Scars, whether they’re caused by accident or by surgery, are unpredictable.  The way a scar develops depends as much on how your body heals as it does on the original injury or on the surgeon’s skills. 

Many variables can affect the severity of scarring, including the size and depth of the wound, the blood supply to the area, the thickness and color of your skin, and the direction of the scar.  How much the appearance of a scar bothers you is, of course, a personal matter.

While no scar can be removed completely, plastic surgeons can often improve the appearance of a scar, making it less obvious through the injection or application of certain steroid medications or through surgical procedures known as scar revisions.

While scar revision is normally safe, there is always the possibility of complications.  These may include infection, bleeding, a reaction to the anesthesia, or the recurrence of an unsightly scar.

Keloid scars are thick, puckered, itchy clusters of scar tissue that grow beyond the edges of the wound or incision.  They are often red or darker in color than the surrounding skin. Keloids occur when the body continues to produce the tough, fibrous protein known as collagen after a wound has healed. 

Keloids are often treated by injecting a steroid medication directly into the scar tissue to reduce redness, itching, and burning. In some cases, this will also shrink the scar. If steroid treatment is inadequate, the scar tissue can be cut out and the wound closed with one or more layers of stitches.

Hypertrophic scars are often confused with keloids, since both tend to be thick, red, and raised.  Hypertrophic scars, however, remain within the boundaries of the original incision or wound.  They often improve on their own, though it may take a year or more, or with the help of steroid applications or injections.

If a conservative approach doesn’t appear to be effective, hypertrophic scars can often by improved surgically.  The plastic surgeon will remove excess scar tissue, and may reposition the incision so that it heals in a less visible pattern.  This surgery may be done under local or general anesthesia, depending on the scar’s location and what you and your surgeon decide.  You may receive steroid injections during surgery and at intervals for up to two years afterward to prevent the thick scar from reforming.