Tailbone Scar Revision – Best Approach for a Stretched Scar?

Question

I had a cyst removed from my tailbone area about 3 years ago. The excision was quite aggressive, and my stitches were removed very early. The scar subsequently stretched and widened over time. Given that this is a high-tension area, what would be the best approach for scar revision? How can the risk of the scar stretching again be minimized after revision? Lasers do not work unfortunately.

Nelson Lee Novick, MD · Answer

At least from the photos provided, a portion of the scar appears elevated. If this is so, intralesional injections of anti-inflammatory agents, such as triamcinolone, can be used to flatten the scar. Once this is done, if the scar is hypopigmented, it may be treated by, professionally performed, manual microneedling (no need for the added expense or risks for adverse reactions from RF microneedling) can be performed accompanied by the topical application of Rx pigment enhancing agents, such tyrosine or latanoprost, to better blend the scar area in both color and texture with the surrounding normal skin. You would be wise to consult with a board certified cosmetic dermatologist scar treatment expert and best of luck.

Anna Chacon, MD, FAAD · Answer

You're asking an important question, and you've already identified one of the biggest challenges: the tailbone (sacrococcygeal) area is a high-tension location, which makes scars there more likely to widen over time.

From your description, it sounds like your scar healed but gradually stretched after the stitches were removed. That doesn't necessarily mean anything was done "wrong" it's a well-recognized issue in this part of the body because the skin is constantly under tension from sitting, bending, walking, and other daily movements.

If you're considering scar revision, surgical excision of the old scar followed by meticulous closure is generally the most effective approach for a widened scar. The success of the revision often depends as much on the closure and aftercare as it does on removing the old scar.

To reduce the chance of the scar stretching again, surgeons may use deep, layered sutures to take tension off the skin, rather than relying only on the surface stitches. In many cases, leaving the deeper support in place while allowing the tissues to heal can make a significant difference.

After surgery, minimizing tension on the incision is also important. Depending on the situation, this may include limiting activities that put excessive stress on the area during the early healing period, using silicone gel or silicone sheeting once the incision has healed, and, in some cases, taping the scar for several weeks to help reduce tension across the healing skin.

Since you've already found that laser treatments haven't helped, that's not surprising. Lasers can improve redness and texture in some scars, but they generally cannot correct a scar that has widened because of mechanical tension. Once a scar has stretched, surgical revision is often the more effective option if the goal is to make it narrower.

It's also worth remembering that even with excellent surgical technique, no revision can guarantee that a scar won't widen again, particularly in an area that experiences constant movement and pressure. The goal is to improve the scar's appearance and reduce the likelihood of recurrence, not to eliminate the scar completely.

Overall, for a mature, widened scar in the tailbone region, a thoughtful surgical revision with careful tension management before, during, and after healing offers the best chance of achieving a thinner, less noticeable scar.

Yasemin Aydinli, MD · Answer

You've identified the exact problem: high tension plus early suture removal caused the stretch, so revision success depends entirely on tension control. The best approach is excision of the widened scar with layered closure &mdash; strong, long-lasting absorbable sutures in the deep dermis carrying the load, not the skin sutures. To prevent re-stretching: keep deep support sutures in place for months (they do the work invisibly), tape or silicone sheeting for 3–6 months, avoid prolonged sitting pressure and stretching activities early on, and consider prophylactic botulinum toxin or scar-unloading techniques in select cases. Done this way, revision in this area has a good success rate despite the tension. That said, even with meticulous technique, some risk of gradual widening over time still remains, and individual skin quality also plays an important role in the final result.

Tailbone Scar Revision – Best Approach for a Stretched Scar?

Answers (3)

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