Surgical Scar Revision in Seoul: When Is the Right Time to Treat a Scar?

Where do surgical scars form, and why?

A surgical scar forms where the skin was cut and stitched closed (the incision). So two scars on the face can sit in very different places and look very different, depending on the operation. Common examples after facial cosmetic surgery are marks from nostril (alar) reduction and double-eyelid incision lines. Others are the scar in front of the ear and "pixie ear" after a face lift (surgery that lifts sagging facial skin). For scars like these, the cause only becomes clear once you know where and how the incision was made.

Where scars can form after facial surgery (example)

Replay

1. 1Double-eyelid incisionan incision across the upper eyelid
2. 2Alar reduction markwhere the nostril wing meets the cheek
3. 3Incision in front of the earmade along the front of the ear in a face lift
4. 4Pixie earthe earlobe's shape changed by the incision and its pull

This guide focuses on one question: when is the right time to have a surgical scar looked at? Scars change over time, so when you act matters as much as what is done.

Do scars keep changing after they heal?

Yes. Once a wound has closed, it can look finished from the outside. Inside the scar, though, the tissue keeps reorganizing for quite a while. A review on scar revision (a paper that gathers and summarizes many studies) explains that scars take around 12–18 months to mature. Over that time they slowly regain 70–80% of the strength of uninjured skin.¹ This means that for a year or more after surgery the scar is still taking shape.

During this period scars usually follow the course below. It varies a great deal by person, body area and type of surgery.

How a surgical scar settles

Replay

1. 1Stitch removalthin red line · tape to reduce tension
2. 2Weeks to 3 monthsmay turn red, firm or raised · silicone, sun protection
3. 3After 8–12 weeksearly revision of a widened scar can be considered (adults)
4. 4Months to a yearoften fades and softens · laser for remaining color
5. 512–18 monthsusually settled · redness and firmness fade but the width stays · plan revision for any shape problem

The same review warns that immature scars thicken easily and tend to give poor results if revised too early.¹ That is why revision is not rushed. It does not mean doing nothing while you wait, though.

What can you do while you wait?

International guidelines on scar management (advice agreed by experts from several countries) list some basic care for all scars. It covers reducing skin tension around the time of surgery, taping, moisturizing and sun protection. They regard silicone sheets or gels as the first-line option for preventing and treating hypertrophic scars and keloids.² A hypertrophic scar is red, thick and raised but stays within the original wound. A keloid grows sideways beyond the edges of the wound.

Here is what the evidence for each kind of care looks like. Some of it is fairly clear, and some is still uncertain.

• Taping to reduce tension: one trial randomly assigned 70 women after cesarean section into two groups (like drawing lots). None of those who used paper tape for 12 weeks after stitch removal had a hypertrophic scar at 12 weeks, compared with 41% of those who did not. However, only 39 women completed the study, and some scars thickened or stretched after the tape was stopped.³
• Silicone sheets and gels: these are widely used. But a Cochrane review that pooled 20 trials concluded that the evidence for preventing abnormal scars in people prone to them is weak and of poor quality. A lot of uncertainty remains.⁴ It is more accurate to see silicone as low-burden basic care whose benefit is still uncertain.
• Sun protection: keeping a red scar out of the sun is part of basic care while the redness lasts.²
• Early laser: a systematic review looked at 25 studies that started laser within 3 months of the wound. This kind of review searches for all relevant studies in a set way and sums them up. Early laser may reduce scar formation, but the differences were not always significant, and better studies are needed.⁵ Vascular laser, which targets the tiny blood vessels that make a scar look red, is sometimes started around the time stitches are removed.¹

A randomized trial of tape to reduce tension

Replay

1. 1When the skin pullstension tends to make hypertrophic scars worse
2. 2Taping to reduce tensionpaper tape for 12 weeks after stitch removal
3. 3Hypertrophic scars at 12 weeks41% without tape · none with tape
4. 4Howeveronly 39 completed the study · some scars thickened or stretched after the tape was stopped

When to start each of these depends on how your wound is healing, so follow the advice of the team who operated on you first. Even three months after surgery, the dermis (the layer under the surface that gives skin its strength) has regained only about 80% of its original strength.⁶ That is why care that reduces tension on the scar keeps mattering for several months.

Which changes mean you should be seen early?

If you notice any of the following, it is better to have the scar checked now rather than wait for it to settle.

• The scar keeps getting thicker, or spreads beyond the original wound
• It itches or hurts
• On a part of the body that moves, such as near a joint or on the neck, the scar pulls and makes movement uncomfortable
• The wound has opened, or inflammation or oozing keeps coming back
• The scar is pulling on the shape of the eye, mouth or nostril

Hypertrophic scars usually stay within the original wound, while keloids grow sideways beyond its edges. Both tend to worsen under skin tension and to grow in the direction of that pull. People of Asian and African descent are known to be more prone to them.⁶

What is your scar doing now?

• Getting thicker, itchy or painfulBe seen earlyCalming treatment comes first
• Spreading beyond the woundCheck for a keloidExcision alone may let it return
• Red but gradually flatteningKeep caring and watchTape, silicone, sun protection
• Wide, sunken or pullingPlan the revision timingAdults: from 8–12 weeks on

In these cases, check the scar first instead of waiting. Calming treatments such as injections or silicone can be started first, or revision can be planned for the right time.

When is a scar cut out and re-stitched?

Revision is usually put off until the scar has matured (settled) to some degree. International guidelines also describe invasive treatments, those that cut the skin such as surgery, as a later step for correcting long-standing scars.²

The review mentioned above also gives a point from which early revision can be considered: 8–12 weeks after surgery in adults, and 6 months in children under 7.¹ So for scars that are unlikely to improve in shape with waiting, such as widened scars, a plan is sometimes made earlier.

Scars with strong keloid features are a different matter. According to the Japan Scar Workshop consensus (recommendations agreed after expert discussion), cutting them out alone can lead to recurrence. A keloid that comes back may be larger than before. So it recommends planning radiotherapy or steroid treatment after surgery. On high-tension areas such as the chest and shoulders, stitching methods that spread out the tension are used as well.⁶

What improves with time, and what does not?

Some parts of a scar improve with time, and some stay the same however long you wait.

• Usually improves with time: redness, firmness
• Stays the same with waiting: width, a sunken area, the direction the scar runs

Telling which is which requires seeing the scar in person.

Revision surgery has limits too. It creates a new wound, so the new scar also goes through its own settling period. It makes a scar less visible rather than erasing it.¹ If you are prone to keloids, the scar may come back after excision alone, so excision is planned together with other treatments.⁶ Side effects such as bleeding, infection and inflammation are also possible.

How we approach it at Bonita Clinic

Bonita Clinic's methods by scar type

• 1If it is a thin red line

  Vascular and regenerative lasers to refine redness and texture

  Laser

• 2If it is sunken or pulled down

  Tissue stuck underneath is released, and fat is moved in to fill

  Adhesion release · fat grafting

• 3If the incision line has widened

  The scar is cut out and stitched again along the skin creases

  Excision · re-suturing

• 4If the shape has changed, as in pixie ear

  The earlobe's shape is corrected together with the scar

  Scar and shape correction

Whichever method is used, any remaining color and texture are refined after a review, with combined laser if needed (several lasers chosen and combined for the purpose). In plain words, adhesion release frees a scar that is stuck to deeper tissue and pulled downward. Fat grafting moves some of your own fat to fill a sunken area.

Bonita Clinic has long treated both cosmetic surgery and scar restoration. For some scars, the cause only becomes clear once you know where and how the incision was made. Examples are alar reduction marks, pixie ear after a face lift or double-eyelid incision lines. For these, we trace the scar back to the surgery itself. At Bonita Clinic, we perform facial surgical scar revision as surgery under local anesthesia or sedation; you go home the same day, and stitches are used. How long recovery takes and how often you need to come back depend on the extent of treatment and your own condition.

Treatment options you can discuss in Seoul

Bonita Clinic opened in 1995, and Dr. Kwang-Seop Chung, a board-certified plastic surgeon trained in Brazil, has seen patients at the same location since then. Scars from surgery done elsewhere, including in other countries, can be assessed. The restoration process on our facial surgical scar page covers:

• A review of your previous surgery: what was done, when, where the incisions were and any treatment since
• Vascular and regenerative lasers for scars left as thin red lines
• Adhesion release and fat grafting for scars that are sunken or pulled downward
• Excision and re-suturing along the skin creases for widened incision lines
• Shape correction, such as for pixie ear, together with the scar
• Follow-up, with combined lasers for remaining color and texture if needed

How many of these steps your scar needs, and when, is decided after an examination.

Why the plan and cost vary for scar revision

Two scars from the same operation can need different work. Size, location, how much the area moves and whether the scar behaves like a keloid all shape the plan, and the cost follows from the plan.

• Length and width of the scar
• Face or body, and how much the area moves
• Laser, adhesion release, fat grafting or excision
• Shape correction such as pixie ear
• Anesthesia: local or sedation
• Keloid tendency and care after excision

Plan and estimate after an in-person exam

A final estimate is given after the in-person examination, once the methods and the number of stages are clear. If a scar is still maturing, part of the plan may be confirmed only at a later review.

What photos can show, and what needs an exam in person

For a scar that is still changing, a series of dated photos tells us more than a single picture. Photos still cannot show how firm the scar is, whether it is stuck to the tissue underneath, or how it behaves when you move.

Photos can show

• Length, width and color of the scar
• Visible raised or sunken areas
• How it has changed (dated photos)
• Pull on the eye, mouth or ear

Needs an in-person exam

• Firmness and thickness
• Tethering to deeper tissue
• Tension when you move
• Signs a keloid is still active
• Condition of the skin around it

Helpful photos: the scar in good light from straight on and at an angle, with a ruler or coin beside it for scale. If the scar pulls, add one photo taken while you move the area. If you have photos from different stages since surgery, include them with the date. You can send us a message with your photos, the name and date of the surgery, and the care you have tried.

Timing your visit to the scar's stage

For a surgical scar, when you come matters as much as what is done. If your surgery was only weeks ago, the scar is still changing. It can be more useful to send photos now and plan a visit for the stage when revision or laser makes sense, rather than coming straight away. If the scar is thickening, itching, painful or spreading, though, do not wait for a later trip: see a doctor where you are, or send photos promptly.

What is confirmed in advance is our treatment information: facial surgical scar revision is surgery under local anesthesia or sedation, with same-day discharge and stitches. How long to stay in Seoul, when stitches come out and whether you need to return depend on the extent of treatment. These are planned together with you at consultation. Right after treatment the area is protected. Redness and swelling ease little by little, and from then on sun protection is important.

After returning home, keep up the basic care described above (reducing tension, sun protection and, if advised, silicone) while the new scar settles. Contact a doctor promptly if the wound opens, or if redness, pain or discharge gets worse instead of settling.

Real treatment cases

These are cases of facial surgical and incision scars treated at Bonita Clinic. Results may vary from person to person.

Incision-line scar above the eye

Incision scar around the eye

Linear scar on the forehead

Depressed scar on the forehead

* Results vary from person to person. Side effects are possible, so please decide after a thorough consultation with a doctor.

Frequently asked questions

Can I be treated here if my surgery was done at another clinic?

Yes. Knowing which surgery you had and when helps us judge where the incision was and what caused the problem, so please tell us as much as you remember. Surgical records or dated photos are useful if you have them.

My surgery was recent. Can I start scar treatment now?

It depends on how well the wound has healed. If it is too early, the scar is managed while we watch its progress, and treatment is planned around when it settles. If the scar is getting thicker, itchy or painful, though, have it checked whatever the timing.

How long should I use silicone or tape?

There is no fixed period; it depends on the product and the wound. In the randomized trial above, tape was used for 12 weeks after stitch removal, and a few people had a mild red rash under it.³ Keep going while the scar is red and firm. If the skin breaks down or a rash appears, take a break and ask your doctor.

Can pixie ear be corrected?

We consider ways to correct the ear's shape along with the scar. Pixie ear is a change in the earlobe's shape caused by the incision in front of the ear and the direction of pull. The extent is confirmed at consultation.

How many sessions will I need?

It depends on the scar. Surgical restoration is done once and then reviewed. Remaining color and texture are often refined with lasers over several sessions.

What to prepare before your consultation

• The name and date of the surgery and the clinic where it was done (as much as you remember)
• Care you have tried so far: silicone products, tape, laser, injections
• Any past experience of scars thickening or keloids forming, and similar cases in your family
• Any discomfort: itching, pain, pulling

Bonita Clinic is on the 3rd floor of 565 Gangnam-daero, Seocho-gu, Seoul, around 100 m on foot from Exit 8 of Nonhyeon Station (Line 7). You can read more on our Facial Surgical Scars, Body Surgical Scars and Facial Depressed & Incision Scars pages. Treatment by scar type is covered in separate guides: facial depressed and incision scars, depressed and incision scars on the body, scars after body and breast surgery and nose scars.