Surgical Scar Removal

Why Expert Assessment Matters

Specialist dermatologist-directed assessment is important because we determine:

• Whether surgery is likely to improve the scar, or whether laser treatment alone may be better
• Whether the scar is hypertrophic, keloid, atrophic, widened, tethered, contracted, pigmented, or vascular
• Whether deeper structures, including muscle or contracture bands, are contributing
• Whether the scar is likely to recur without additional treatment
• Which devices and treatments should be combined with surgery
• Whether ACC funding may apply for traumatic, burn, surgical, or treatment-related scarring

Many scars require a staged approach. For example:

1. Surgical revision to improve the position or shape of the scar
2. Laser treatment to reduce redness and improve texture
3. Additional therapy to reduce thickness, tightness, or pigmentation
4. Ongoing scar management to minimise recurrence

This multidisciplinary approach is particularly important for difficult scars such as burn scars, Caesarean section scars, traumatic scars, acne scar excision sites, hypertrophic scars, and scars after cosmetic procedures.

‍

The Science Behind Surgical Scar Removal

Scar revision works by replacing an abnormal or poorly healed scar with a new wound that is designed to heal in a better way.

This may involve:

• Repositioning the scar so it lies within natural skin lines
• Removing widened or irregular scar tissue
• Breaking up tension across the scar
• Releasing tethering beneath the skin
• Rearranging the scar with techniques such as geometric closure, Z-plasty, W-plasty, or local flap reconstruction
• Improving function when a scar causes tightness or restricted movement

After surgery, the new scar is then guided to heal more favourably. This is where laser and energy-based treatments become important.

For red or vascular scars, we may use:

• VBeam Perfecta
• Excel V+

These treatments reduce persistent redness, abnormal blood vessels, and ongoing inflammation that can drive recurrent thickening.

For thick, raised, irregular, or contracted scars, we may use:

• UltraClear
• Alma Hybrid

These devices create controlled channels within the scar to soften dense collagen, improve texture, reduce thickness, and stimulate more organised collagen remodelling.

For scars with pigmentation or colour change, we may also use:

• PicoWay

For raised, thickened, or recurrent scars, laser-assisted drug delivery may be incorporated after fractional laser treatment. This allows medications such as corticosteroids or anti-metabolites to penetrate more effectively into the scar.

This is particularly useful for:

• Hypertrophic scars
• Early keloid scars
• Secondary thickening after surgery
• Burn scar contractures
• Recurrent scars after previous excision

‍

How Surgical Scar Removal May Be Combined With Laser Treatments

Wide or Stretched Scar

• Surgical excision and careful re-closure
• Followed by vascular laser if redness develops
• Fractional laser later if texture remains uneven

Raised or Thickened Scar

• Surgical reduction if appropriate
• Fractional laser combined with steroid or anti-metabolite delivery
• Ongoing prevention of recurrence

Tethered or Depressed Scar

• Surgical release beneath the scar
• Subcision or scar revision
• Fractional laser to improve surface texture

Burn Scar or Contracture Scar

• Surgical release where necessary
• Fractional ablative laser to soften and remodel
• Laser-assisted delivery of steroid or anti-metabolite medication to reduce recurrent thickening and improve flexibility

Red or Persistent Surgical Scar

• Vascular laser to reduce redness and inflammation
• Sometimes surgery is not required if colour is the main issue

‍

‍