Scar Revision Surgery FAQs

Scar revision is one of the most commonly enquired-about plastic surgical procedures, and it generates a particular set of recurring questions: what realistic improvement can be expected, when is the right time to operate, how does the procedure actually work, and what happens to the new scar after the old one is removed. This FAQ answers the questions our consultants address most often at consultation.

For the underlying biology and the full menu of scar types, start with different types of scars and how they are treated. For the wider service overview, see scar revision surgery at Centre for Surgery’s CQC-regulated Baker Street private hospital.

What is a scar?

A scar is the body’s natural repair tissue. When an injury or surgical incision breaches the deeper dermal layer of the skin, the body responds by laying down collagen to bridge the gap. This replacement collagen is structurally different from the original skin — more disorganised, less elastic, often a different colour and texture. The scar is what remains visible at the surface.

Scar formation moves through three phases. Inflammation in the first week clears debris and recruits repair cells. Proliferation over weeks one to six lays down new collagen and the scar appears red, firm and raised. Remodelling over the following 12 to 18 months gradually reorganises the collagen and the scar matures into its final form — typically paler, flatter and softer than during the early phases. This timeline matters because it is the reason scar revision is usually deferred for at least 12 months after the original injury.

What are the different types of scars?

Every patient heals differently, and scars vary by location, depth, technique, skin type and several other factors. The main categories:

Fine-line scars — typical surgical scars that mature to a pale flat line
Hypertrophic scars — raised, firm scars that stay within the original wound boundary
Keloid scars — raised scars that extend beyond the original boundary into healthy skin
Atrophic scars — depressed scars sitting below the surrounding skin level (most acne scarring falls here)
Contracture scars — tight scars that pull surrounding tissue and can restrict movement, most common after burns
White (hypopigmented) scars — paler than surrounding skin from pigment cell loss
Stretch marks — dermal scarring from rapid skin stretching

Different scar types respond to different treatments, which is why the consultation begins with identifying which type of scar you actually have. For full discussion see different types of scars and do hypertrophic scars go away?

How long does scar healing take?

The skin surface closes within 1 to 2 weeks of an injury or surgical incision. Scar maturation, however, continues for 12 to 18 months. The appearance during the first few months is not the final appearance.

Typical maturation timeline:

Weeks 0–2 — wound healing; sutures still in place; scar is red, swollen, sometimes uncomfortable
Weeks 2–6 — wound closed; scar is pink-red, firm, may itch or feel tingly
Weeks 6–12 — peak redness and firmness; scar can look more prominent than it eventually will
Months 3–6 — scar starts fading and softening; redness gradually replaced by pink, then pale
Months 6–12 — significant fading; scar approaches its final mature appearance
Months 12–18 — scar reaches final mature appearance; further change after this point is slow

The implication: most scars look worst between weeks 6 and 12, and best between months 12 and 18. This is one reason scar revision is generally not performed until at least 12 months after the original injury.

Can a scar be harmful or just cosmetic?

Most scars are entirely benign and cosmetic — they cause no functional problem and serve simply as a visible reminder of the injury. Some, however, can cause genuine functional or symptomatic issues:

Itch or tenderness — common during the maturation phase, usually settles by 6–12 months
Restricted movement — particularly with scars crossing joints or contracture scars after burns
Recurrent ulceration or breakdown — in some chronic or poorly healed scars
Persistent pain — sometimes from nerve entrapment within the scar tissue
Numbness — often a normal feature of healing that improves over months
Cosmetic concern with psychological impact — a legitimate clinical indication for treatment

Scars causing functional problems benefit from earlier rather than later assessment. Cosmetic concern is also a legitimate reason to seek treatment, particularly when the scar is in a visible area or causing distress.

When is the right time for scar revision?

The standard guidance: wait at least 12 months from the original injury before considering surgical scar revision. The reasons:

Most scars improve substantially during natural maturation. Operating earlier risks revising a scar that would have settled adequately on its own.
Scar tissue continues to remodel during the maturation phase. Operating on immature tissue produces a less predictable result.
The patient’s response to scar maturation tells the surgeon something useful about how they will respond to a revised scar.

This guidance applies to surgical scar revision specifically. Non-surgical scar management — silicone, sun protection, gentle massage, selective intralesional steroid injection for problem scars — should start during the maturation window, ideally as soon as the wound has fully closed at around 2 weeks post-operation. Early non-surgical management is the most cost-effective intervention for influencing the final scar appearance.

For specific scar types the timing varies. Acne scarring is typically treated once active acne is controlled. Hypertrophic scars often improve naturally over 12–24 months and can be treated non-surgically during that period before considering revision. Keloids need active treatment rather than watchful waiting.

What does scar revision surgery actually involve?

Scar revision is performed by excising the existing scar and re-closing the area with optimised technique. The procedure varies in complexity from simple linear excision to more involved geometric rearrangements:

Simple excision and primary closure — the scar is cut out and the skin edges re-approximated with fine sutures along natural tension lines. Suitable for many narrow linear scars.
Z-plasty — a geometric rearrangement of the scar to break up a straight line, redirect tension, or lengthen a contracture. Useful for scars crossing skin tension lines or restricting movement.
W-plasty — converts a straight scar into a zigzag pattern that is harder for the eye to follow.
Punch excision — for small, deep, individual scars (such as ice-pick acne scars). The scar is removed with a circular blade and closed with one or two fine sutures.
Geometric broken-line closure — for longer facial scars, breaking the line into multiple irregular segments to reduce visibility.
Skin grafting or flap reconstruction — for very large scars where simple excision and closure would not be possible.
Tissue expansion — for very large scars where surrounding skin is gradually stretched over weeks to months to allow eventual excision and primary closure.

Most scar revisions at Centre for Surgery are performed under local anaesthetic as day-case procedures. More complex cases — multiple scars, large areas, contracture release with skin grafting — may need TIVA (total intravenous anaesthesia) or general anaesthesia.

What about non-surgical scar improvement?

Many scars improve substantially with non-surgical treatment alone, without surgical revision. This is generally the first-line approach because it carries less risk and lower cost. Options include:

Silicone gel or sheeting — the strongest evidence for topical scar treatment. Applied daily for several months once the wound is fully closed. See do silicone strips help scars heal better?
Intralesional steroid injection — for hypertrophic and keloid scars. Given as a course every 4–6 weeks.
Laser skin resurfacing — erbium and CO2 fractional laser for texture improvement and redness reduction.
Morpheus8 radiofrequency microneedling — for atrophic scars, stretch marks, and broader textural concerns. See does Morpheus8 help treat acne scars?
Chemical peels — TCA CROSS for individual ice-pick acne scars; broader peels for surface texture.
Dermal fillers — for selected depressed scars.
Fat transfer — for atrophic scars with significant volume loss.

Many patients benefit from combining several modalities. The treatment plan is tailored to the scar type, location, skin type, and the patient’s goals.

Do some patients scar more than others?

Yes. Several factors influence how prominently a patient scars:

Skin type — patients with darker skin types (Fitzpatrick IV–VI) have higher rates of hypertrophic and keloid scarring and a higher rate of post-inflammatory pigmentation changes
Family history — keloid tendency runs in families
Age — younger patients tend to produce more vigorous healing responses, sometimes including hypertrophic scarring; older skin heals more slowly but often more cleanly
Anatomical location — chest, shoulders, upper back, deltoid, jawline and earlobes are higher-risk areas
Wound tension — high-tension closures heal less cleanly than low-tension ones
Infection — any post-operative infection worsens scarring
Smoking — measurably impairs wound healing
General health and nutrition — supports tissue repair

Knowing your individual risk profile lets your surgeon plan technique and post-operative scar management accordingly.

Are scars permanent?

Yes, in the strictest sense. Once the deeper layer of skin has been damaged and repaired with replacement collagen, that structural change is permanent. What treatment can achieve is significantly reducing the scar’s visibility, sometimes to the point where it is hard to find without close inspection.

This is why realistic expectations matter. A patient who arrives expecting “the scar will be completely gone” is likely to be disappointed even with an excellent result. A patient who arrives expecting “the scar will be much less noticeable” is likely to be delighted with the same outcome. Good consultation includes a frank discussion about what is realistically achievable for the specific scar in question.

What about recovery from scar revision?

Recovery depends on the technique used. For simple linear excision and re-closure:

Days 0–2 — local discomfort, mild swelling. Pain controlled with paracetamol.
Days 3–7 — discomfort fading. Keep the wound dry. Standard wound care.
Days 7–14 — sutures removed. Light activity resumes.
Weeks 2–6 — silicone scar treatment can begin once the wound is fully closed. Avoid strenuous activity that stretches the wound.
Months 2–12 — scar gradually matures. Diligent sun protection essential.
Months 12+ — final mature scar appearance established.

More complex revisions — tissue expansion, contracture release, skin grafting — have longer recovery profiles that are discussed individually at consultation.

What we don’t recommend

Surgical revision of an immature scar — operating on a scar that is still red and firm in the first 6 months risks revising tissue that would have matured into an acceptable scar without intervention.
Setting expectations of complete scar removal — scars cannot be erased. Significant improvement is realistic; invisibility is not.
Skipping non-surgical management first — for most scars, silicone gel, sun protection, and scar massage materially improve the result before surgical revision is considered.
Excising a keloid without combined treatment — keloid surgery alone has high recurrence. Surgical revision must be combined with post-operative steroid injection or radiotherapy to prevent the keloid returning.
Operating in active skin disease — eczema, active acne or other inflammatory conditions in the area should be settled before scar revision.
Smoking around scar revision surgery — wound healing is meaningfully impaired by smoking. Stopping for at least 2 weeks before and 4 weeks after is one of the highest-yield interventions available.
DIY scar revision — needs no explanation. Scars are easier to make worse than to make better.

Frequently asked questions

Will the new scar be invisible?

No — there will be a new scar in place of the old one. The aim is for the new scar to be much less noticeable than the original. The outcome depends on the technique used, the patient’s skin type, and how the new scar is managed during its 12–18 month maturation.

How much does scar revision cost?

Costs vary by complexity. Simple local anaesthetic revision starts from around £1,500–2,500. More complex cases involving tissue expansion, multiple stages, or general anaesthesia are priced accordingly. Finance from 0% APR is available. For full discussion see how much does laser scar removal cost in the UK?

Will the NHS cover scar revision?

NHS funding for scar revision is restricted. Cases with functional impairment (restricted movement, recurrent ulceration, contracture) may qualify; cosmetic revision usually doesn’t. Most patients seeking scar revision proceed privately.

How long does the procedure take?

Simple linear revisions take 30–60 minutes under local anaesthetic. More complex techniques (Z-plasty, multiple-stage closure, tissue expansion) take longer. The consultation establishes the right approach and the expected procedure duration.

Will I need time off work?

For simple linear revision under local anaesthetic, most patients return to non-physical work within 1–2 days. Heavy physical work or work involving the wound area should be avoided for 2 weeks. More complex revisions may need longer.

Can I have multiple scars treated in one session?

Often yes — multiple small scars can be addressed in a single appointment. We assess this at consultation based on the number, size, and locations.

Will the scar revision hurt?

The local anaesthetic injection produces a brief sting. The procedure itself is painless. Mild soreness for 1–2 days afterwards is normal and managed with paracetamol.

Can older scars (10+ years) be revised?

Yes — there is no upper limit on how old a scar can be before revision. The technique and realistic expectations are discussed at consultation.

What if my revised scar doesn’t heal well?

For most patients it will. For those at higher risk of problematic healing — keloid history, darker skin types, high-tension areas — the post-operative scar management is intensified, sometimes with adjunctive steroid injection or laser treatment, to optimise the result.

Can scar revision be combined with other procedures?

Yes — scar revision is often combined with adjacent procedures such as facelift surgery, abdominoplasty (which itself produces a scar that benefits from optimised technique), or other plastic surgical procedures.

Scar revision at Centre for Surgery

Centre for Surgery is a CQC-regulated plastic surgery clinic at 95–97 Baker Street, Marylebone. All scar revision procedures are performed by GMC-registered consultant plastic surgeons. We offer the full range of surgical and non-surgical scar treatments, calibrated to your specific scar type and skin. No GP referral is required.

Centre for Surgery · CQC-regulated · GMC specialist-registered surgeons · 95–97 Baker Street, Marylebone, London W1U 6RN · 0207 993 4849 · Book a consultation · Finance from 0% APR