Scar revision with Dr. Henry Sandel
Scar Revision
A scar cannot be erased. It can be moved, narrowed, flattened, released, and made to blend — and choosing which of those a particular scar needs is most of the work.
At a glance
Surgeon
Dr. Henry Sandel
Approaches
Surgical, laser, injection, topical
Typical timing
12+ months after the original injury
Anesthesia
Local or general, by extent
Goal
Improvement, not removal
Insurance
Sometimes, when function is affected
What can and cannot be changed
A scar cannot be erased. Any incision through the full thickness of the skin leaves a permanent mark, and no treatment returns the skin to the state it was in beforehand. What can be changed is how a scar sits, how wide it is, what color and texture it has, and whether it pulls on the tissue around it.
Dr. Sandel evaluates scars in three dimensions: the scar itself, the tissue tension acting on it, and the surrounding skin it has to blend into. A wide flat scar, a raised hypertrophic scar, a depressed one, and a scar that has contracted and distorted a nearby feature are four different problems requiring four different approaches.
Timing matters more here than in most procedures. Scars change for a year or more on their own, usually improving, and operating too early can produce a worse result than waiting. Where a scar is still maturing, the honest recommendation is often to treat it non-surgically and reassess.
After Mohs and skin cancer removal
Scars left by skin cancer excision on the face are a substantial part of this work. Where reconstruction is what you need rather than revision, see Mohs reconstruction and facial reconstruction.
Scars we treat
On timing
Most scars are not ready for surgical revision until they have matured, which commonly takes twelve months or more.
That does not mean doing nothing in the meantime. Come in early — scar care started in the first weeks influences the final result more than any revision performed later.
Approaches
Surgical is not always the answer.
Topical and pressure
Scar care
Silicone sheeting or gel, taping, massage, and sun protection. Unglamorous, evidence-supported, and the most underused tool available. Started early, it changes how a scar matures and sometimes removes the need for anything else.
Best for new and maturing scars, in the first year
Injection
Steroid and adjunct injection
Injections placed directly into the scar to flatten and soften it, usually as a series spaced weeks apart. Often the first-line treatment for keloids, which have a real tendency to recur if simply cut out.
Best for raised hypertrophic scars and keloids
Laser
Laser treatment
Vascular and resurfacing lasers address the color and texture of a scar rather than its shape. Frequently combined with the other approaches on this page, and sometimes used to prepare a scar before surgical revision.
Best for redness, pigment, and surface texture
Surgical
Surgical scar revision
The scar is excised and the wound closed in a way that redirects tension, repositions the line into a crease or shadow, or breaks a straight scar into a less visible geometry. This trades an existing scar for a new one that should heal better placed and less conspicuous.
Best for wide, poorly placed, or contracted scars
Reconstructive
Flap and graft revision
Where a scar has pulled an eyelid, lip, or nostril out of position, correction means releasing the contracture and bringing in tissue to fill the deficit. This is reconstructive work rather than cosmetic refinement.
Best for scars that have distorted a nearby feature
Setting expectations
Improvement, not erasure.
Patients who are happiest with scar revision are the ones who came in understanding what the ceiling is. We would rather tell you plainly at the consultation than have you discover it afterward.
A scar can be made less noticeable. It cannot be removed, and there will always be a scar.
Revision replaces one scar with another, and the new one also needs a full year to mature.
Keloids and hypertrophic scars can recur, and patients prone to them are prone to them again.
Skin tone affects how scars heal and how visible they remain; we will discuss what that means for you.
Nicotine in any form must be stopped for at least four weeks before surgery and throughout recovery — it is the single largest controllable risk to wound healing.
More than one approach, and more than one session, is common. This is often staged.
Questions
Commonly asked.
How long should I wait before treating a scar?+
Come in early for advice, but expect surgical revision to be recommended later. Scars remodel for twelve months or more, usually improving on their own, and operating on an immature scar can produce a worse result than waiting. Non-surgical care in the meantime is not a delay tactic — it genuinely influences the final outcome.
Will the new scar be less visible than the old one?+
That is the goal, and it is achievable when the original scar was poorly placed, closed under tension, or healed badly for a reason that can be corrected. Where the original was already well placed and well closed, there may be less to gain, and we will say so.
Can you treat keloids?+
Yes, but carefully. Keloids recur readily after simple excision, so treatment usually combines approaches — injection, sometimes pressure or laser, and surgery only as part of a broader plan. Patients who form keloids should expect ongoing management rather than a single procedure.
Does insurance cover scar revision?+
Sometimes. Where a scar restricts movement, distorts a feature, or causes symptoms, revision may be considered functional rather than cosmetic. Where the concern is appearance alone, it is not covered. We help you understand which category yours is likely to fall into. Dr. Sandel is an out-of-network provider. If your insurance company offers you out-of-network benefits, you could be reimbursed for the medically necessary portion of the procedure. We will give you the medical notes, procedure codes, and diagnostic codes to help with this process.
Who performs scar revision here?+
Dr. Henry Sandel, who is double board-certified in facial plastic and reconstructive surgery and in otolaryngology — head and neck surgery. Facial scars, and reconstruction following skin cancer removal, are a core part of his practice.
Start with a conversation.
Every patient receives an extensive consultation with a comprehensive review of options. No one feels rushed, and we answer every question before anything is scheduled.
Candidacy and expected outcomes are determined in consultation. Results vary from patient to patient.
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