Scar Removal Surgery: What You Need to Know

A key factor to consider before scar removal surgery is the age of the scar.

Due to continuous collagen remodeling, it can take a year or more for a scar to mature, so “generally, you don’t rush in to do anything,” says Dr. Ostad.

Immature scars are prone to becoming thick and raised, and they often give poor results after scar revision surgery. “There’s a timeline for the wound healing process, and if you intervene early, when your collagen is turned on, you may aggravate the situation and potentially cause the collagen layer to produce too much collagen,” says Dr. Ostad.

Other factors to be considered are your:

• Expectations. Surgery can improve but not erase a scar. The process also requires patience. “Scar tissue requires a year or more to fully heal and achieve maximum improved appearance,” says Dr. Ostad. 
• Medical history. Conditions like diabetes and immunosuppression may negatively affect wound healing.
• Smoking status. Tobacco use can complicate or delay healing. Abstaining from smoking from four weeks before to four weeks after surgery can improve scar quality.

Pros

• Scar removal surgery helps make scars less noticeable, which may help boost your confidence or even put a traumatic event behind you.
• An excision procedure usually takes around an hour. 
• It can be performed anywhere on the body.
• There’s little to no downtime. Depending on the size and location of your scar and physical demands of your job, you may be able to return to work the next day.
• The improvement is permanent.

Cons

• Most scars cannot be fully erased. In some cases, it may not even be improved. One study that evaluated the satisfaction rate of scar revision surgery two years after the procedure found that while 82% of patients were satisfied, 16% saw no change, and 2% felt their scar was worse.
• Some scars, like keloids, typically need a combination of treatments to be improved or prevent them from returning. It may even take more than one surgery to get the results you’re after. 
• You’ll usually be advised to wait for scars to mature before having scar removal surgery. “You can’t apply a cookbook approach, but generally, if a scar is bothering you from a cosmetic standpoint give it at least six months,” says Dr. Ostad. “If it’s causing functional issues, I’d still wait for a couple of months to let things settle down.” 
• New, immature scars need to be diligently protected during the healing process. For instance, UV exposure can trigger hyperpigmentation, making the scar more prominent.

• Average Cost:
• $1,775

• Range:
• $500 - $9,000

Your scar removal surgery cost will depend on:

• your surgeon's credentials and level of expertise
• their practice location
• the type of anesthesia you need and who administers it
• the details of your procedure, such as whether you need a skin graft or a combination of treatments

During your initial consultation, your provider should recommend the best treatment plan for your situation and budget. This is the perfect time to request a detailed price quote that includes their surgeon's fee, the facility fee, anesthesia, and follow-up visits. Also ask about the cost of any recovery supplies you'll need.

Most insurance plans won't cover scar removal surgery if they consider it an elective cosmetic procedure. However, if you're having it for functional reasons—for instance, the scar is on your nose and affects your breathing, or it’s on your finger and prevents it from moving correctly—your provider may be able to help you get insurance coverage. Ask your insurance provider for details about what kind of documentation your policy requires for approval.

The scar removal surgery photos in our gallery have been shared by the provider who performed the procedure, with the patient's consent.

A scar excision procedure is typically performed in the office under local anesthesia, so you won’t feel anything. “If the scar is, say, next to the eye and the patient is very scared or anxious, I’ll give them IV sedation,” says Dr. Ostad. In situations where the scar covers a large area of skin, your surgeon may recommend general anesthesia.

Your surgeon’s technique will also depend on the type of scar that’s being removed. 

In many cases, a linear section of scar tissue is excised, and the surrounding skin is neatly sutured closed.

Another common scar revision technique, Z-plasty, can change the direction of a scar. The old scar is removed, and incisions are made on the side of the wound to create flaps, which are then rearranged to create a “Z” pattern. “By converting a scar into a zigzag line—or, in the case of a W-plasty, continuous Ws—you create irregular lines that make the scar less visible,” explains Dr. Ostad.

These incisional patterns also reposition the scar so it becomes parallel to “relaxed skin tension lines,” the natural direction of the collagen fibers in the skin. “When placed in that vector, scars generally heal much nicer,” says Dr. Ostad. This technique also improves flexibility.

Once the scar is revised, the surgeon typically performs a layered closure by placing sutures both down in the dermis and in the more superficial tissue. This helps relieve tension on the incision and prevent the scar from widening. 

In a part of the body that moves a lot (like the shoulder or the back), your surgeon may also tape the incision to help support it. “This can reduce micromotions of the tissues, so the incision can heal earlier,” says Dr. Daniel Barrett, a plastic surgeon in Beverly Hills, California. 

RealSelf Tip: To improve the healing of your new scar, stop herbal supplements and medication that can increase bleeding for at least 3 days before your scar removal surgery.

Most people return to work the following day, without the need for pain medication. “As a general rule, because you’re not usually going into muscle or nerves, there’s minimal discomfort,” says Dr. Ostad.

Your provider will give you specific aftercare instructions that should be followed to the letter. Patients who are diligent about their skin care after surgery usually have the best results. You’ll likely be advised to:

• Keep the wound clean. Infection can lead to poor scarring.
• Keep it covered with ointment and a surgical dressing. “I see great results in keeping the area covered for one full week, followed by a twice-daily application of Aquaphor,” says Dr. Ostad. “I’ve tried other ointments and scar sheetings and still find Aquaphor to be superior.”
• Refrain from exercise—especially any activity that places undue stress on the area of the incision—for at least one week, to avoid popping your stitches and widening the scar. Physical activity can also raise your blood pressure, which can increase bleeding and compromise healing.
• Protect the scar from sun exposure to help prevent discoloration and pigmentation. 
• Follow up with your surgeon as scheduled, so they can evaluate healing and remove your stitches before the top layer of skin heals over them. When left in too long, stitches can cause marks that resemble train tracks to form. The result “railroad scar” may necessitate another scar removal surgery. How long stitches are left in will vary; according to doctors on RealSelf, facial stitches are typically removed after five to seven days. In areas prone to stretching and increased movement, sutures may be left in longer and Steri-Strips may be used to protect the wound.

The scar should look better as soon as the stitches come out, about a week after surgery, but it may take a year or more for the new scar to flatten and fade, to match the surrounding skin.

Different parts of the body heal differently, so full recovery times will vary. For instance, surgery to repair a scar on your leg may take two weeks to heal, while a facial procedure may take a week or less. 

How quickly a revised scar heals can vary as well, depending on where it’s located. “If you do surgery in an area from the heart up, there’s better blood supply, so scars tend to do better,” says Dr. Ostad. “From the waist down, the blood supply isn’t as good because it’s farther away from the heart, so there’s more risk of the scar not healing as well.”