# Scar Revision Surgery

> **Scar revision** improves the appearance of scars through surgical and non-surgical techniques, making them less noticeable and more aesthetically pleasing.

- Canonical page: https://doctormaresky.co.za/procedure/scar-revision
- Category: [Hand Surgery & Trauma](https://doctormaresky.co.za/procedure-category/hand-surgery)
- Procedure directory: https://doctormaresky.co.za/procedures.md
- Medical disclaimer: https://doctormaresky.co.za/medical-disclaimer


## Overview

**Scar revision** encompasses various surgical and non-surgical techniques to improve the appearance or function of scars. While scars cannot be completely removed, they may become less noticeable, smoother, or less restrictive.

**Types of Scars Treated**:

**Hypertrophic Scars**: Raised, red scars that stay within original wound boundaries
**Keloid Scars**: Raised scars that grow beyond original wound boundaries
**Atrophic Scars**: Depressed scars (acne scars, chickenpox scars)
**Contracture Scars**: Tight scars that restrict movement (burn scars)
**Surgical Scars**: Wide, thick, or poorly healed surgical incisions
**Trauma Scars**: Irregular scars from accidents or injuries
**Stretch Marks**: Atrophic scars from skin stretching

**Treatment Options**:

**Surgical Techniques**:
- **Scar excision and closure**: Removing scar and re-closing with meticulous technique
- **Z-plasty**: Repositioning scar along natural skin lines
- **W-plasty**: Breaking up straight scars into zigzag pattern
- **Skin grafts**: For large scars or contractures
- **Tissue expansion**: Growing new skin to replace scarred area

**Non-Surgical Techniques**:
- **Steroid injections**: Flatten raised scars
- **Laser therapy**: Improve color, texture, and thickness
- **Dermabrasion/Microdermabrasion**: Smooth surface irregularities
- **Chemical peels**: Improve texture and color
- **Dermal fillers**: Fill depressed scars
- **Silicone sheets/gels**: Flatten and soften scars

**Dr Maresky** evaluates your scar and recommends the most appropriate treatment or combination of treatments.

## The procedure

- **Duration:** **30 minutes to 3 hours** depending on scar size, location, and technique

- **Anaesthesia:** **Local anesthesia** for small scars
**IV sedation or general anesthesia** for extensive revisions

- **Location:** **Christiaan Barnard Memorial Hospital** or office-based procedure room

### Procedure steps

- **Consultation**: **Dr Maresky** examines scar and discusses treatment options
- **Anesthesia**: Appropriate anesthesia administered
- **Scar excision**: Old scar tissue is carefully removed (if surgical revision)
- **Tissue repositioning**: Surrounding tissue is mobilized and repositioned
- **Closure**: Wound is closed in layers with meticulous suturing technique
- **Dressing**: Sterile dressing applied; silicone sheets may be placed
- **Post-operative instructions**: Detailed scar care instructions provided

- **Technique:** **Dr Maresky** selects scar revision techniques according to scar type, location, and skin quality:
- **Tension-free closure** to minimize new scar formation
- **Layered closure** to support wound healing
- **Fine sutures** (5-0, 6-0, or smaller) for minimal scarring
- **Z-plasty or W-plasty** to reorient scars along natural skin lines
- **Dermabrasion** of scar edges for smooth blending
- **Combination approaches** (surgery + laser + injections) when appropriate

## Candidate information

- Individuals with **scars that are bothersome** cosmetically or functionally
- Those with **mature scars** (at least 1 year old for surgical revision)
- Non-smokers or willing to **quit 4 weeks** before and after surgery
- Patients with **realistic expectations** (scars can be improved, not erased)
- Individuals in **good overall health**
- Those without **active skin infections** at scar site
- Patients not prone to **excessive scarring** (for surgical revision)
- Those willing to follow **post-operative scar care** protocols

## Preparation

- **Timeline:** **2-4 weeks** before surgery (varies by technique)

### Medical tests

- No routine tests for minor revisions
- **Complete blood count (CBC)** for extensive revisions
- **Allergy testing** if injectable treatments planned

### Medications

#### Medications to discuss stopping

- **Stop** aspirin and blood thinners **2 weeks** prior
- **Stop** NSAIDs (ibuprofen, naproxen) **1 week** prior
- **Stop** herbal supplements **2 weeks** prior
- **Stop** vitamin E supplements **1 week** prior

#### Medications to continue

- **Continue** essential medications as advised by **Dr Maresky**
- **Inform Dr Maresky** of all current medications

### Lifestyle

- **Smoking:** **Quit** smoking at least **4 weeks** before surgery (critical for healing)

- **Alcohol:** **Avoid** alcohol **48 hours** before

### Arrangements

- **Arrange** transportation home if sedation used
- **Plan** time off work (varies by extent: **1-7 days**)
- **Stock** scar care products as recommended
- **Avoid** scheduling before important events

## Recovery and aftercare

### Timeline

- **Immediate:** Dressing in place; mild discomfort; swelling and bruising

- **24 48hours:** Dressing changed; wound care begins

- **5 7days:** Sutures removed (for facial scars); scar care regimen starts

- **10 14days:** Sutures removed (for body scars); can resume most activities

- **2 4weeks:** Scar begins remodeling; redness improving

- **3months:** Scar appearance continues to change as healing progresses

- **6 12months:** **Final results**; scar continues to mature and fade

- **12 18months:** Scar fully mature

### Restrictions

#### First 2 weeks

- **Keep** wound clean and dry as instructed
- **Avoid** stretching or tension on scar
- **No** strenuous activities or heavy lifting
- **Protect** from sun exposure
- **No** swimming or soaking in water
- **Apply** prescribed ointments and dressings

#### 2 6weeks

- **Gradually** resume normal activities
- **Continue** scar care regimen (silicone sheets, massage)
- **Protect** from sun with SPF 50+ sunscreen
- **Avoid** trauma to healing scar

#### Long term

- **Daily sun protection** (SPF 50+) for at least 1 year
- **Massage** scar as instructed to soften and flatten
- **Use** silicone sheets or gels for 3-6 months
- **Avoid** excessive sun exposure permanently

- **Pain management:** **Minimal to moderate discomfort** depending on extent of revision, managed with prescribed pain medication. Most patients describe it as mild soreness.

- **Scarring:** **New scar will form** but should be less noticeable than original. Final scar appearance depends on:
- Surgical technique
- Individual healing
- Scar location
- Post-operative care
- Sun protection

## Expected results

- **Timeline:** **Initial improvement**: 2-4 weeks
**Significant improvement**: 3-6 months
**Final results**: 12-18 months (scars take time to fully mature)
**Permanence**: Results are long-lasting, but scars never completely disappear

- **Expectations:** **What Scar Revision CAN do**:
- Improve scar appearance
- Make scars less noticeable
- Improve scar texture and color
- Reduce scar width or thickness
- Reposition scars along natural skin lines
- Improve function if scar restricts movement
- Address appearance, comfort, and functional concerns related to scarring

**What Scar Revision CANNOT do**:
- Completely remove scars (scars are permanent)
- Guarantee perfect, invisible results
- Prevent all new scar formation
- Guarantee no keloid recurrence (in predisposed individuals)
- Reverse all effects of severe trauma or burns
- Provide immediate results (healing takes months)

- **Satisfaction:** Results vary based on original scar characteristics, scar location, individual healing, and adherence to post-operative care. Scar revision can improve appearance or function, but it cannot remove a scar completely.

## Risks and considerations

### Common

- **New scar formation** (goal is improvement, not perfection)
- **Temporary swelling and bruising**
- **Redness** (fades over months)
- **Temporary numbness** at scar site
- **Itching** during healing

### Rare

- **Infection** (treated with antibiotics)
- **Wound dehiscence** (wound reopening)
- **Hypertrophic or keloid scar recurrence** (especially in predisposed individuals)
- **Asymmetry** or irregularity
- **Pigmentation changes** (darkening or lightening)
- **Unsatisfactory cosmetic result** (may need revision)

### Serious

- **Severe infection** requiring hospitalization (very rare)
- **Nerve damage** causing permanent numbness or weakness (rare)
- **Excessive bleeding** or hematoma (rare)

- **Prevention:** Appropriate specialist assessment, surgical technique, wound care, and following post-operative instructions can reduce risk and support healing.

## Frequently asked questions

### Can all scars be improved?

Most scars can be **improved**, but results vary. Factors affecting improvement include scar type, location, age, size, and individual healing. **Dr Maresky** assesses your scar and provides realistic expectations during consultation.

### How long should I wait before revising a scar?

Scars should be **at least 1 year old** before surgical revision to allow full maturation. However, **non-surgical treatments** (steroid injections, laser) can begin earlier. **Dr Maresky** determines optimal timing.

### Will the new scar be invisible?

**No scar is completely invisible**, but revision aims to make it **less noticeable**. The new scar should be thinner, flatter, and better aligned with natural skin lines. Final appearance depends on technique, location, and individual healing.

### Can keloid scars be revised?

**Yes, but with caution**. Keloids have high recurrence rates (up to 50%) even after revision. Treatment often combines **surgical excision + steroid injections + radiation therapy** to prevent recurrence. **Dr Maresky** discusses risks and prevention strategies.

### How long until I see final results?

Scars take **12-18 months** to fully mature. You'll see **initial improvement at 2-4 weeks**, **significant improvement at 3-6 months**, and **final results at 12-18 months**. Patience is essential.

### Can acne scars be revised?

**Yes!** Acne scars respond well to various treatments including **laser resurfacing**, **subcision**, **dermal fillers**, **microneedling**, and **chemical peels**. Severe acne scars may benefit from **surgical excision**. **Dr Maresky** creates a personalized treatment plan.

### Will insurance cover scar revision?

Usually **no** for cosmetic revision. However, if the scar **restricts movement**, causes **pain**, or results from **trauma/surgery with complications**, insurance may provide partial coverage. Check with your provider.

### Can I combine scar revision with other procedures?

**Yes!** Scar revision is often combined with **laser treatments**, **skin resurfacing**, **fat grafting**, or other procedures for comprehensive improvement. **Dr Maresky** discusses safe combinations.

### What's the most important factor for good results?

**Post-operative scar care** is critical! This includes:
- Keeping wound clean
- Using silicone sheets/gels
- Massaging scar
- **Sun protection** (SPF 50+ for at least 1 year)
- Following all instructions from **Dr Maresky**

### Can stretch marks be revised?

Stretch marks are **atrophic scars** that can be improved with **laser therapy**, **microneedling**, **chemical peels**, or **topical treatments**. Complete removal is not possible, but appearance can be significantly improved.

### How soon can I return to work?

Depends on extent of revision. **Minor revisions**: **1-3 days**. **Extensive revisions**: **5-7 days**. **Dr Maresky** provides personalized recommendations based on your procedure and job requirements.

### What if I'm not happy with the results?

If you're unsatisfied after full healing (12-18 months), **revision surgery** may be possible. However, multiple revisions increase risks. Setting **realistic expectations** initially is crucial. **Dr Maresky** discusses potential outcomes honestly during consultation.

## Indicative pricing

- Estimate: R25,000 to R50,000 ZAR
- Cost factor: Size and location of scar
- Cost factor: Technique used
- Cost factor: Single vs multiple stages
- Detailed cost page: https://doctormaresky.co.za/cost/scar-revision
- Final pricing is confirmed after an individual consultation.

## Consultation and contact

- Consultation: https://doctormaresky.co.za/procedure/general-consultation
- Contact: https://doctormaresky.co.za/contact