Scar revision is generally a low-risk procedure, particularly when it is performed under local anaesthetic, but it is still surgery. The main risks are that the new scar does not look better than the old one, or thickens again, along with infection, bleeding, wound separation and altered sensation. Keloid scars carry the highest risk of recurrence. Careful selection, good technique and consistent aftercare reduce these risks but cannot remove them entirely.
The key risk: the scar itself
Every revision replaces one scar with another. The aim is a finer, flatter or better-positioned scar, but there is no certainty that it will heal better than the first. Factors that caused the original scar to be poor, such as tension across a joint, your natural healing tendency or skin type, still apply. Some scars are improved only modestly, and a small number end up similar or, rarely, worse. This is why Mr Nassab will explain honestly whether revision is likely to help before recommending it.
Recurrence of raised scars
Hypertrophic scars can thicken again after revision, and keloids are particularly likely to return, sometimes larger than before. To reduce this risk, excision of a keloid is combined with steroid injections into the wound and close follow-up, and silicone is used for months afterwards. People with a strong keloid tendency may be advised to avoid surgery and rely on injections instead. See our guide to keloid scars for more detail.
General surgical risks
- Infection: reduced by sterile technique and good wound care. Signs include increasing pain, redness, heat, swelling, pus or fever; contact the team the same day.
- Bleeding and haematoma: a collection of blood under the skin. Stopping certain supplements and blood-thinning medicines beforehand, only on medical advice, reduces the risk. Rapid swelling needs urgent contact with the team.
- Wound separation: more likely under tension or in smokers; managed with dressings and sometimes re-stitching.
- Altered sensation: numbness or tingling around the scar, which usually improves over months but can persist in a small area.
Anaesthetic and blood clot risks
Most revisions are done under local anaesthetic, which avoids the risks of a general anaesthetic. Rarely, people react to the local anaesthetic itself. Larger revisions under general anaesthetic carry the small risks associated with any anaesthetic, including nausea and, rarely, more serious reactions, which your anaesthetist will discuss. Blood clots in the leg (deep vein thrombosis) or lung are uncommon after short procedures but are considered for longer operations. Sudden one-sided leg swelling or calf pain needs same-day assessment via your GP or NHS 111; chest pain or breathlessness requires a 999 call.
Side effects of steroid injections
Steroid injections are often used alongside revision. Side effects can include thinning or denting of the skin, lightening of skin colour around the scar (more noticeable in darker skin), and small visible blood vessels. Periods may be temporarily irregular in some women. These effects are minimised by using the lowest effective dose and spacing injections appropriately.
Reducing your own risk
You can make a real difference. Stop smoking and nicotine products well before and after surgery, keep to a stable weight, and tell Mr Nassab about all medicines and supplements, previous problem scars and any history of keloids. Follow wound-care instructions closely, avoid stretching the area in the early weeks, protect the scar from the sun, and attend follow-up appointments so that any thickening can be treated early.
What is normal and what is not
It is normal for a new scar to be pink, slightly raised, firm and a little itchy for several months, and for bruising and mild swelling to last a week or two. It is not normal to have increasing pain after the first few days, a hot and spreading redness, discharge, a fever, or a wound that opens. If you are unsure, contact the team; it is always better to be checked. Treatment is described on the scar revision page.
Frequently Asked Questions
Can scar revision make a scar worse?
Rarely, yes. Most revisions aim for and achieve some improvement, but the new scar depends on healing factors that cannot be fully controlled.
Is scar revision safe for keloids?
It can be, but keloids have a high chance of returning. Excision is combined with steroid injections and careful follow-up.
Does scar revision need a general anaesthetic?
Most revisions are done under local anaesthetic. Larger or more complex revisions may need a general anaesthetic.
How is infection prevented?
Through sterile surgical technique, careful wound care and prompt review of any warning signs.
How soon will you know whether the revision has worked?
Early healing can be judged within a few weeks, but the final appearance of the new scar is usually assessed at around 12 to 18 months, once redness and firmness have settled.
