Surgical Scar Revision

The 411 About Surgical Scar Revision: Are You A Candidate?

October 12, 2022


The 411 About Surgical Scar Revision: Everyone's got scars. When you think about it, aren't scars amazing? Your body uses its natural healing abilities to repair its own damaged skin, muscle, and even bone. This article will discuss skin scars and their treatment. Usually, whenever there is damage to the skin, the body rushes blood to the area. The damaged skin is temporarily plugged with blood. Chemical messengers are sent from the blood clot to recruit further tissue healing. There are three phases of wound healing: the inflammatory phase, granulation tissue formation, and matrix formation and remodeling. Scar maturation begins during matrix formation, and remodeling. You should remember that a wound is an opening of the skin. A scar is when the skin is sealed. In this article, we will discuss scars, not wounds.

Who are the players in the creation of a scar?

The creation of a scar is a well-choreographed dance between collagen and fibroblasts. Collagen is a fibrous protein and is the primary structural support in connective tissue. There are almost 30 different types of human collagen. 90% of the collagen in the human body is type 1. Collagen type 1 is solid and has a tensile strength greater than steel. Collagen type 1 is responsible for skin elasticity and is critical in creating scar tissue. The leading players in scar formation are collagen types 1 and 3. Collagen type 3 is the first collagen produced by fibroblast in the wound and early scar. Type 3 collagen is not nearly as strong as collagen type 1, but it gets the initial job done. The cells that synthesize or make collagen are called fibroblasts. Think of fibroblasts as tiny little muscle cells within the wound. Fibroblasts also help to bring the edges of the wound together.

What happens in a scar?

Once the skin is closed, your body starts repairing and remodeling the scar. In the initial repair of the scar, most of the scar is collagen type 3. Initially, the scar is filled with type 3 collagen.  During the maturation of the scar, type 3 collagen is replaced by type 1 collagen. In addition, the type 3 collagen is also placed in a haphazard criss cross throughout the scar. During remodeling, the collagen fibers are changed from type 3 to type 1, and the collagen fibers are rearranged in a more organized, cross-linked, and parallel fashion. Organized placement of collagen is thought to increase the tensile strength of the scar. It takes two years for the scar to fully mature.

How strong is your scar repair?

Scars are amazing, but never perfect. Even when completely healed, the peak strength of the scar never equals the surrounding skin. However, in optimal conditions, healed scars approach 80% of the strength of the surrounding uninjured skin.

What influences the appearance of a scar?

Many things influence the final scar appearance. Scar influencers include your age, genetics, history of skin damage (including sun and radiation), and the scar's location.

Different types of scars

Scarring depends on the nature of the injury. However, most mature normal scars are flat and lack pigment. In contrast, hypertrophic scars are raised, thick, red, and regular. Hypertrophic scars are within the limits of the original wound. Some scars are keloid scars. Keloid scars are thick, puckered, and often itchy. Keloid scars grow beyond the edges of the wound. Keloid scars occur due to the uncontrolled growth of fibroblasts within the scar.

Treatment of scar

One of the problems with scarring is that your body overreacts and makes too much scar. This over-reaction results in hypertrophic or keloid scars. Some treatments include suppressing your body's natural attempts to create a scar. Other treatments stimulate and trick the body into remodeling the scar.


Initial scars treatment should include silicone ointment and silicone strips. By far, applying silicone is the best thing you can do for your scars. Countless articles in the plastic surgery literature prove that silicone helps scars to flatten and become less vascular or red or purple.  Silicone is thought to work by hydrating the skin and regulating collagen synthesis. Silicone ointment and strips can have a positive effect up to two years after the initial scar formation.  Other modalities, such as aloe vera, cocoa butter, collagen cream, and peptides, may slightly improve the scar, but studies show that silicone is the best.


Lasers can also enhance the appearance of the scar. Different lasers alter scars differently by stimulating scar remodeling. A common laser for scar treatment is the V-beam laser, which decreases the redness of scars. Another popular laser for scar treatment is the Fraxel laser.


One of the ways to suppress the natural healing process is to inject anti-inflammatories. Common anti-inflammatories include steroids like cortisone and Kenalog. However, a new novel product is 5 fluorouracil (5FU). 5FU is a chemotherapeutic drug that also suppresses the natural healing of scars.


This minimally invasive treatment involves using tiny needles to pierce or penetrate the scar. This micro-trauma stimulates the body to react, break down, and remodel the scar. The reaction causes changes in the percentage of collagen 1 vs. 3 within the scar.

Platelet-rich plasma (PRP)

PRP is a novel way to treat scars. PRP involves taking your blood. Then, your blood is centrifuged to shatter your red blood cells. Once the red blood cells are shattered, this process allows access to the stem cells within your red blood cells. The stem cells are then injected into the scar. It is believed that these stem cells can help to remodel and improve the scar.


Another form of scar treatment includes camouflage tattooing. There are medical-grade tattoo artists who can inject the scar with pigment that matches your surrounding skin. These medically tattooed scars blend very well with the surrounding skin.


When scars become extreme, like keloids, tangential radiation can be applied to minimize excessive healing. However, when radiation is used on a body part, radiation decreases your body's ability to heal. Thus, radiation can reduce your body's ability to form large hypertrophic and keloid scars.


Another surgical technique for scar treatment involves a procedure called dermabrasion. Dermabrasion is "surgical sanding." During dermabrasion, a sterile, surgical rotary sander is used to burr or decrease the projection of the scar. Dermabrasion can be highly effective in the treatment of certain scars. Dermabrasion can be performed in the office under local anesthesia or the operating room under general anesthesia.

Surgical Excision

Another possible option is surgical reception. Usually, surgical scar excision can be applied when the scar is soft. After your initial healing, scars usually are firm. Due to the firmness, initially, scars are difficult to re-approximate. Once the scar is softened, it is generally possible to surgically excise the scar and revise it. There are multiple techniques for surgical scar resection, including complete scar removal, w-plastics, and z-plastics. These forms of surgical scar revision should be reviewed and discussed with your plastic surgeon.

Surgical Scar Revision Conclusion

So, there you have it. Consider surgical scar revision if you have a scar and don't like it. Consult with an experienced, board-certified plastic surgeon to discuss your options. Most scars can be revised. 

Dr. J. Timothy Katzen is certified by the American Board of Plastic Surgery, and is the President of the American Society of Bariatric Plastic Surgeons. Dr. Katzen specializes in reconstructive plastic surgery 

Surgical Scar Revision
timothy katzen


Dr. J. Timothy Katzen is certified by the American Board of Plastic Surgery, and is the President of the American Society of Bariatric Plastic Surgeons. Dr. Katzen specializes in reconstructive plastic surgery after massive weight loss. He has written many articles and given lectures around the world about how to perform plastic surgery on patients who have undergone massive weight loss. Dr. Katzen has plastic surgery offices in two different states and two different countries. Specifically, he has offices in Beverly Hills (California), Las Vegas (Nevada), and Dubai (United Arab Emirates). Read more articles from Dr. Katzen!