Surgery for Scars & Keloids
Plastic surgeons at NYU Langone who specialize in treating scars use advanced aesthetic and reconstructive techniques to improve the appearance of a scar or reduce its size. In an outpatient setting, our surgeons can remove excess scar tissue, reconstruct the surrounding skin and other soft tissues, and minimize scarring after the procedure.
To achieve the best results in treating hypertrophic scars or keloids, our doctors often recommend a combination of revision surgery and steroid injections.
Scar revision surgery can minimize the appearance of a scar and help it blend with the surrounding skin. Large or highly visible scars are often an unavoidable result of injury or surgery. The soft tissues surrounding a wound may change shape, dimple, or become sunken, uneven, or raised as the wound heals.
When a surgical incision is healing, stitches—or sutures—can alter the look of a scar. If stitches aren’t removed before the top layer of skin heals around them, the entry points of the stitches may become permanent features, resulting in a “railroad scar.” Scars that form after an injury can heal unevenly, causing the skin on one side of the scar to be higher than the skin on the other, a type of scar sometimes called a “trapdoor scar.”
Our reconstructive plastic surgeons perform revision surgery using a variety of approaches and select the most effective technique for you based on the type, size, and location of the scar.
A surgeon may reduce the size of a scar; reposition a scar to a less visible area; or smooth the contours of the skin and other soft tissues to correct sunken or dimpled scars, which usually occur when the wound that caused the scar was deep and broad.
A surgeon may use aesthetic techniques to move a scar to a less visible place. With scars on the face, a surgeon may remove and reposition the scar formed by an incision closure so that it is broken up or heals along a natural fold in the skin, making it less noticeable. For example, surgeons may reposition a scar located on the cheek closer to the ear, making it almost imperceptible. With large burn scars, a surgeon may reduce and realign the scar tissue to more naturally follow the contours of the body.
Other cosmetic techniques include injecting a small amount of fat—which surgeons typically remove from another part of your body, such as the thigh or belly—to fill in any sunken areas caused by an open wound that healed by itself or by a wide zone of injury.
In some instances, a surgeon may recommend removing a large hypertrophic scar or keloid. Keloids that far exceed the margins of the original wound, for example, require removal to allow surgeons to reconstruct the surrounding skin and tissue and restore as much of the underlying structure as possible.
A surgeon may also remove a large hypertrophic scar rather than revise it. Removing a scar enables a surgeon to reclose the incision using specialized cosmetic techniques, resulting in a thinner, less noticeable scar.
For scars that cover large areas of skin—for example, a burn scar—a surgeon may use a reconstructive technique, such as skin expansion, to allow for replacement of the burn scar with normal skin. In skin expansion, surgeons first implant a small balloon beneath healthy skin next to the scar. In the weeks before surgery to remove the scar, the balloon is slowly filled with saline water during office visits to expand the healthy skin. Then, when performing surgery to remove the scar, the surgeons use this expanded skin to replace the damaged or burned skin. The new skin heals naturally.
NYU Langone doctors also offer hair transplantation if a scar forms in a location where hair naturally grows, such as the eyebrow. Surgeons remove healthy hair follicles, usually from the back of the scalp, and implant them in the scarred area of the skin to restore a natural look.
What to Expect After Surgery
After surgery, a doctor places a sterile bandage over the wound. If surgery was extensive, the doctor may recommend an over-the-counter or prescription pain medication to help you recover comfortably. Doctors schedule a follow-up appointment for six to eight days after surgery to evaluate healing and, if necessary, remove stitches.
Over the following six to eight weeks, the skin heals and the new, smaller scar begins to flatten and fade to match the surrounding skin. Complete healing can take as long as a year. During this time, surgeons schedule additional follow-up appointments as needed to monitor how the scar is healing.
If necessary, doctors can administer a corticosteroid injection if it appears that a hypertrophic scar or keloid is forming after surgery. If you have a history of developing keloids, surgeons may plan on injecting corticosteroids into the scar tissue several times during the months following surgery in an attempt to prevent recurrence.
In addition, our surgeons may recommend postoperative superficial external beam radiotherapy to prevent a keloid from forming. This therapy is typically performed within 24 to 48 hours of surgery for best results.