Reconstructive surgery · New York and New Jersey
Scar Revision
Scar revision improves scars from earlier surgery, injuries, and burns, making them thinner, flatter, better placed, or less tight. Dr. Steven Ovadia is a board certified plastic and reconstructive surgeon who revises scars with surgical and non-surgical treatment, with offices in New York City and New Jersey.
Overview
What scar revision is
Every cut through the skin heals with a scar. Most scars fade into a thin line, but some heal wide, raised, dark, or tight, or sit in a place where they draw attention or pull on something nearby. Scar revision is the treatment of those scars.
A scar cannot be erased. What revision does is replace a scar with a better one, or improve the scar that is there: narrower, flatter, smoother, turned to follow the natural lines of the skin, or loosened so it no longer limits movement.
The right treatment depends on the kind of scar, where it is, how old it is, and what bothers you about it. Often it is a combination of surgery and treatment afterward. The kinds of scars are covered below.
Kinds of scars
Scars that can be improved
Scars differ in what went wrong as they healed, and so in what helps. Many scars are a mix of more than one of these.
Wide or stretched scars
Scars that healed flat but spread, often where the skin is under tension, such as the back, shoulders, or abdomen. These are often improved by cutting out the scar and closing it again in layers.
Raised (hypertrophic) scars
Thick, red, raised scars that stay within the edges of the original wound. Many soften with time, pressure, silicone, and steroid injections. Those that do not can be revised surgically.
Keloids
Scars that grow beyond the edges of the original wound, often on the earlobes, chest, shoulders, or jaw. Keloids tend to come back after being cut out alone, so treatment usually combines surgery with steroid injections or other treatment afterward.
Contracture scars
Scars that tighten and pull, often after burns or across a joint, the neck, or the hand. They can limit movement. Treatment releases the tightness and brings in new skin with a Z-plasty, a local flap, or a skin graft.
Depressed or tethered scars
Scars that sit below the surrounding skin or are stuck to the tissue underneath. Releasing the scar and filling the area, often with your own fat, can raise and soften it.
Poorly placed scars
Scars that run against the natural lines and creases of the skin, or that pull on a nearby feature such as an eyelid or the lip. Changing the direction of the scar can make it blend in and release the pull.
Timing
When to revise a scar
A scar keeps changing for a year or more. It starts pink and firm, then gradually fades, flattens, and softens. Many scars that look poor in the first months improve on their own, so surgical revision is usually planned once a scar has matured.
Some scars should not wait. A scar that tightens across a joint, the neck, or the hand, or that pulls an eyelid or the lip out of place, can be treated sooner. Raised scars and keloids are often treated with injections and silicone while they are still active.
Scar revision tends to work well when:
- A scar bothers you because of how it looks, how it feels, or how it limits movement
- The scar has had time to mature, usually a year or more, or it causes a problem that should not wait
- You understand that a revision improves a scar but leaves a scar
- You do not smoke or vape, or you are able to stop well before and after surgery
- You are able to follow scar care at home for several months afterward
Techniques
How scars are revised
Surgical revision removes the old scar and closes the skin in a way that heals better. The three most common techniques are shown here.
Excision and layered closure
The old scar is cut out and the skin is closed again in layers, with deeper stitches taking the tension off the skin. It works best for scars that are wide, raised, or uneven but already run in a good direction.
Z-plasty
The scar is removed and two small triangles of skin on either side of it are swapped. This lengthens a scar that has tightened, and turns part of it to follow the natural lines of the skin. It is a common way to release a contracture.
W-plasty
The scar is removed with a zigzag edge on both sides, and the two edges are fitted together. A long straight scar becomes a series of short segments, which the eye notices less, especially on the face.
The gold line marks the new scar.The shaded area is the old scar that is removed.
Other treatments
Steroid injections
Injected into a raised scar or keloid, a steroid can flatten and soften it and ease itching. A series of injections several weeks apart is common. They are also used after a keloid is cut out, to lower the chance it comes back.
Silicone and pressure
Silicone sheets or gel and pressure garments help flatten and soften raised scars while they mature. They are also used after a surgical revision.
Fat grafting
Fat taken from elsewhere by liposuction is placed under a depressed or tethered scar to lift it and release it from the tissue underneath. Fat grafting can also soften the scar itself.
Skin grafts and flaps
When there is not enough skin to close the area once a large scar or a contracture is released, skin is brought in, either as a graft from another part of the body or as a flap of nearby skin moved into place.
Side by side
| Excision and closure | Z-plasty or W-plasty | Non-surgical treatment | |
|---|---|---|---|
| Works best for | Wide, raised, or uneven scars that run in a good direction | Scars that pull or tighten, or that run against the natural lines of the skin | Raised scars and keloids |
| What it changes | Width and texture of the scar | Direction and length of the scar, and the tightness | Thickness, firmness, and itching |
| The scar afterward | A new, usually thinner line in the same place | A new scar with a broken or redirected shape | The same scar, flatter and softer |
| Sessions | Usually one | Usually one | Often a series |
Many scars are best treated with a combination: a surgical revision, followed by silicone or injections while the new scar matures. Dr. Ovadia goes over the plan for your scar at your consultation.
Procedure
What scar revision involves
Scar revision ranges from a series of injections in the office to an operation that releases a contracture and brings in new skin. These are the usual steps.
Assessment
Dr. Ovadia examines the scar: its width, height, color, direction, how it moves, and whether it pulls on anything nearby. He asks how it formed and how long ago, and what bothers you about it.
Planning
He explains which treatment, or combination, fits the scar, what improvement is realistic, and whether it is better done now or after the scar has had more time to mature.
The revision
The scar is revised with the technique planned. Where the operation is done and the anesthesia depend on the size and location of the scar, and Dr. Ovadia goes over them with you before surgery.
Scar care
The new scar is protected while it heals. Silicone, massage, sun protection, and sometimes injections follow over the next several months.
Every surgery has risks. For scar revision these include bleeding, infection, a new scar that heals wide or raised, a keloid that comes back, changes in skin color, numbness around the scar, and the possible need for further treatment. Smoking and vaping raise the risk of healing problems. Dr. Ovadia goes over the risks with you at your consultation.
Recovery
What to expect after scar revision
Most revisions are a short recovery
Small revisions usually mean a few days of soreness and a dressing. Larger revisions, such as contracture releases with grafts or flaps, take longer. Dr. Ovadia tells you what to expect for your revision.
Stitches and tension
Stitches come out in the office, or dissolve on their own. Avoid stretching or straining the area at first so the new scar is not pulled wide while it heals.
The scar looks worse before it looks better
A new scar is pink, firm, and sometimes raised for the first few months. This is the normal course of healing. It fades and softens over a year or more.
Protect it from the sun
Sun on a healing scar can darken it, sometimes for good. Cover it or use sunscreen for at least the first year.
Silicone and massage
Silicone sheets or gel, and gentle massage once the incision has healed, help the scar flatten and soften. You are shown what to do and when to start.
Follow-up matters
Scars are watched over several visits. If a scar starts to thicken, it can be treated early, often with an injection, before it becomes a problem.
Spreading redness, increasing pain, drainage from the incision, or a fever should be brought to your physician's attention right away.
A general timeline
This is a general guide. Everyone heals differently. During your recovery, Dr. Ovadia will review your timeline with you.
Cost
Cost and insurance
Revision done only to improve how a scar looks is unlikely to be covered by insurance. Revision of a scar that causes a medical problem, or that is part of a reconstruction, may be covered by some plans.
The cost depends on the size and location of the scar, the treatment, and whether more than one session is needed. We go over it with you once your treatment plan is set.
When scar revision may be covered
- A scar that limits movement, such as a contracture across a joint, the neck, or the hand
- A scar that pulls on an eyelid or the lip and affects how it works
- A scar that causes ongoing pain, or breaks down and does not heal
- Revision of a scar that is part of a reconstruction, such as breast reconstruction after cancer
- Photographs and medical records that document the problem
Every plan sets its own criteria. Coverage is not guaranteed.
If you have questions about possible insurance coverage for scar revision, call or email us and we will go over it with you.
Your surgeon
Board certified and double fellowship-trained
Dr. Ovadia is board certified by the American Board of Plastic Surgery. After his plastic surgery training he completed two fellowships: gender-affirming surgery and microsurgery at Johns Hopkins, and craniofacial and pediatric plastic surgery at UT Austin / Dell Children's Hospital.
Reconstructive surgery is a large part of his practice, including breast reconstruction, wound care, and complex reconstruction. He revises scars from his own surgery and from surgery done elsewhere, and sees patients in New York City and in Jersey City and Millburn, New Jersey.
Questions
Common questions about scar revision
Can a scar be removed completely?
No. Any surgery on the skin leaves a scar. Scar revision replaces a scar that is wide, raised, tight, or poorly placed with one that is thinner, flatter, better placed, or less noticeable. Non-surgical treatment improves a scar without cutting it out.
How long should I wait before revising a scar?
Scars keep changing for a year or more, and many improve on their own. It is usually best to wait until a scar has matured before revising it. A scar that limits movement or pulls on an eyelid or the lip may be treated sooner. Raised scars and keloids can be treated with injections and silicone while they mature.
What is the difference between a raised scar and a keloid?
A raised (hypertrophic) scar stays within the edges of the original wound and often flattens with time. A keloid grows beyond those edges and does not go away on its own. Keloids are more likely to come back after surgery, so their treatment usually combines surgery with steroid injections or other treatment afterward.
Will my keloid come back?
It can. Keloids return more often than other scars, especially when they are cut out with no other treatment. Steroid injections after surgery, pressure, and close follow-up lower the chance. Dr. Ovadia goes over the options and the chance of recurrence for your keloid at your consultation.
Can you revise a scar from surgery done by another surgeon?
Yes. Many scar revisions are of scars from earlier surgery, whether done by Dr. Ovadia or by another surgeon, including scars from a C-section, a breast operation, a tummy tuck, or surgery on the face.
Can you help with burn scars?
Yes. Burn scars that tighten and limit movement can be released with a Z-plasty, a local flap, or a skin graft. Raised burn scars can be treated with injections, silicone, and pressure. Burn scars often need treatment in stages.
Do you treat acne scars?
Depressed scars, including some acne scars, can be improved by releasing them and filling the area, often with fat grafting. Dr. Ovadia tells you at your consultation whether your scars are likely to improve.
How many treatments will I need?
A surgical revision is usually one operation. Non-surgical treatment such as steroid injections is often done in a series. Larger scars, burns, and keloids may need treatment in stages.
Is scar revision covered by insurance?
Revision done only to improve how a scar looks is unlikely to be covered. Revision of a scar that causes a medical problem, such as a contracture that limits movement, may be covered by some plans, as may revision that is part of a reconstruction. Every plan sets its own criteria, and coverage is not guaranteed.
Can I have a consultation without coming to the office?
Yes. Phone and video consultations are available, in addition to in-person visits in New York City, Jersey City, and Millburn, New Jersey. For a scar, clear photographs in good light help a great deal.
Next step
Start with a consultation
Dr. Ovadia will examine your scar, go over what bothers you about it, and explain what improvement is realistic, which treatment fits, and whether now is the right time.
225 Broadway, Suite 3100, New York, NY
377 Jersey Ave, Suite 440, Jersey City, NJ
90 Millburn Ave, Suite 206, Millburn, NJ
Phone and video consultations available · info@ovadiaps.com