A badly placed, wide, sunken or tethered scar can be improved a great deal. What cannot be done is to make it disappear: every revision replaces one scar with another, better placed and of better quality.
Scars of every origin come to this consultation: caesareans that ended up high or raised, appendix or gallbladder scars, the aftermath of road accidents, acne marks, facial scars that show when you speak, and also tattoos someone has come to regret or that stand in the way of a job. They all share the same starting point: once skin has been cut, it always leaves a mark. Surgery works on the quality, the direction, the width and the position of that mark, not on its existence.
That said, the difference between a bad scar and a good one is enormous. A scar reoriented along the correct lines of the skin, closed in layers and without tension, and looked after during the months of maturing, can go from being the first thing you see to something you have to look for. And timing matters: a recent scar is still maturing and usually improves on its own, so revising it before twelve months is frequently operating unnecessarily. In scars with a keloid tendency the approach is different and is dealt with separately.
It usually helps when there is
- A scar that is wide, sunken, raised or a different colour from the skin.
- A scar badly oriented or displaced in relation to the natural creases.
- A scar that pulls, limits movement or distorts an eyelid or a lip.
- Acne scarring and facial scars that show when you move your face.
- A tattoo you want removed, through regret or for work reasons.
Worth discussing first if
- A scar less than twelve months old, which is still improving on its own.
- A tendency to keloids or a history of hypertrophic scarring.
- An area of considerable tension, where the result is less predictable.
- Current smoking, which worsens the quality of healing.
- Expecting the scar or the tattoo to disappear completely.
None of these rules the procedure out on its own; all of them change the conversation.
What can be done
More than one technique is frequently combined in the same plan.
Surgical revision
The scar is excised and closed again, reorienting it along the natural creases and without tension. It is also used for small tattoos.
Plasties and expansion
Z-plasties to release scars that pull, and expansion or flaps when the surface to be removed is large.
Complementary treatments
Silicone, injections, microneedling and laser. They improve colour and texture, and for tattoos laser is the treatment of choice.
The scar is changed, not removed
Revision works because it replaces a poor-quality scar with a good-quality one: reoriented along the natural lines of the skin, closed in layers so that the deep tissue takes the tension rather than the skin, and with no tightness at the edges. That is why a revised scar ends up better, and it is also why in areas of considerable tension — the shoulder, the breastbone, the back — the result is less predictable and sometimes it is better not to operate.
Time is an ally and it is worth using. A scar goes through a red, firm phase during the first months and gradually lightens and softens up to a year or eighteen months. Revising it before then is operating on something that was still improving by itself. In the meantime, silicone, massage and above all strict sun protection make a real difference.
With tattoos, surgery is reserved for small ones or for those that can be excised in an area with enough skin: the tattoo is traded for a line. For extensive ones the treatment of choice is laser, which requires several spaced sessions and whose result depends greatly on the colour: blacks and blues respond well; greens, yellows and whites are the most resistant.
What the process is like
Most are dealt with in the consulting room, under local anaesthesia.
Assessment
The scar or tattoo, the tension of the area, the skin type and how long it has been there are studied. Whether to operate or wait is decided.
Plan
The technique is decided and whether more than one session will be needed. With tattoos, the number of laser sessions and what to expect are estimated.
The procedure
Usually under local anaesthesia in the consulting room. Extensive cases and those in children are done under sedation or general anaesthesia.
Aftercare
Silicone, massage and strict sun protection for months. This part is done by the patient and weighs as much as the surgery.
What to expect
The new scar goes through its own phases before it looks good.
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Days 1 to 10
Simple dressings and stitches out between the fifth and tenth day according to the area. Normal life almost immediately.
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Weeks 2 to 8
The new scar turns red and somewhat firm: that is normal and does not mean it has gone wrong. Silicone and massage begin.
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Months 3 to 6
It starts to lighten and soften. Strict sun protection, which is what stops it staying dark permanently.
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Months 12 to 18
Final result. This is the point at which to consider whether any complementary treatment is needed.
Risks, and what is not promised
Infection, bleeding, opening of the wound, a scar of worse quality than the original — possible, above all in areas of tension and in people with a hypertrophic tendency — widening over time, changes in skin colour and altered sensation in the area.
With tattoos treated by laser: changes in skin pigmentation, blistering, scarring if the energy is excessive or the aftercare insufficient, and an incomplete response. Light colours — green, yellow, white — may not respond, and some pigments darken after the first session before they fade.
It is not promised that the scar will disappear: every revision replaces one scar with another, and the goal is for the new one to be finer, better oriented and less visible. Nor is it promised that a tattoo will be removed one hundred per cent: what is usual is a very considerable fading with a residual shadow noticeable close up. These risks are reduced by waiting for maturation, closing without tension and being strict with sun protection. They are not eliminated. The ones that apply to your case are set down in writing in the informed consent.
The information on this page is for guidance and does not replace an in-person medical consultation. Medical practice is an obligation of means, not of result.
The questions we are asked most
No. Skin that has been cut always leaves a mark, and every revision replaces one scar with another.
What does change — and changes a great deal — is the quality: a reoriented, fine scar closed without tension can go from being the first thing you see to something you have to look for.
Generally at least twelve months. A recent scar is still maturing: it goes through a red, firm phase and lightens on its own up to a year or eighteen months.
Revising it earlier is usually operating on something that was going to improve by itself. In the meantime, silicone, massage and strict sun protection.
Rarely one hundred per cent. With laser a very considerable fading is achieved over several spaced sessions, almost always with a residual shadow visible close up.
Blacks and blues respond well; greens, yellows and whites are the most resistant. Small tattoos can be excised surgically, trading the design for a line.
Most are done under local anaesthesia in the consulting room and the discomfort afterwards is mild, manageable with ordinary painkillers.
Normal life resumes almost immediately, with stitches out between the fifth and tenth day according to the area and no exertion for the first two weeks.
Question not answered here? There are more answers in the frequently asked questions.
