- Procedure time
- 20 minutes to an hourDepends on the scar
- Downtime
- About ten daysSutures out at day ten
- Results last
- Essentially permanent
Why some scars disappear and others do not
A scar is conspicuous for identifiable reasons: it is wide, it runs against the natural tension lines of the face, it sits across a boundary rather than within one, or it is raised or discoloured.
Revision is the process of removing as many of those reasons as the anatomy allows.
Surgery is not always the answer
Scars remodel over a long period, and many improve considerably with time, sun protection, and silicone alone. Others are better treated by resurfacing than by re-excision. Recommending patience or a non-surgical route is a legitimate outcome here, and often the right one.
The conversation before the operation
Scar revision is the one procedure where I spend more time on the conversation than the surgery. You are trading one scar for another, and you should walk in understanding that.
If a perfect result means an invisible scar, that is not what this is. Anytime you cut skin there is a scar. The goal is improvement.
How a scar heals has a great deal to do with you: your genetics, your ethnicity, and whether you are prone to hypertrophic or keloid scarring. Those are things we go through specifically before I agree to operate.
I am direct about what I think I can achieve. The worst outcome here is a patient who goes through a procedure and ends up with no improvement, or something worse than they started with, and avoiding that is mostly a matter of choosing carefully who to operate on.
The other ways to improve a scar
Cutting it out is one option among several, and often not the first.
- Fractional CO2 laser, which can improve texture and color without another incision
- Steroid injections, for raised or thickened scars
- Injections with chemotherapeutic agents, in the more stubborn cases
- Scar camouflage tattooing, which I would refer out to someone who does it well
Where the scar sits badly, running across a natural boundary instead of along one, repositioning or reorienting it into the relaxed skin tension lines can do more than any surface treatment.
Common questions
- How long should I wait before revising a scar?
- Scars remodel for a long time, and many improve substantially without any intervention. Operating too early can mean operating on something that would have settled on its own. Timing is part of the assessment.
- Can a scar be removed completely?
- No — revision exchanges a scar you have for one that is expected to heal better, sit in a better direction, or fall in a less conspicuous place. Anyone promising removal is describing something surgery cannot do.
- Do you revise work done by another surgeon?
- Yes. Revision of previous facial surgery and of scars from injury or from procedures performed elsewhere is part of the practice.
- Do you repair fresh facial lacerations?
- On occasion, for patients already known to the practice, and during normal business hours. I do not take emergency call for facial lacerations. If you have an injury that needs attention now, go to an emergency department — a laceration repaired promptly by whoever is available beats a better surgeon several hours later. If a scar from that repair bothers you afterward, that is exactly what this page is about.
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