Assessing Your Scar
Every scar is assessed individually — its type (hypertrophic, atrophic, contracted, or simply wide and stretched), its site, its age, and the symptoms it causes (tightness, itching, pain, or purely appearance). This assessment determines which point on the treatment ladder below is the right starting place, and whether a single treatment or a combination is likely to help most.
Managing a Scar: Conservative, Non-Surgical & Surgical
Scar management follows a ladder, and multiple adjuncts can be combined to flatten, soften and improve the symptoms of a scar — surgery is often not the first or only step.
Conservative Management
- Time — many scars continue to soften and fade for 12–18 months after injury or surgery
- Silicone gel or sheeting — good evidence for improving scar appearance, particularly for hypertrophic scarring
- Scar massage, once fully healed
- Sun protection — reduces long-term pigmentation of a healing scar
Non-Surgical Adjuncts
- Steroid injections — reduce thickness, redness and itch in raised scars
- 5-Fluorouracil (5-FU) injections — often combined with steroid for scars that are resistant to steroid alone
- Laser treatment — vascular lasers for redness, fractional lasers for texture
- Microneedling — stimulates collagen remodelling to improve texture, particularly for atrophic scarring
- Dermabrasion — mechanical abrasion of a raised or irregular scar surface, typically from around 6–8 weeks
- Fat grafting — autologous fat can soften and improve the quality of adherent or depressed scars by restoring volume and gliding beneath the skin
Surgical Revision
- Direct excision and closure — the scar is excised and the wound closed precisely in layers with fine sutures; suitable for most simple, wide or stretched scars
- Z-plasty — geometric rearrangement of scar tissue that changes its direction, lengthens a tight contracture, and breaks a long, straight scar into shorter, less conspicuous segments
- W-plasty — interrupts the regularity of a long scar to make it less noticeable, particularly on the face
Facial Scars: Placement & Concealment
On the face, where a scar sits matters as much as how it is closed. Where a scar crosses a natural crease or relaxed skin tension line at an unfavourable angle, moving or reorienting it — often using Z-plasty or W-plasty — so that it instead falls along or within a natural line, fold or hairline can substantially improve how visible it is, without changing the underlying tissue that was repaired. This principle of relocating or reorienting a scar into a hidden or camouflaged position is central to good facial scar revision.
Keloid & Hypertrophic Scars
Keloid and hypertrophic scars are managed somewhat differently, with a greater emphasis on preventing recurrence. See Keloid & Hypertrophic Scarring for a dedicated guide to these scar types.
Aftercare & Recovery
- Shower after 48 hours
- Face sutures removed at 5–7 days; body at 10–14 days
- Silicone tape or sheet from 2–4 weeks post-healing; continue for 3–6 months
- Massage protocol commenced once healed
- Return to work: 1 week (face); 1–2 weeks (body)
- Sun protection: mandatory for 6–12 months; SPF50+