Scar Revision

What is a scar revision?

A scar revision is surgery to improve the appearance of scars.

Prominent scars can cause functional or cosmetic problems and be a constant reminder of the injury or surgery. Although no scar can be completely removed, a scar revision can improve its appearance, so that the chance of someone noticin it may be greatly reduced.

There are various forms of scarring that can be of concern:

Hypertrophic scars: These are highly visible that appear raised, thickened and are red in colour. They are contained by the confines of the original scar.

Keloid scars: They have a similar appearance but grow out with the original scar. They tend to occur in darker skinned individuals and in areas such as ears or chest.

Stretched Scars: Stretched (or widened) scars occur when healing wounds are exposed to mechanical stress. They can be the result of the wound physically coming apart – dehiscence – and then healing by secondary intention, or from the early scar deforming in response to the extrinsic forces. Most stretching occurs in the first 3 months after surgery or injury, but the process can continue for up to one year.

Poorly orientated scars: If scars cross “relaxed skin tension lines” or wrinkles then they can be obvious. Plastic surgeons normally orientate scars to lie in these lines if a procedure is performed electively. However, in traumatic scars or scars that were not planned in the best position, it is possible to reorientate the scar to sit in the best position.

Atrophic scars: These are pitted or indented scars that occur when your skin heals below the normal layer of skin due to a lack of regenerative tissue. These scars form because of inflammation that breaks down the collagen fibres in your skin and prevents full tissue regeneration. Typical examples are chicken pox scars or acne scars.

There are a variety of scar revision techniques, ranging from topical skin therapies to scar revision surgery. The goal of any scar revision is to help your scar more closely match the colour and texture of your surrounding skin, but it will never eliminate your scar. Most scars need 12 to 18 months to mature, as new scars do not usually respond well to scar revision.


Possible options include:

No further surgery or treatments: There is a risk that any intervention could worsen the current appearance and recreate a fresh scar that needs to go through the healing process again. It is likely to be red and raised for 3 to 6 months after any surgery before it begins to fade.

Topical treatments: The types of topical treatments include Silicone gel, pressure therapy, massaging using any simple moisturizing cream (Vitamin E, Vitman A, cocoa butter, Bio-oil etc.). These treatments can help to soften scars and encourage them to fade. However, they are not suitable for scars that have stretched, are atrophic or badly orientated.

Most people need to use topical treatments for 12 to 24 hours each day, sometimes, for several months to make a difference.

Injectables: These are treatments injected into the scars to modify their appearance. These include steroid injection for raised scars and keloids, and filler or fat grafting for atrophic scars. Most people need multiple injections.

Skin resurfacing: Treatments work by removing the top layers of your skin. They help reveal smoother, undamaged skin, which can improve the colour and texture of scars. Types of resurfacing treatments include:

  • Dermabrasion: Layers of skin are removed by sanding it away with a brush or rough pad. It can be used on both the face and body.
  • Dermaplaning: This is when a healthcare provider uses a special razor to shave away the upper layers of your skin. Dermaplaning can help improve the appearance of acne scars.
  • Light or laser therapy: These treatments use light or heat rays to trigger skin cell turnover.
  • Laser skin resurfacing: Reduces irritation from scars, returning them to a normal skin colour.
  • Microneedling: A healthcare provider uses a device to create microscopic punctures in your skin, which encourages remodelling and improves the scar’s appearance.

Surgery: Scars can be excised and re-sutured to give a better appearance. This works best for stretched scars with a contour deformity, poorly orientated scars or contracted scars causing deformity. This should improve the contour and prominence of the scar, but it can take up to 3 months for the colour to fade and the scar to soften.

The operation can be performed under local anaesthetic injection (you are awake, but the area is numb) or general anaesthetic (you will be fully unconscious). It is mostly performed under local anaesthetic in the procedure room at Cayman Surgery. The affected area is numbed with an injection, and the procedure takes approximately 40 minutes to perform.

The scar is excised and re-sutured. In most cases, the lesion is removed, and the edges are drawn together as a straight scar. However, if the lesion is adjacent to a cosmetically sensitive area, such as the mouth or eye, or the closure would be too tight, then an alternative method of skin closure is needed. The options are:

A Z-plasty, W plasty or “jumping man flap”: There are a variety of methods plastic surgeons can use to reorientate a scar, lengthen the scar or break it up to make it look less obvious. The technique used depends on the size, tightness and location of the scar.

Local flaps: These are created by freeing a layer of surrounding tissue with its blood supply intact and then moving the freed layer to fill a defect. The skin where the flap is “borrowed from” is closed directly. This method of reconstruction is highly effective, as it ensures that the replaced skin matches in colour, texture, and thickness, resulting in well-settled and inconspicuous scars.

Skin grafts: These consist of skin being taken from one area of the body, to cover an area where skin is missing or damaged. Unlike ‘flap’ reconstruction (which has its own intrinsic blood supply), a skin graft is a free piece of tissue, which receives blood supply from the bed onto which it is grafted. Therefore, the skin’s survival relies on the integrity of the underlying wound bed.

A split-thickness skin graft removes a thin layer of skin from the thigh (donor site) and it is used to close the skin excision site that needs to be covered (recipient site).

The donor site is like a carpet burn and it is covered with a dressing that is left in place for 2 weeks. When the dressing is removed it should all be healed, and it will leave a patch of shiny pink skin. With time this donor patch may become paler than your normal skin.

The recipient site should be healed within 5 days and will leave a patch of pale skin with a slight depression.

A full thickness skin graft (FTSG) is taken by removing all the layers of the skin down to the fat with a scalpel and is done in a similar way to a skin excision. The piece of skin is cut into the correct shape, then applied to the wound. This type of graft is often taken from the inner upper arm, neck, in front of or behind the ear, where there is more laxity in the skin to facilitate closure of the donor site.

Since it includes the full layer of dermis, it has a better cosmetic outcome than a split-thickness graft, less contraction (shrinkage) over time, and more resistance to subsequent trauma. However, due to the increased thickness of this graft, FTSGs initially have a lower chance of survival. They are also limited by the size of the donor site, as harvesting leaves a full-thickness defect that must, itself, be managed and stitched closed.
The incision is sutured with dissolvable stitches in the trunk and limbs, whilst those on the face are non-dissolvable and require removal after 5 days. You can go home immediately after surgery and return to work the following day.

Complications are infrequent and usually minor. However, all surgery has risk, and it is important that you are aware of the possible complications. All the risks will be discussed in detail with you at your consultation. However, if you have further questions or concerns, please do not hesitate to discuss them with me. Decisions about cosmetic surgery should never be rushed.
These risks can be divided into those specific to the surgery and those that relate to the anaesthesia.

General Anaesthetic risks: An anaesthetic is very safe, however, should a complication arise, the relevant medical expertise is immediately available to deal with this.

The risks increase if you have certain medical problems, which will be discussed at length during the consultation. The risks include:

  • Unintended intraoperative awareness, which is very rare.
  • Dizziness and nausea.
  • Sore throat.
  • Damage to teeth or mouth.
  • Nerve injury due to body positioning.
  • Allergic reaction or anaphylaxis.
  • Malignant hyperthermia, which is a rare life-threatening condition.

The anaesthetist will go through these risks in more detail prior to your surgery.

Scars: Your revised scar should settle remarkably well. However, the body can sometimes heal in unpredictable ways and may result, unfortunately, in a thicker scar than planned. If this occurs, further revision surgery may be required to remedy this.

Bruising and swelling: This is very common and may take approximately 2 weeks to resolve.

Haematoma: This can happen if a bleed occurs under the skin, allowing a large blood clot to form. If a haematoma develops, it is likely to do so within 4 to 6 hours post-surgery. Any increase in swelling or pain should be reported immediately so that timely treatment can be given. Sometimes patients need to have this collection of blood removed with another short operation.

Infection: This is rare, but you may require antibiotics if there are any concerns.

Numbness, reduced sensation or oversensitivity: These can occur around the scar. They are usually temporary, but occasionally the changes can remain to some degree.

Wound healing problems: These healing difficulties can range from minor problems, such as small areas of wound separation, to major issues, resulting in skin loss.

People who have diabetes, smoke, are obese or elderly are at an increased risk of delayed healing.

Dog-ears: These are soft tissue prominences where the scar stops. In most cases these settle over the course of 3 months. A small local anaesthetic procedure may be required to remove any excess that remains.

Recurrence: Even when a lesion is completely excised, it is possible that it could recur, or a new one can grow in the area.

Deep Vein Thrombosis/Pulmonary Embolism (DVT/PE): Following any surgical procedure it is possible to develop a blood clot in your legs, which could potentially break off and move to your lungs. If the blood clot is large enough it could prove fatal. To reduce any risks of this, we give you special stockings to wear in bed and a blood thinning injection if you are not mobile.

All the risks outlined above will be discussed in detail at your consultation with me. However, if you have further questions or concerns, please do not hesitate to ask.

Decisions about having surgery should never be rushed.

Depending on the area of your scar revision surgery, your incisions are closed with either dissolvable or non-absorbable sutures.

Dissolvable sutures under the skin do not require removal whereas the non-absorbable sutures will need to be taken out after 5 days. You normally have a waterproof dressing to enable you to shower.

Before you leave the clinic, you will be given a follow up appointment to see the nurses at one week post-operatively to check your incisions and an appointment to see me in Clinic 2 weeks’ time.

Scar advice
Once the dressings are removed, I recommend that you massage the incisions, using small circular motions at least twice a day for 5 minutes. You can use any moisturising cream of your choice and apply firm pressure until it blanches.

The scars will also benefit from silicone scar gel (ScarAway® or Kelo-Cote®) twice a day, which will soften and fade them, as well as applying sunblock for 12 months to provide sun protection.

The ScarAway® can be purchased from Healthcare Pharmacy at Governors Square in Grand Cayman.

Recovery times vary from one person to another, but most patients return to work the next day, and I recommend that you avoid swimming and strenuous activities for 1 to 2 weeks.

For self-funding patients, surgical fees are a combination of the hospital costs, the surgeon, anaesthetic fees and any consumables. I do not charge additional fees for post-op appointments. The fees are based on the surgical time taken to perform the surgery, rather than procedure itself. This means that the costs are calculated fairly.

You will be given a quotation for surgery approximately 48 hours following your consultation.

Scar Revision - Nicotine and Surgery