How can I improve these scars? Excision or scar revision?

Question

Original plastic surgeon offered to locally excise the small overlapping portion in from of the ear and thinks the rest looked fine. Would also revise scar behind ear. Second opinion doctor wants to do a full scar redo with sedation and because I fully regret this surgery, I really don’t want to do this. I just want my scars to look better. I have a 3rd opinion on Monday. Any thoughts?

Nelson Lee Novick, MD · Answer

At least from the photos provided, it would appear that the elevated portions of the scars can be flattened via the use of intralesional injections of anti-inflammatory agents, such as triamcinolone in varying concentrations and amounts that fit the individual scar being treated. Sometimes, more resistant elevations can, the elevation can be removed by Scalpel Sculpting and then subsequently treated to ensure complete flattening and reducing the chances for recurrences. Since scar tissue is typically either off-white or ivory in color, you may consider the use of manual microneedling (no need for the added expense and the risks for adverse reactions from RF Microneedling) plus Rx pigment enhancing topicals, such as tyrosine and latanoprost, to better blend the now flattened scar in both 
More aggressive approaches, such as surgical revision, run the risk for the subsequent development of stretch scars and even stitch tracks. So, I certainly appreciate your hesitancy in going this route. 
You would be wise to consult with a board certified cosmetic dermatologist scar treatment expert and best of luck.

Anna Chacon, MD, FAAD · Answer

Thank you for sharing your photos and your concerns so openly. Regret after surgery—especially when it involves visible scars—is more common than people admit, and your hesitation about undergoing another major procedure is completely understandable.

Looking at the area you’ve highlighted, what stands out is localized scar irregularity and overlap, particularly in front of the ear, rather than a globally poor scar everywhere. This distinction is important.

Here are some honest, anatomy-based thoughts:

1) A full scar “redo” is not automatically better
A complete scar revision under sedation involves reopening the entire incision, creating a new wound with its own healing risks. There is no guarantee the new scar will heal better—and sometimes it heals similarly or worse, especially if your skin already tends to scar visibly. Given your regret and reluctance, it’s reasonable to be cautious here.

2) Localized excision can be very appropriate in cases like this
When the main issue is a small overlapping segment, step-off, or puckering, a targeted local excision of that specific area can meaningfully improve how the scar blends without disturbing the rest of it. This approach is often done under local anesthesia and is much less physically and emotionally taxing.

3) Scars often look worse to the patient than they do medically
From a surgical standpoint, the majority of the scar appears acceptable, with the problem areas being focal rather than diffuse. Improving those focal issues can significantly improve how the scar reads overall, even if it’s not “perfect.”

4) Non-surgical scar optimization still matters
Before committing to another major surgery, options such as:

silicone gel or sheets

steroid injections (if thickened or raised)

laser scar treatments (vascular or resurfacing)

can further soften color, texture, and visibility over time. These don’t erase scars, but they often make a meaningful difference.

5) Your instinct to seek a third opinion is wise
When opinions vary this much—from minimal revision to full redo—it usually means the decision is preference-sensitive, not mandatory. That’s exactly the kind of situation where taking your time is appropriate.

Bottom line:
Based on what you’ve shared, a conservative, localized excision of the problematic overlapping area—with optional revision behind the ear—sounds reasonable and proportionate to your goals. A full scar redo is not the only path to improvement and may be more than what’s truly needed.

Wanting your scars to look better, not perfect, is a very healthy and realistic goal. Trust that instinct—it often leads to the best outcomes.

How can I improve these scars? Excision or scar revision?

Answers (2)

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