Procedure

Scar Revision

The whole set of procedures used to make an existing scar less noticeable — cutting it out and closing it more neatly, flattening it, releasing it, or resurfacing it. No procedure erases a scar. Revision trades the scar you have for one you would rather live with.
Dr. Schwarz, MD · Board-certified dermatologistLast reviewed September 8, 2026
16:9 hero for Scar Revision. Never cropped: the tone strip and the corner logo depend on the full frame.

Start here

The scar is permanent; what can change is how wide it is, how raised, how red, and which direction it runs, and those changes are often worth having. Match the treatment to the scar: a keloid and an indented acne scar are opposite problems, and what helps one makes the other worse. Most scars keep improving on their own for a year or two, so revising at three months often means operating on something that was going to settle anyway. If you have ever made a keloid — including on an earlobe from a piercing — say so at the first visit, because it changes the plan.

— Dr. Schwarz, Board Certified Dermatologist

Key Facts

−
Also calledScar revision surgery, scar excision, scar repair, scar surgery
TreatsRaised keloid and hypertrophic scars, indented (atrophic) scars, wide or stretched scars, and tight contracture scars that limit movement
DowntimeNone after an injection. About 1 to 2 weeks of visible healing after surgery or resurfacing
SessionsRarely one. Steroid injections are repeated every 4 to 6 weeks; surgical revision is usually staged with other treatments across a year or more
Typical costWide range in the US. Steroid injections are relatively inexpensive per visit; surgical revision and laser resurfacing run into the hundreds or thousands of dollars
Results timelineA revised scar looks worse before it looks better. Judge it at 12 to 18 months, not at 6 weeks
PainLocal anesthetic for surgery and needling. Injecting a firm scar stings sharply for a few seconds
Skin tone safetyKeloids and lasting dark or light patches are more common on deeper skin tones. This changes which approach is chosen, not whether a scar can be treated
InsuranceSometimes covered when a scar limits movement or vision, or follows cancer surgery or trauma. Rarely covered for appearance alone

What It Is

−

Scar revision is a set of options, chosen by what kind of scar you have. The four kinds of scar: A keloid is raised, firm, and grows past the edges of the original wound. It does not settle on its own. A hypertrophic scar is raised but stays inside the wound edges, and often flattens by itself over one to two years. An atrophic scar is indented, because the skin there is thin or tethered down from underneath — most acne scars are this kind. A contracture is a tight scar that pulls, usually across a joint or near an eyelid or the mouth, and limits movement. The main tools: Steroid and other anti-scar injections, excision and re-closure, geometric closures such as Z-plasty that change a scar's direction, punch excision and subcision for indented scars, filler, microneedling, and laser resurfacing. Most plans use several, in a set order.

How It Works

−

A scar is collagen. Skin cut deeply enough cannot rebuild its fine basket-weave pattern, so it lays down thick bundles running mostly one direction. That is why a scar looks and feels different, and why every procedure here works on the same material.

Injections: These turn down the cells making that collagen. Triamcinolone, a steroid, softens and flattens most raised scars over several treatments, and stops the itching first. 5-fluorouracil is sometimes added for stubborn keloids.

Surgery does the opposite. It removes the scar and restarts the wound under control — clean edges, closure in layers so deep tissue takes the tension, fine stitches at the surface, and a new line placed along a natural crease where possible. A Z-plasty breaks one straight line into short segments running in different directions, which lengthens a tight scar and makes it read as texture.

Indented scars: These work differently again. Subcision releases the strands anchoring the surface down, punch excision removes a small pit outright, and filler or collagen-building treatments raise the floor. Lasers and microneedling remodel collagen in the upper layers so the scar edge blends in.

The limit is the same in every case: healing makes new collagen, so cutting out a scar makes another scar. The bet is that the new one, placed and closed deliberately, will be finer. On skin that makes keloids, that is a poor bet unless the healing is controlled at the same time.

Skin is about two millimetres thick on the face. How deep a treatment reaches decides what it can change, and whether it treats all of the skin or scattered columns of it decides how long you take to heal.

How it works
Compare
Skin basics
EPIDERMISDERMISFAT0.05 mm — pigment0.5 mm — texture + pores1.0 mm — collagen1.5 mm — deep dermisPEELNEEDLINGNON-ABLATIVE LASERABLATIVE LASERGOES BELOW THE SKIN

This works below the skin altogether, in the fat or the muscle beneath it. Nothing applied to the surface reaches here, which is the whole reason the procedure exists — and why it is done by injection, by needle or with a blade rather than with a cream.

A peel or a scrub takes the skin off evenly from the surface down. Everything above the line goes and nothing below it is touched, which is why peels suit surface pigment and rough texture, and why the whole face flakes for a few days after.

Needles make hundreds of separate channels and leave the skin between them untouched. That untouched skin is what heals the rest, so recovery is quick — but a needle only injures the skin to start repair. It removes nothing.

The light passes through the surface and heats a column underneath it. The surface stays whole, so you leave red rather than raw — and it takes a course of sessions rather than one.

The laser removes columns of skin outright: the white gaps here are tissue that is gone, and new skin grows in from the sides. The strongest of the four, and the longest to heal.

The outer layer, and the only one anything in a jar reaches. It renews itself constantly: a cell made at the bottom takes about a month to reach the surface and flake off. Most of what a skincare product does, it does here.

The living layer underneath, holding the blood vessels, the nerves and the collagen. It is where lasting change happens and it is hard to reach: most of what is sold for the skin never gets this far.

What It Treats

−
Close-up of the cheek, nose and mouth of an adult with light skin, turned three-quarters away from the camera against a pale blue background. The surface of the cheek is uneven, dimpled with shallow depressions and small pits that catch the light. There are no active spots — the change here is in the texture of the skin rather than its color.
Acne Scarring
Moderate evidence
A single deep, narrow scar is cut out and closed, or punched out and grafted, trading a pit for a fine line that resurfacing can then blend. It suits a handful of stubborn icepick or deep boxcar scars, not a whole cheek. It is normally done before laser rather than instead of it.

Pros and Cons

−
Pros
  • Real change on raised scars Steroid injection flattens most.
  • Width and direction can be fixed Re-cut as a finer line.
  • Function, not only appearance Contractures can be released.
  • Approaches combine Injection, surgery, needling and laser stage together.
  • Some of it is low risk Injections, silicone, taping.
Cons
  • A scar is never erased You trade up, not erase.
  • Keloids come back Excision alone brings it back larger.
  • It takes a year to judge Worse at two to three months first.
  • Cost and coverage Covered only if function is limited.
  • Not everything responds Deep or tethered scars improve modestly.

How to Prepare

−
6 to 12 monthsA few weeks before2 weeks before
Waiting
6 to 12 months
Surgeons want 6 to 12 months of natural settling first. A scar still improving may not need surgery. Sooner only if it limits movement.
Sun
A few weeks before
Keep the scar out of the sun and use SPF 30 or higher. A tanned scar heals with more color change.
Smoking and vaping
2 weeks before
Stop both at least two weeks before and after surgery. Nicotine narrows the vessels feeding a healing wound.
What to bring
Photographs from before the injury, if you have them.

What Happens

−
ArrivingThe treatmentLeaving
Arriving
The scar is photographed and examined relaxed and stretched. For surgery it is marked while you sit or stand, so the new line follows a natural crease. Local anesthetic goes in around the scar for surgery, punch techniques and subcision, stinging 10 to 30 seconds. Steroid injections need no numbing. Your provider will ask about these things.
The treatment
A steroid injection takes minutes and meets real resistance. Surgical revision cuts the scar out as a narrow ellipse and closes it in layers, usually 30 to 90 minutes. A Z-plasty swaps small flaps to change direction. Punch excision removes a small round scar. Laser or microneedling takes 20 to 45 minutes. Expect pressure, not sharpness.
Leaving
Tape over the line, wound care instructions, and a date for stitch removal — 5 to 7 days on the face, 10 to 14 days on the body.

Recovery

−
First 2 weeksWeeks 2 to 8Months 3 to 18
First 2 weeks
Swollen, bruised and tender. Ice in short spells and keeping it raised help; ordinary painkillers cover a day or two. Keep the wound clean and moist with plain ointment rather than letting it scab. Stitches out at 5 to 7 days on the face, 10 to 14 days on the body.
Weeks 2 to 8
The new line turns pink, firm and slightly raised — normal healing, not failure. Start silicone once the skin is fully closed. A steroid-injected scar softens over these weeks, with bruising and sometimes a small dip or pale halo.
Months 3 to 18
Redness fades and the ridge softens from month 3 to 6, with massage and silicone doing the work. By month 12 to 18 the scar is what it will be; earlier judgments are usually wrong.

Aftercare

−
2 to 4 weeks2 to 3 monthsAt least a year
Exercise
2 to 4 weeks
No lifting, stretching or straining across the wound. Tension turns a fine line into a wide one.
Silicone
2 to 3 months
Sheets or gel once the wound is fully closed, most days, for at least 2 to 3 months. The best-supported home step there is.
Sun
At least a year
SPF 30 or higher daily. Sun on a new scar is the main cause of a permanently darker line.
Wound care
Clean and covered as instructed. Plain petrolatum ointment, not hydrogen peroxide, and never let a fresh wound dry into a scab.
Taping
Paper tape or a tension-relieving dressing for several weeks if advised, so the closure does not stretch.
Massage
Firm daily massage once healed, if advised. Never on an open wound.
Picking
Leave crusts alone. Pulling one off early widens the scar.

Risks

−

Risk depends on which procedure is used. An injection and an operation are not the same conversation.

A scar thickening or spreading again
The first sign of a keloid or hypertrophic scar returning. Far easier to treat at 6 weeks than at 6 months.
Itching, burning or tenderness in the scar
Often the earliest sign a raised scar is active again.
A dent or pale patch after an injection
Steroid can thin the fat underneath and lighten the skin. It usually recovers over months, but say so before the next dose so the strength can be adjusted.
A new dark patch
Common on deeper skin tones after any procedure. Treated early, it clears faster.
Numbness or odd sensation
Along the scar, usual for weeks after surgery. Mention it if it is not improving after a few months.

In Deeper Skin Tones

−

This is the part of scar revision that changes the plan most. Keloids and thick hypertrophic scars are more common on deeper skin tones, and so is post-inflammatory hyperpigmentation — the brown mark left after inflammation. Every scar procedure is a controlled injury, so both matter.

Cutting is less often the first move. A raised scar is usually injected first, and silicone, pressure earrings for earlobe keloids, and taping are used for longer. If a keloid is excised, something goes alongside it — steroid injections during healing, and in some centers a short course of superficial radiation for high-risk sites. Excision alone has a high chance of the keloid returning larger on any skin tone, but the stakes are higher here.

Site matters. The chest, shoulders, upper back, jawline and earlobes produce keloids most often, and elective surgery there deserves a careful conversation.

Resurfacing settings: Conservative, with sessions spaced further apart, because heat drives pigment change. Ablative and deep resurfacing can leave a permanent pale patch that does not repigment. Many providers pre-treat with a pigment-lowering cream, start sun protection weeks before, and restart the cream once healed.

Mention keloids early: Say at the first visit if you or a relative has ever formed a keloid. It is the most useful thing you can tell the doctor.

If You Stop

−

It depends which part you stop.

Stopping steroid injections early is the common mistake with raised scars. A keloid flattened but not finished can build again over the following months, and is harder to treat the second time. Silicone and pressure work the same way — the benefit comes from months of consistent use, and stopping at week three achieves very little.

A surgical revision, once healed, is permanent: the old scar is gone and the new line is what you have. It keeps maturing for a year or more either way, though sun protection and taping improve how it matures.

Filler used to lift an indented scar softens over months to a couple of years. Gains from subcision, needling and laser are largely kept but partial, and stopping partway leaves you with the partial result.

Combining Treatments

−
Same day
Silicone and sunscreen
Silicone, sun protection and gentle massage help every scar treatment.
Same day
Steroid injection
Often paired with silicone sheeting and pressure.
Same day
5-fluorouracil
Added to steroid injection for stubborn keloids.
Same day
Subcision and filler
Indented scars are staged — release, filler, then surface.
Wait 4–6 weeks
Laser or needling
Until the wound is fully closed and settled.
Wait 4 weeks
Repeat steroid injection
At least 4 weeks apart, to limit skin thinning.
Wait 6 months
Isotretinoin
Most providers wait about 6 months before resurfacing.
Wait 6–12 months
Surgical revision
Let a scar mature 6 to 12 months, unless it restricts movement.

Insurance Coverage

−

Insurance often pays when a scar limits movement or vision, interferes with function, or follows cancer surgery or an injury. It usually refuses when the reason is appearance. The answer often comes down to how the request is documented, so ask the office to check before booking.

Ask Your Doctor

−
If you are pregnant or breastfeeding
Ask the doctor managing your pregnancy or breastfeeding before any elective scar procedure.
If you have ever had a keloid
Say so before anything is cut. It changes the plan, even if it was only an earlobe.
If you take a blood thinner
Or have a bleeding disorder. Bruising and bleeding are heavier. Never stop a prescribed blood thinner without asking the doctor who prescribed it.
If you smoke or vape
Nicotine worsens wound healing. Most surgeons ask for two weeks off before and after.
If you have diabetes
Or take medicine that suppresses your immune system. Wounds heal slower and infection risk is higher.
If you finished isotretinoin recently
Most providers wait about 6 months before resurfacing or surgery.
If the scar is less than 6 months old
Ask whether waiting is better. Many scars improve on their own in that window.
If you have a deeper skin tone
Ask about keloid risk at that site and how pigment change is handled.
If the scar limits movement
Or pulls on an eyelid or your mouth. Say so plainly — that is a functional problem, treated differently, and more likely to be covered.
If you get cold sores
And the scar is near your mouth. Procedures can trigger an outbreak, and antivirals work best started beforehand.

At-Home Versions

−
Silicone gel or sheets
Good alternative
Applied to a fully closed wound most days for 2 to 3 months. The best-supported home treatment for raised and thickened scars, and the sensible default.
Daily sunscreen on the scar
Good alternative
SPF 30 or higher for at least a year. Sun on a new scar is the main reason a line ends up permanently darker than the skin around it.
Paper tape or tension dressings
Okay alternative
Tension-relieving dressings, worn over a healing line for weeks to take tension off the closure. Cheap, and worth asking your surgeon whether it suits your scar.
Scar massage
Okay alternative
Firm massage of a healed scar for a few minutes daily. Helps soften and flatten, and is the part of home care people abandon first.
Vitamin E oil
Bad alternative
Trials have not shown benefit and it causes a rash in a fair number of people.
Onion extract and cocoa butter
Okay alternative
Creams. Popular and harmless, but the effect is small at best. Silicone is the better use of the same money and effort.

How It Compares

−
Silicone sheets and gel
Different job
The best-supported thing you can do at home, and often used alongside everything else. Slow, needs months of daily use, and does nothing for indented scars.
Steroid injection
Different job
For keloid and hypertrophic scars. Flattens and stops the itch without surgery. Needs repeating, and can thin the skin or leave a pale patch at the site.
A patient in protective goggles lying under a large laser head positioned over their face16:9 hero for Pulsed Dye Laser (V-Beam). Never cropped: the tone strip and the corner logo depend on the full frame.
Pulsed dye laser
Different job
Targets redness in a scar and may soften a raised one. Little effect on the shape or depth of the scar.
Fractional laser resurfacing
Better
Better on indented and irregular scars than surgery is, with several sessions, real downtime, and more care needed on deeper skin tones.
MicroneedlingDiagram: how Microneedling works in the skin
Microneedling
Different job
Cheaper and gentler than laser for shallow texture, with less downtime, but less change per session and no effect on a scar tethered from underneath.
Filler
Different job
Immediate lift with almost no downtime, but temporary, and it does not release a tethered scar.
Doing nothing
Better
Reasonable for many scars. Most keep improving for a year or two, and a scar that is settling well may end up better untreated than revised early. Keloids are the exception, because they do not settle on their own.

Finding a Provider

+

It depends on the scar. Dermatologists and dermatologic surgeons do most injections, punch techniques, subcision, needling and laser. Plastic, facial plastic and oculoplastic surgeons do larger excisions, flaps and grafts. Burn and hand surgeons treat contractures that limit movement.

Questions worth asking: What kind of scar is it, what is the plan if the first step fails, and what would they do if a keloid came back. Ask to see their own results at 12 months rather than 6 weeks, and on skin like yours.

Red flags: a promise to remove the scar, excising a keloid with nothing planned alongside, no discussion of your keloid history, before-and-after photographs taken weeks apart, and pressure to buy a package on the first visit.

Myths

+
  • "A scar can be removed completely." It cannot. Every treatment replaces one scar with another meant to be less noticeable. Anyone promising removal is describing something that does not exist.
  • "Vitamin E oil heals scars." Trials show no benefit, and it causes a rash in a fair number of people. Silicone has far better evidence.
  • "You should treat a scar as soon as it forms." Usually the opposite. Most scars improve on their own for a year or more, so revising early means operating on something unfinished. Raised scars that are actively growing are the exception.
  • "Cutting out a keloid gets rid of it." On its own it usually comes back larger. Excision only works as part of a plan that controls the healing.
  • "Cocoa butter, onion extract and scar creams work." The evidence is weak. The massage may help slightly, but they are not doing what the packaging suggests.
  • "People with deeper skin tones cannot have scar surgery." They can. The approach is chosen more carefully, keloid risk is planned for, and pigment change is managed.

Questions Patients Ask

+

Can a scar be removed completely?

No. Every treatment replaces the scar with a different one — flatter, narrower, paler, or running in a less obvious direction. Often a large improvement, not removal.

How long should I wait before revising a scar?

Usually 6 to 12 months, because most scars keep improving on their own in that time. Scars that limit movement and raised scars still growing are treated sooner.

What is the difference between a keloid and a hypertrophic scar?

A hypertrophic scar is raised but stays within the original wound borders and often flattens over a year or two. A keloid grows beyond them, keeps going, and does not settle by itself. Keloids come back after surgery much more often, so they are usually injected rather than cut.

Will scar revision help my acne scars?

Some of them. Rolling scars respond to subcision, needling and laser; deep icepick scars often need punch excision or a targeted acid technique; boxcar scars sit in between. Expect a course and partial improvement, not one operation.

Does insurance cover it?

Sometimes — when the scar restricts movement or vision, causes symptoms, or follows cancer surgery or trauma. Revision for appearance is cosmetic. Ask the office to check with your insurer before you book.

I have deeper skin tone, and I keloid. Is anything safe?

Yes, but the order changes. Injections, silicone and pressure come first, elective surgery on high-risk sites is approached carefully, and if a keloid is removed, something is always done alongside to control the healing. Tell the provider at the first visit.

References

+