Scar Revision Surgery in Sydney, Penrith and Orange

Scar revision surgery replaces a scar that has healed badly with one that is planned. It does not remove a scar — nothing does — but a widened, raised, tethered or poorly placed scar can often be improved. Dr Rohit Kumar is an Australian-trained specialist plastic surgeon (FRACS) consulting in Sydney, Penrith and Orange.

• What it can and cannot do
• Types of scar
• Why you wait
• The operation
• Non-surgical options
• Recovery
• Risks
• Cost and Medicare
• Where
• Questions

What scar revision can and cannot do

This is worth being plain about, because the gap between what patients hope for and what surgery delivers is where disappointment comes from.

It can narrow a stretched scar, flatten a raised one, release a scar that is pulling or restricting movement, reposition a scar into a crease where it is less obvious, correct a step or notch where the edges did not line up, and even out a scar that is depressed or tethered to the tissue beneath.

It cannot remove a scar. Skin that has been cut will always carry a mark. The realistic aim is a finer, flatter, better-placed line — and in some cases, particularly with keloid scarring, the honest advice is that surgery alone is likely to make things worse rather than better.

Types of scar Dr Kumar treats

Widened or stretched scars

Common on the trunk, shoulders and limbs, where skin is under tension. These often respond well to excision and careful layered closure that takes the tension off the skin edges.

Hypertrophic scars

Raised and red but confined to the original wound. Many settle on their own over twelve to eighteen months, which is why patience usually comes before surgery.

Keloid scars

Raised scar tissue that grows beyond the boundary of the original wound. Keloids have a strong tendency to recur after excision alone, so surgery is only considered as part of a combined plan, and sometimes not at all. Dr Kumar will tell you if that is the case.

Contracted scars

Scars that tighten across a joint, the neck or the corner of the mouth and restrict movement or distort a feature. These are functional problems and are approached differently from cosmetic ones.

Scars after body-contouring surgery

Abdominoplasty, body lift, arm and thigh reduction all leave long scars, and after major weight loss those scars sit on skin that has been under considerable strain. A scar that has widened, stepped at a junction, or left a standing fold at the end of the line can usually be revised once it has matured. This work is closely related to Dr Kumar’s body contouring after major weight loss practice.

Why you usually wait twelve months

A scar is not finished when the wound has closed. It remodels for a year or more, passing through a red, firm, raised phase before softening and fading. A scar assessed at three months often looks considerably better at twelve without anything being done to it.

Operating too early means revising a scar that was going to improve anyway, and doing so while the tissue is still inflamed. The exceptions are contracted scars restricting movement, and scars causing a functional problem such as interfering with eyelid closure, where earlier intervention is appropriate.

The operation

Excision and layered closure

The scar is cut out and the wound closed again in layers, with deep sutures taking the tension so the skin edges sit together without being pulled. Most widened scars are treated this way.

Z-plasty

Triangular flaps are transposed to change the direction of the scar, lengthening it and redirecting it into a natural skin crease. Particularly useful for scars that cross a joint or pull on a feature.

W-plasty and geometric closure

A straight scar is replaced with a zig-zag line. The scar is longer overall but harder for the eye to follow, which is often the point on the face.

Excision in stages

A wide scar — for example after a burn or a skin graft — may be narrowed over more than one operation, allowing the surrounding skin to stretch between stages.

Non-surgical management

Not every scar needs an operation, and some should not have one. Depending on the scar, Dr Kumar may recommend silicone-based scar therapy, massage, pressure, sun protection, or injections into the scar to soften and flatten it. These are often tried first, and for keloid scarring they form part of the plan whether or not surgery is involved.

Recovery

When	What to expect
Days 0–2	Dressing in place. Discomfort is usually mild and settles with simple analgesia.
Days 5–14	Sutures removed, earlier on the face. Scar care begins once the wound is sealed.
Weeks 2–6	The new scar is pink, firm and at its most obvious. This is normal and expected.
Months 3–6	Redness fades, the scar softens and flattens.
Months 12–18	Final appearance. Assessment of the result is made at this point, not before.

Most people return to desk work within a few days. Activity that puts tension across the scar — lifting, sport, stretching — is restricted for several weeks, because tension during healing is what widens a scar in the first place.

Risks

All surgery carries risk. For scar revision these include bleeding, infection, wound breakdown, altered or reduced sensation, a new scar that is wider, thicker or more visible than the original, recurrence of a keloid or hypertrophic scar, asymmetry, the need for further surgery, and risks related to anaesthesia.

It is important to understand that scar revision trades a known scar for an unknown one. Dr Kumar discusses the likelihood of improvement for your particular scar, and will advise against surgery where the balance does not favour it. Read more about the risks of surgery here.

Cost and Medicare

Where a scar causes a functional problem — restricting movement, interfering with the function of an eyelid or the mouth, or repeatedly breaking down — a Medicare item number may apply. Revision undertaken for appearance alone is generally not covered. Eligibility depends on the clinical criteria being met and is assessed individually at consultation.

A current referral from your GP is required, and is also what allows you to claim the Medicare rebate on your consultation. Cost depends on the length and site of the scar, the technique, the anaesthetic and the facility. You are given a written estimate before anything is booked.

Costs and payment  |  Medicare rebates and plastic surgery

Where Dr Kumar consults and operates

Consultations are available at Westmead, Penrith and Orange. Day-case scar revision is performed at Somerset Private Hospital in Kingswood, with longer or more complex revisions at Westmead Private Hospital.

Common questions