Scars are a natural part of the skin’s healing process after an injury, surgery, or trauma. In some cases, however, scars may become too visible, uncomfortable, or cause functional limitations.
Surgical scar revision aims to improve the appearance and, when necessary, the function of a scar using specialised reconstructive techniques.
Depending on the situation, the surgeon may reposition, reorient, or reshape the scar tissue to achieve a result that is more discreet, better integrated into the surrounding skin, and less restrictive in daily life.
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Clinical indications for surgical scar revision
Surgical scar revision may be considered in several situations:
Poorly oriented scars
Scars that run perpendicular to the natural skin tension lines (relaxed skin tension lines – RSTL) are often more visible. Surgical reorientation can help make them less noticeable.
Wide scars
In clinical practice, certain wide scars (for example, several millimetres in width) may benefit from revision, depending on their location and the surgeon’s assessment.
Contracted scars
Scars that pull on the surrounding skin or limit movement of a nearby joint may require surgical release.
Raised or depressed scars
Contour irregularities that cause aesthetic or functional discomfort can be surgically corrected.
Scars distorting anatomical structures
Scars affecting the eyelids, lips, or nostrils may lead to functional problems that justify surgical treatment.
In most cases, scar revision is considered after the scar has fully matured, usually 6 to 12 months after the initial injury. More complex cases may require a longer waiting period, sometimes up to 18 months.
Surgical techniques for scar revision
Z-plasty: reorientation and scar lengthening
Z-plasty is one of the most commonly used techniques in scar revision. It involves creating small triangular skin flaps that are repositioned to change the orientation of the scar and reduce tension.
Principle
The scar forms the central limb, with two lateral limbs created at specific angles. The chosen angle determines the degree of lengthening achieved.
Benefits
- Releases contracted scars
- Reorients the scar along natural skin lines
- Breaks up linear scars, improving camouflage
- Preserves surrounding tissue as much as possible
This technique is particularly useful on the face, especially on the forehead and in the nasolabial region.
W-plasty: controlled irregularisation of the scar line
W-plasty transforms a straight scar into a broken zigzag line, allowing it to blend more naturally with the surrounding skin.
Principle
Small triangular segments are drawn along the scar, excised, and carefully closed.
Benefits
- Creates a more natural, less noticeable appearance
- Better alignment with skin tension lines
- Well-established and reliable technique
Limitations
W-plasty requires removal of a small amount of healthy tissue and slightly increases the total scar length. It is not suitable near free margins such as the eyelids or lips.
Geometric broken line closure (GBLC)
Geometric broken line closure is a more advanced technique, mainly used for highly visible scars, particularly on the face.
Principle
The linear scar is replaced with an irregular geometric pattern, making it much harder for the eye to detect.
Benefits
- Highly effective camouflage
- Complete disruption of the linear appearance
- Particularly discreet results in exposed areas
Important to know
This technique requires sufficient skin laxity and specific surgical expertise. The choice always depends on scar location and individual anatomy.
Simple excision and linear closure
In selected cases, classic excision followed by careful linear closure remains the best option, especially when the scar is well oriented and located in an area with good skin laxity.
How the procedure is performed
Preoperative consultation
The consultation allows the surgeon to:
- assess the scar (size, orientation, texture, colour)
- determine the most appropriate technique
- discuss realistic expectations
- take standardised medical photographs
Surgical procedure
Depending on complexity:
- simple revisions may be performed under local anaesthesia
- more extensive procedures may require general anaesthesia in a hospital setting
The surgery includes precise marking, scar correction using the selected technique, and meticulous layered closure.
Procedure duration ranges from 30 minutes to 2–3 hours.
Recovery and aftercare
After surgery:
- the treated area is protected for 7 to 14 days
- intense physical activity is avoided for 2 to 4 weeks
- sutures are removed after a few days to two weeks, depending on the area
To optimise healing:
- gentle scar massage after 2–3 weeks
- silicone sheets or gels for several months
- strict sun protection for 12–18 months
- smoking cessation is strongly recommended
Results and effectiveness
Scars evolve gradually over time. Initially, they may appear red or slightly raised, then progressively flatten and fade.
Studies show that most patients experience a noticeable improvement after surgical scar revision. Results depend mainly on:
- the type of scar
- the technique used
- adherence to postoperative care
Cost of scar revision surgery in Belgium
Costs vary depending on complexity:
- Simple revision: from €800–1,500
- Complex revision (Z-plasty, W-plasty): €1,500–3,000
- Extensive or multiple revisions: up to €5,000
These figures are indicative and may not include anaesthesia or hospital fees.
Some functionally indicated revisions may be partially reimbursed, subject to approval by the health insurance medical advisor. Purely aesthetic revisions are generally not covered.
Non-surgical alternatives for scar treatment
In selected cases, non-surgical treatments may complement or replace surgery:
- CO₂ laser or fractional laser
- radiofrequency microneedling
- PRP or PRF injections
These options are explained in dedicated guides on iGlowly.
Frequently asked questions about surgical scar revision
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