Scar revision

No. Both the ASPS and the AAD state plainly that a scar cannot be erased. Revision replaces the existing scar with a new one that is thinner, flatter and better camouflaged, so it sits closer to the surrounding skin in tone and texture.

Most scars need 12 to 18 months to mature, and surgical revision is generally advised only after that, ideally at least a year. Scars often improve substantially on their own in that period, and operating too early risks revising something that would have settled by itself.

Very likely, if surgery is used alone — the AAD reports that nearly 100% of keloids return after excision by itself, and the published range is 45 to 100%. Keloid excision has to be paired with adjuvant treatment: corticosteroid injections, pressure garments, cryosurgery, silicone sheeting, or radiotherapy in selected refractory cases. Agree before you travel who delivers that course at home.

Usually not. The ASPS states that most health insurance plans will not cover scar revision, its complications, or further surgery to revise the appearance of a scar. Cover is more plausible when a contracture restricts function than when the concern is appearance alone — check your policy in writing beforehand.

Not necessarily. Local anaesthesia, intravenous sedation and general anaesthesia are all used, and the choice follows the size, depth and location of the scar and whether flaps, grafts or tissue expansion are involved. Small, superficial revisions are commonly done awake under local anaesthetic as a day case.

They treat different problems. Laser and light therapy, dermabrasion and chemical peels address colour, texture and surface irregularity, and dermatologists now use lasers first-line for many scar types; excisional surgery addresses width, contour, tethering and direction. Combined regimens are common, and corticosteroid injection alone can reduce the size of a raised scar by 50% or more.

Plan 7 days, with 6 hotel nights and 2 follow-up visits. That covers the operation, a wound check, and — for facial scars — suture removal before you fly. A body scar may mean suture removal happens at home, which we arrange in writing before you leave.

Anyone whose scar is still maturing — before 12 to 18 months, revision risks trading a scar that would have improved on its own for one that starts over. We also defer or decline when the scar or the skin around it is actively infected or inflamed, when diabetes is poorly controlled, and when a clotting disorder or blood thinners cannot be safely managed around surgery — all of these undermine the wound healing a good result depends on. Smokers must stop nicotine completely beforehand. A history of keloids does not rule surgery out, but we will not excise a keloid without an agreed adjuvant course, because excision alone almost guarantees recurrence.

Contact us straight away — or, once home, the clinician you identified before departure — if you notice spreading redness or warmth around the incision, discharge, a wound edge that is opening, fever, pain that worsens after the first couple of days instead of easing, or sudden swelling or bleeding at the site. Infection, haematoma and wound separation are the complications that undo a careful closure, and every one of them is easier to treat early. Send photographs in daylight — a healing incision is straightforward to assess remotely.

Silicone is the one topical with real support behind it — gel or sheeting, started once the wound has closed and worn consistently for months, is the standard first-line measure for flattening and softening a raised scar. Vitamin E is not: a controlled trial found it made no scar look better, worsened the appearance in a third of patients, and caused contact dermatitis in about a third. Onion-extract gels have weak and inconsistent evidence. The other thing that genuinely changes the outcome costs nothing: keeping the healing scar out of the sun, because UV drives pigmentation that becomes permanent.

Yes, in two ways. Keloids and hypertrophic scars are markedly more common in people with darker skin — Black, Hispanic, Asian and Mediterranean ancestry — so we plan the adjuvant course alongside the excision rather than waiting to see what happens. Richly pigmented skin is also more prone to post-inflammatory hyperpigmentation, where the new scar darkens rather than fades, which makes strict sun protection and unhurried timing more important, not less. None of this rules revision out; it changes how it is staged.