after the wound has healed.

A keloid is an abnormal scar that is thicker and of a different color and texture than the rest of the skin. Keloids extend beyond the edge of the wound and are likely to come back. They often create a thick, puckered effect that looks like a tumor. Keloids are removed at the place where they meet normal tissue.

Massive injuries (such as burns) can cause loss of a large area of skin and may form hypertrophic scars. These types of scars can restrict the movement of muscles, joints, and tendons (contracture). Surgery removes extra scar tissue. It involves a series of small cuts (incisions) on both sides of the scar site, which create V-shaped skin flaps (Z-plasty). The result is a thin, less noticeable scar, because the way the wound closes after a Z-plasty more closely follows the natural skin folds.

Skin grafting involves taking a thin (split thickness) layer of skin from another part of the body and placing it over the injured area. Skin flap surgery involves moving an entire, full thickness of skin, fat, nerves, blood vessels, and muscle from a healthy part of the body to the injured site. These techniques are used when a large amount of skin has been lost in the original injury, when a thin scar will not heal, and when the main concern is improved function (rather than improved appearance). Other procedures may be needed to improve the appearance of the skin.

No scar can be removed completely. How much the scar improves will depend on the direction and size of the scar, the age of the person, the skin type and color, and hereditary factors that may affect the healing process.

Risks for any anesthesia are:

• Reactions to medications
• Breathing problems

• Bleeding
• Infection
• Blood clots
• Scar recurrence
• Keloid formation (or recurrence)
• Separation (dehiscence) of the wound

A pressure or elastic dressing may be placed over the area after the operation to prevent the keloid from coming back. For other types of scar revision, a light dressing is applied. Sutures are usually removed in 3 to 4 days for the facial area, and in 5 to 7 days for incisions on other parts of the body.

When you return to normal activities and work depends on the type, degree, and location of the surgery. Most people can resume normal activities soon after surgery. Doctors usually recommend that you avoid activities that stretch and may widen the new scar.

If you have long-term stiffening of the joint, you may need physical therapy in addition to surgery to restore full function.

Avoid exposure to the sun for several months after treatment. Use sunblock or a dressing (such as a Band-Aid) to keep the sun from permanently tanning the healing scar.