Scars are the one part of a surgery - or an accident, a burn, a bout of acne - that keeps telling a story long after the original event is over. Most scars fade on their own over twelve to eighteen months. Some don't. They stay raised, or sunken, or tight, or a different color than the surrounding skin, and they sit there as a daily reminder of something the person would rather not think about every time they look in the mirror.
Dr. Hardik Doshi, a double board-certified facial plastic surgeon based on Long Island, sees this exact problem constantly - not because his own surgical patients are scarring poorly (meticulous incision placement and closure technique are a core part of any well-run facial plastic surgery practice), but because scar revision is one of the most requested "second opinion" procedures in facial plastic surgery. Patients arrive after a prior surgery, an old injury, a bad case of cystic acne, or a childhood accident, and they want to know one thing: can this actually be made better?
The honest answer is almost always yes - but "better" means something different depending on the type of scar, its age, its location, and why it looks the way it does. This guide walks through exactly what scar revision is, which techniques apply to which scar types, what recovery looks like, and how to figure out if you're actually a candidate.
What Scar Revision Actually Means
Scar revision is not scar removal. No technique - surgical, laser, or injectable - can erase a scar completely, because a scar is, by definition, a different kind of tissue than the skin around it. What scar revision does is make a scar less visible: flatter, narrower, better color-matched, less puckered, and positioned so it follows the natural lines and shadows of the face or body rather than cutting across them.
There are three broad categories of scar revision, and most treatment plans combine more than one:
Surgical revision - cutting out the old scar and closing the wound with a more refined technique, often reorienting the scar line along a natural skin crease (a technique sometimes called a Z-plasty or W-plasty depending on the shape needed).
Non-surgical/energy-based revision - lasers, microneedling with radiofrequency, and dermabrasion that resurface the skin's texture and stimulate collagen remodeling without cutting.
Injectable revision - steroid injections to flatten raised or thickened scars, filler to lift depressed or tethered scars, and in some cases fat grafting to restore lost volume underneath a scarred area.
The right combination depends entirely on what kind of scar you're dealing with.
The Five Types of Scars, and Why They Need Different Approaches
1. Hypertrophic Scars
These are raised, thick, often red or pink scars that stay within the boundary of the original wound. They're common after surgery, cesarean sections, or any injury where the skin was under tension while healing. Hypertrophic scars often respond well to a combination of steroid injections (to flatten the raised tissue) and laser treatment (to fade the redness), sometimes without any surgery at all.
2. Keloid Scars
Keloids look similar to hypertrophic scars but behave very differently - they grow beyond the original wound boundary and can keep expanding for years. Keloids are more common in patients with darker skin tones and often run in families. They are notoriously difficult to treat because surgically cutting one out can trigger the formation of an even larger keloid at the new incision site. The most effective approach usually combines surgical excision with immediate post-operative steroid injections, pressure therapy, or radiation in select cases, under close monitoring.
3. Atrophic (Depressed) Scars
These sit below the surrounding skin level - classic examples are acne scars and chickenpox scars. Because the problem is a loss of tissue rather than an excess of it, treatment focuses on rebuilding volume: fillers, fat transfer, or subcision (a technique that releases the fibrous bands tethering the scar down) combined with microneedling or laser resurfacing to smooth the surface texture.
4. Contracture Scars
Contracture scars form when a scar tightens and pulls on the surrounding tissue, sometimes restricting movement - most often seen after burns or deep lacerations. These almost always require surgical release, sometimes with a skin graft or local tissue flap to replace the missing skin and restore normal mobility.
5. Widened or Stretched Scars
These start as a normal, thin surgical scar but stretch out over months as the skin heals under tension - common on the chest, shoulders, and abdomen, and sometimes seen on facial scars that cross high-tension areas like the jawline or forehead. Surgical revision that removes the widened tissue and closes it with a layered, tension-relieving technique is typically the most effective fix.
What About "Scar Removal Surgery"? Setting Expectations Correctly
A lot of patients search for "scar removal surgery" expecting a procedure that erases the mark entirely. It's worth being direct about this: no legitimate surgeon can promise complete removal of a scar, because any incision - including the one made during a revision - will itself heal into a new scar. The goal of scar revision surgery is always to trade a bad scar for a better one: less visible, better positioned, better matched in color and texture to the surrounding skin.
Patients who understand this going in tend to be by far the most satisfied with their results, because their expectations match what surgery can realistically deliver.
Facial Scar Revision: Why the Face Requires a Different Skill Set
Scars on the face are held to a different standard than scars almost anywhere else on the body, for one simple reason: the face is the part of the body other people look at directly, up close, in good lighting, during conversation. A scar that would be entirely unnoticeable on a shoulder or a knee can be the first thing someone notices on a cheek or a chin.
This is where facial plastic surgery training matters. A facial plastic surgeon thinks about scar placement in terms of the face's natural "relaxed skin tension lines" - the creases and shadow lines that form the face's natural topography. A scar placed along or parallel to these lines tends to heal thinner and less visible than one that crosses them at an angle, because the tension pulling on the wound while it heals is lower.
Dr. Doshi's dual board certification in facial plastic surgery covers exactly this kind of tissue-specific expertise - understanding how skin of different thicknesses, in different facial zones, with different blood supply, heals and scars differently. A scar revision on the nose, where skin is thin and tightly adherent to underlying cartilage, requires a very different technique than a revision on the neck, where skin is thicker and more mobile.
Common Scars We See for Revision on Long Island
Post-surgical facial scars - from a rhinoplasty, facelift, blepharoplasty, or other procedure performed elsewhere that healed with visible thickening, widening, or poor placement.
Acne scarring - box-car, rolling, and ice-pick scars from moderate-to-severe cystic acne, usually treated with a combination of subcision, microneedling with radiofrequency (Potenza and similar platforms), and sometimes fractional laser resurfacing.
Trauma and laceration scars - from childhood accidents, sports injuries, or cuts that healed without careful wound closure at the time.
Cleft lip and other congenital scars - often revised in the teenage or adult years to further refine the result from an earlier childhood repair.
Ear and earlobe scars - including gauge-stretched earlobes, torn piercings, and keloids from ear piercing, which is a frequent, specific request (see our earlobe repair guide for more on this).
Chin, cheek, and jawline scars - from prior dimpleplasty, buccal fat removal, or other cosmetic procedures that didn't heal as planned.
How a Scar Revision Consultation Actually Works
The single most important part of scar revision is diagnosis - figuring out why a scar looks the way it does before deciding how to fix it. A scar that's raised because of tension needs a different plan than one that's raised because of a keloid tendency, and both need a different plan than one that's simply widened from stretching.
At a consultation with Dr. Doshi, this typically involves:
- A close visual and tactile examination of the scar - its color, texture, height or depth relative to the surrounding skin, how it moves, and whether it's still actively changing (scars can take up to 18 months to fully mature, and revising too early can sometimes work against you).
- A conversation about the scar's history - how it formed, how it was originally closed, how it healed, and whether you've had any previous revision attempts.
- Photography under consistent lighting, which is used both for planning and for tracking results over time.
- A discussion of realistic outcomes specific to that scar's type, location, and your own skin's healing tendencies (skin type, history of keloids, sun exposure habits, and smoking status all affect how a new scar will heal).
- A staged treatment plan, since many scars - especially acne scarring and older post-surgical scars - respond best to a sequence of treatments spaced weeks or months apart, rather than a single procedure.
Non-Surgical Options: When You Don't Need to Go Under the Knife
Not every scar needs surgery. In fact, many scars - particularly hypertrophic scars, early post-surgical scars, and mild-to-moderate acne scarring - respond very well to non-surgical treatment:
Steroid injections flatten raised, thickened scar tissue by slowing down the overactive collagen production that causes the scar to bulge.
Fractional laser resurfacing creates controlled micro-injuries in the skin that trigger new collagen formation, smoothing texture and fading discoloration over a series of treatments.
Radiofrequency microneedling (a technology we also use for general skin rejuvenation) combines the mechanical benefit of microneedling with heat delivered directly into the deeper layers of skin, which is particularly effective for acne scarring and stretched or thinned scar tissue.
Dermabrasion mechanically smooths the surface of a scar, which can be effective for scars with an uneven or "shiny" surface texture.
Fillers and fat transfer address depressed scars by restoring the volume the scar tissue is missing, physically lifting the depression level with the surrounding skin.
Surgical Scar Revision: What the Procedure Involves
For scars that are too wide, too depressed, poorly oriented, or contracted, surgery remains the most effective option. The general steps look like this:
- Excision of the existing scar tissue, removing the poorly healed skin down to healthy tissue on either side.
- Reorientation, when needed, using techniques like Z-plasty or W-plasty to break up a straight scar line into a zig-zag pattern that better follows the skin's natural tension lines and is harder for the eye to track.
- Layered closure, closing the deeper tissue layers first to relieve tension on the skin surface - this is one of the biggest factors in whether a new scar stays thin or widens over time.
- Meticulous skin closure, often with very fine sutures placed close together, particularly on the face, where suture spacing directly affects the final scar width.
Most facial scar revisions are performed under local anesthesia or light sedation and take between 30 minutes and two hours, depending on the scar's size and complexity.
Recovery After Scar Revision
Recovery timelines vary by technique, but a general pattern for surgical facial scar revision looks like this:
- Days 1–3: Mild swelling and bruising around the incision; sutures typically remain in place.
- Days 5–10: Sutures removed (for facial revisions); the new scar looks pink and slightly raised - this is completely normal at this stage.
- Weeks 2–6: The scar continues to settle; most patients can resume normal activity and light exercise within this window.
- Months 2–6: The scar goes through its "remodeling" phase, gradually fading in color and flattening in texture.
- Months 6–18: Final scar maturation. This is the point at which the true, long-term result becomes visible - which is also why we generally recommend waiting at least a year before considering a second revision.
Sun protection is critical during the entire healing period. A new scar exposed to UV light can darken permanently, which is one of the most common - and most avoidable - reasons a scar revision underperforms.
Who Is (and Isn't) a Good Candidate
Good candidates for scar revision typically have:
- A scar that has fully matured (generally 12+ months old, unless it's causing functional problems like restricted movement)
- Realistic expectations about improvement rather than removal
- No active skin infection or inflammation at the scar site
- A willingness to follow post-procedure sun protection and wound care instructions closely
Patients with a strong personal or family history of keloid scarring need a more cautious, staged approach and should discuss this openly during consultation, since it changes both technique selection and expected outcome.
Ready to Talk About Your Scar?
Every scar has its own history, and the right treatment plan depends on understanding that history first. If you have a scar - from surgery, an injury, or acne - that's bothered you for a while, a consultation with Dr. Doshi is the right next step to find out what's realistically possible.
Schedule a consultation or learn more about Dr. Doshi's credentials and approach before your visit. If your scar is related to a previous procedure such as rhinoplasty, dimpleplasty, or buccal fat removal, you may also want to review those pages for procedure-specific scarring information.
