A scar is the body’s repair, and it is not always a good one. Some heal wide because the wound was under tension, some heal raised because the skin over-produced collagen, some pull on the skin around them, and some simply sit in the wrong direction on a face. Scar revision is the set of treatments, from a steroid injection to a surgical redesign, that make a scar less visible or less troublesome. The most important sentence on this page comes from the American Society of Plastic Surgeons: a scar cannot be completely erased. The realistic goal is a better scar, and what better means depends on which kind you have.
The four kinds of scar
The ASPS groups scars into four types, and the type decides the treatment. Discoloration and surface irregularities, a scar that is red, brown or slightly uneven but flat and painless, are treated at the surface. Hypertrophic scars are thick, raised, often red or itchy clusters of scar tissue confined to the wound. Keloids are larger, can be painful or itchy, and extend beyond the edges of the original wound; they run in families and are more common in darker skin. Contractures are scars that tighten during healing and restrict movement, often after burns or across a joint. The everyday cosmetic complaint, a surgical scar that stretched wide or healed with a step, sits between the first two groups and is the classic surgical revision case.
The treatments, from least to most
The ASPS procedure page lists the full menu. Topical: silicone gels, tapes and compression, the standard low-risk measure for new scars in people prone to raised healing; a Cochrane review of 20 trials found weak evidence of benefit and called the research poor, so use them and expect modest results. Injections: triamcinolone (a steroid) into raised scars to flatten them and relieve itch, in a series; and dermal filler to lift depressed scars, lasting three months to several years and needing repeats. Surface treatments: dermabrasion, laser or light therapy, chemical peels and bleaching agents for texture, redness and pigment; the laser resurfacing and microneedling pages cover the device options. Surgery: excision of the old scar and closure in layers under no tension, which is what turns a wide scar into a fine line; W-plasty and Z-plasty, which break a straight scar into a zigzag that hides in skin creases or lengthens a contracture; flap closures that reposition a scar; skin grafts; and tissue expansion, an inflatable balloon placed under nearby healthy skin and filled over weeks so the stretched skin can replace the scarred area.
Keloids are a different problem
Cutting out a keloid and closing the wound produces, often, a bigger keloid. A systematic review of 162 treatment studies found intralesional steroid, laser and radiotherapy the most used approaches, most steroid studies confirmed it works alone, and the consistent finding was that combinations, steroid with 5-fluorouracil, steroid with laser, excision followed immediately by steroid injection or low-dose radiotherapy, outperform any single treatment and recur less; the review names sole or inadequate treatment as a major risk factor for recurrence. If you form keloids, the consult you want is with someone who talks about a sequence, not a single procedure.
Timing, sun and smoking
A scar is ready for revision when it has matured, usually at a year: the redness has faded and it has stopped changing. Revising a scar that is still remodeling invites the same process that made it. Contractures that limit movement and keloids that are growing are the exceptions treated earlier. Through that first year, sun protection matters more than any treatment, because a scar that tans stays darker for good. Smoking impairs every outcome and most surgeons will not revise a scar in a smoker.
What it costs
Steroid injections $100 to $300 a session, laser $300 to $800 a session in a series, filler $600 to $1,200 repeated as it fades, and surgical excision with layered closure $1,500 to $6,000 per scar in the US depending on length, site and whether a Z-plasty, flap or graft is involved; facial work costs more per centimetre. Insurance sometimes covers revision that restores movement, relieves pain or follows injury or surgery; cosmetic revision is self-pay. Canadian pricing tracks similar figures.
Recovery and risks
Surgical revision means sutures for one to two weeks, tape or silicone for months, and a new scar that takes its own year to mature, so the final judgement waits that long. Injections and lasers cost a day or two of redness. Risks are those of any skin surgery: bleeding, infection, poor healing, spreading if the new scar crosses a tension line or a joint, colour change and numbness, plus, in keloid-prone patients, a new keloid, which is why surgery alone is avoided in them.
Choosing a provider
A board-certified plastic surgeon or a dermatologic surgeon who revises scars regularly, who classifies your scar before proposing anything, who talks about combinations for raised scars, and who shows results at a year rather than at six weeks. Ask what they would do if the revision itself scars badly. The scars page covers the full range from acne scars to stretch marks, most of which are treated in the office rather than the operating room.
Where to compare scar revision surgeons
Compare surgeons in Los Angeles, New York, Houston, Miami and Chicago, or browse scar revision surgeons in your city.