Scar Revision

Not all scars are alike, and effective treatment depends on identifying the type of scar and how it developed. Common types include:

• Atrophic scars: These appear as small depressions or “pits” in the skin and are often caused by acne or chickenpox. They occur when tissue loss happens during healing, leaving the skin indented.
• Hypertrophic scars: Raised scars that remain within the boundary of the original wound. They may feel firm and appear red or pink but can flatten over time.
• Keloid scars: These grow beyond the edges of the original wound and may be thick, raised, and sometimes itchy. Keloids tend to continue growing and often require medical management to control.
• Contracture scars: These result when skin tightens as it heals, often following burns or large injuries. They can limit movement if they occur near joints.
• Surgical scars: Narrow, linear scars left from clean incisions or surgical wounds. When properly cared for, these often heal well with minimal visibility.

Understanding which type of scar is present helps guide the best treatment options for each patient.

The term “scar revision” describes one of several procedures intended to improve the appearance or quality of the scar. Depending on the scar characteristics, there are different approaches to achieve the desired aim. The goal is most commonly to make the scar less noticeable by blending it more naturally with surrounding skin, although in some cases where scars coincide with certain anatomical boundaries, the goal may be to move the scar entirely. Dr. Freedman’s approach aims to:

• Reduce raised or thickened tissue
• Smooth uneven skin texture
• Diminish redness or discoloration including hyperpigmentation
• Improve flexibility of the skin over the scar

Results vary depending on the size, location, and age of the scar, as well as individual healing responses.

Scar treatment begins with a thorough evaluation of the scar’s type, depth, and color. Based on this assessment, Dr. Freedman may recommend one or more of the following procedures:

• Laser therapy: Laser treatments resurface the skin and encourage new collagen growth. Ablative lasers (like CO₂ or Erbium lasers) remove damaged skin layers, while non-ablative lasers target the deeper layers to remodel collagen with minimal downtime.
• Microneedling or radiofrequency microneedling: These treatments use fine needles to create micro-injuries in the skin, stimulating collagen production. The addition of radiofrequency energy enhances tightening and texture improvement.
• Chemical peels: Chemical peels, such as those using trichloroacetic acid (TCA), exfoliate the upper layers of skin to improve shallow scars and uneven pigmentation.
• Dermabrasion and microdermabrasion: These methods gently sand away outer skin layers to smooth raised or uneven scars. Dermabrasion is more intensive and may be recommended for deeper scars.
• Corticosteroid injections: For raised or keloid scars, steroid injections help reduce inflammation and flatten thickened areas. Treatments are typically spaced several weeks apart for best results.
• Surgical scar revision: Some scars may require surgical correction. Dr. Freedman can remove thick or irregular scar tissue and close the skin precisely for a more refined appearance. Techniques such as Z-plasty or W-plasty can reorient the scar so it blends more naturally with surrounding skin lines.
• Silicone gels and sheets: These medical-grade topical treatments help hydrate and flatten scars. They are often used after other procedures to maintain results.

Many patients benefit from a combination of these approaches to achieve optimal results. Treatment plans are customized to balance effectiveness with minimal downtime.

Recovery time varies depending on the type of procedure.

Laser resurfacing and dermabrasion can cause temporary redness, swelling, and peeling for several days to a week. Microneedling and light chemical peels usually have shorter recovery periods, with mild redness lasting one to three days. After surgical scar revision, stitches are removed within one to two weeks, and the area gradually improves over several months.

Dr. Freedman provides detailed aftercare instructions for every patient. Keeping the area clean, moisturized, and protected from the sun is essential for proper healing. Sunscreen use is particularly important to prevent pigmentation changes. Results often continue to improve for months as collagen rebuilds and the skin remodels itself.

Scar treatment can lead to significant cosmetic improvement. Scars typically become flatter, softer, and more even in tone, making them far less noticeable. The extent of improvement depends on the scar’s age, depth, and location, as well as the patient’s skin type and adherence to post-treatment care.

While complete removal is rarely possible, most patients experience visible, lasting improvements that enhance overall skin appearance and self-confidence. Some cases require a series of treatments to achieve the best outcome, but results are long-term when proper care is maintained.