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Salamanders Young Burn Survivors > Facts and Figures > Surgery for Scars

Plastic surgeons can often improve scars, using procedures known as Scar Revisions.

It is important to keep in mind that no scar can ever be removed completely. During and after any kind of scar revision, it is very important to follow your surgeon's instructions. Scar revision is usually safe, but there is always a possibility of complications which can include infection, bleeding, or a reaction to the anaesthesia. In the case of hypertrophic and keloid scars, surgical removal of a scar may carry a very high risk of recurrent excessive scarring.

Scar Revisions

Chemical Peels

use chemicals to remove the top layer of the skin in order to smooth sunken scars and give the skin a more even colour. The amount of scarring and colour change determines the type of peel chosen. Deeper peels can take up to two weeks to heal. There is a risk that the treated area will end up looking either paler or darker than before.


is a technique which uses special equipment to freeze the scar tissue with liquid nitrogen or carbon dioxide. It is only effective in around 30% of cases and is mainly used to improve scars on the shoulders or back. In some cases there is a risk that the treated area will end up looking paler than before.


removes the surface of the skin with a special instrument, similar to a drill-bit. It may be helpful where the scar is raised above the level of the skin around it. Afterwards there may be pain, redness and swelling lasting from a few days to a couple of weeks. There is a risk that the treated area will end up looking either paler or darker than before.


is similar to dermabrasion, but gentler and performed without anaesthetics. Ten to twenty sessions (probably a greater number for more serious scars) are needed before there will be much difference in appearance.


sometimes called "permanent make-up", is a permanent method of colouring an area of lightened skin to make it match the surrounding skin, in what is basically a tattooing process.

Laser Surgery

can both lighten a scar and reduce the amount of scar tissue. It uses a high-energy beam to vapourise scar tissue in a session lasting anywhere from a few minutes to an hour and a half, often performed under local anesthesia, and sometimes under general anesthesia, and requires new skin to be able to grow from the deeper layers.

CO2 Lasers

are used to remove a layer of skin and expose a more natural-looking skin layer, which heals over time. During the first two weeks, quite a lot of redness and weeping of the skin can be expected. The skin may continue to show signs of pinkness or redness for several weeks following treatment. There may also be swelling and bruising, but this should only last for a couple of weeks.

Pulsed Dye Lasers

are often used to treat hypertrophic and keloid scars. These lasers do not burn off the skin surface; they target the tissue underneath and stimulate new collagen growth. Immediately after treatment, bruising appears and can last for a week or two. Treatments are repeated at intervals of six to eight weeks. It is typical to see 50% or greater improvement in hypertrophic scars after two treatment sessions. More treatment sessions are often needed to improve keloid scars. The biggest side effect is darkening or lightening of the area, which usually improves over time.

Skin Flap Surgery

is a procedure in which normal skin, along with underlying fat, blood vessels, and sometimes muscle, is moved from a healthy part of the body to the damaged part. It is usually used when the area needing reconstruction does not have the blood supply needed to support a skin graft. In some flaps, the blood supply remains joined at one end to the donor site (the place the skin is taken from); in others, the blood vessels in the flap are re-joined to vessels at the new site.

Skin Grafting

is taking undamaged skin from one part of the body (the "donor site") and using it to replace the skin in a damaged area (the "recipient site"). All grafts leave some scarring at the donor and recipient sites, so grafting as a scar revision procedure is usually only used for really bad or really tight scars. (Read more about skin grafting.)

Tissue Expansion

is a procedure which enables the body to grow extra skin for use in reconstructing almost any part of the body. The surgeon will make an incision (cut) next to the area of skin to be repaired, create a pocket beneath the skin, and insert a silicone balloon expander in the pocket. The expander includes a tiny tube and a self-sealing valve, which is usually left just beneath the surface of the skin. Once the incision has healed, the surgeon can inject saline solution (germ-free salty water) through the valve into the expander. These injections are repeated at intervals, gradually filling the expander. As the expander gets bigger, the skin over it will stretch. When the skin has stretched enough, the surgeon will do a second operation to remove the expander and re-position the new skin. Most tissue expansion patients experience only mild discomfort, and can follow their normal lifestyle while the expander is in place. Complications are rare, but sometimes an infection will develop around the expander. If this happens, the expander may need to be removed until the infection disappears. Occasionally, a leak can occur in the silicone expander, but this will do no harm, because saline solution is similar to the fluid (liquid) normally found between the cells of the body.


is a surgical technique used to reposition a scar so that it more closely follows the natural lines and creases of the skin, where it will be less noticeable. It can also relieve the tightness caused by a contracture. In this procedure, the old scar is removed and new incisions are made on each side, creating small triangular flaps of skin. These flaps are then rearranged and interlocked to cover the wound at a different angle, giving the scar a 'Z' pattern. The wound is closed with fine stitches, which are removed a few days later. The new scar should be thinner and less visible.