Scar Revision in Singapore

Plastic surgeon-led assessment and treatment of established scars

Not all scars heal as expected. Some become raised, thickened, or itchy. Others widen, remain red, or cause discomfort long after the original wound has closed. At Doctor Stitch, scar assessment and revision are led by Dr Ng Zhi Yang, a dual-accredited UK and Singapore plastic surgeon with specific training in wound healing and scar management. Treatment is tailored to the scar type, location, and your individual healing profile - ranging from steroid injections to silicone, lasers, microneedling, fat grafting and surgery.

Types of Scars We Treat

1. Keloid Scars

Keloids are scars that grow beyond the original wound boundary, sometimes significantly. They are firm, raised, and often itchy or tender. Keloids are more common in individuals with darker skin tones and have a tendency to recur after treatment. Management typically involves a combination of approaches rather than a single intervention, and realistic expectations are an important part of any treatment discussion.

An important caveat in keloid management is the need to exclude an underlying diagnosis before committing to treatment. Dermatofibrosarcoma protuberans (DFSP) is a locally aggressive soft tissue cancer that can present as a firm, raised lesion on the chest or trunk. This is oftentimes clinically indistinguishable from a keloid without histological confirmation. DFSP treated as a keloid with steroid injection or excision without adequate margins has a high recurrence rate and risks compromising definitive oncological management. Where there is any clinical uncertainty about a "keloid" particularly one that is enlarging rapidly, has no clear precipitating trauma, recurred after previous excision, or is not responding to standard treatment, a biopsy is warranted before any further intervention.

2. Hypertrophic Scars

Hypertrophic scars are raised and thickened like keloids but remain within the original wound boundary. They often develop in areas of high skin tension such as the shoulders, chest, and upper back, and especially after burns. They may improve spontaneously over time, although this can take one to two years. Early intervention with steroid injection or silicone dressings can accelerate improvement and reduce symptoms.

Hypertrophic scar - Doctor Stitch, Singapore

3. Widened or Stretched Scars

Widened scars occur when a wound heals flat but spreads over time, typically due to tension across the scar. They are common on the abdomen, back, and over joints (due to movement). Surgical revision with careful re-closure and tension-reducing techniques can significantly narrow a widened scar, though site and skin type influence the final result.

4. Post-Traumatic Scars

Scars resulting from injuries such as lacerations, dog bites, burns, road traffic accidents, or previous surgery performed without cosmetic closure, are among the most common referrals we see. The quality of the original wound closure has a significant bearing on the final scar, but even poorly healed traumatic scars can be substantially improved with the right combination of treatments. Early assessment is worthwhile even if active treatment is not yet appropriate.

Treatment Options

1. Steroid Injections

Intralesional corticosteroid injection is the first-line treatment for keloid and hypertrophic scars. It reduces inflammation, flattens raised scars, and relieves itching and tenderness. A course of injections (usually 10 mg/mL, NOT 40 mg/mL) is typically required at four to six week intervals. This is performed in clinic under local anaesthesia and takes but a few minutes per session.

Not all scars are suitable for steroid injection. Scars that have healed by secondary intention (for example where the wound was left open to heal by itself after a dog bite, and is now formed of granulation tissue and epithelialisation rather than surgical closure) have a different tissue architecture and respond poorly to steroids. Injecting these scars risks dermal and fat atrophy, producing a depressed, irregular surface that is harder to correct than the original scar. Assessment of scar type and healing history is absolutely essential before any steroid injection is planned.

2. Silicone and Pressure Garments

Silicone gel sheets and topical silicone are first-line adjuncts for hypertrophic and keloid scars and are recommended as part of most scar management plans. Pressure therapy may be added for selected cases. These are non-invasive measures that can be started early and maintained alongside other treatments. While there are various commercial brands in the market with all sorts of additional active ingredients, the evidence suggests non-superiority of any particular type.

3. Lasers and Injectables

Fractional lasers (CO2 or erbium) and vascular lasers such as Nd:YAG and pulse dye lasers are effective tools for improving scar texture, redness, and surface irregularity. Lasers are particularly useful for red or pigmented scars, acne scarring, and post-surgical scars where the surface quality rather than the overall shape requires improvement. A course of treatments is usually required. Laser therapy is provided directly or coordinated with a trusted provider depending on your specific scar and treatment plan.

Injectable treatments such as PDRN improve scar surface quality in terms of texture, pigmentation, and pliability. They do not correct the underlying architecture of a scar that was never properly closed. A scar that is wide, stepped, or poorly oriented because the original wound was closed inadequately will not be improved by laser or PDRN alone, and repeated treatments without addressing the underlying problem represent a significant financial cost to the patient with limited to no benefit, or worse. In select cases, micro-doses of botulinum toxin can help with relieving of tension to allow scar remodelling and maturation. In all cases, accurate assessment of the scar type is still the first step towards correct treatment.

4. Surgical Scar Revision

Surgical revision involves excising the existing scar and re-closing the wound with meticulous technique to achieve a finer, better-positioned result. It is most appropriate for widened scars, scars with poor orientation relative to natural skin tension lines, and scars that have not responded adequately to non-surgical treatment. For keloid scars, surgical revision (see picture below) is combined with adjuvant treatment, typically steroid injection and silicone therapy, to reduce the risk of recurrence. In rare cases of multiply recurrent keloids, a light dose of radiotherapy may be considered following marginal excision (where a tiny bit of keloid is left behind to "trick" the body into thinking that it has not been fully removed, so that it is less likely to recur).

Ear keloid excision - Doctor Stitch, Singapore

Where simple excision and re-closure is insufficient (for example, where a scar is large, bound down to underlying structures, or located over a joint or cosmetically sensitive area), more complex reconstructive techniques may be required. These include skin grafting and local flap reconstruction, which bring healthy, well-vascularised tissue into the area to achieve a durable and cosmetically acceptable result. Newer techniques include intra-lesional brachytherapy but this has not gained widespread acceptance. The appropriate technique is discussed at assessment based on the specific characteristics of the scar and the patient's goals.

5. Microneedling and Nanofat

As an adjunct to surgery, microneedling stimulates collagen remodelling and can improve the texture and pliability of established scars. Nanofat grafting, the injection of processed fat containing stromal vascular fraction, is an emerging technique for improving scar quality, particularly in atrophic or bound-down scars. These treatments are provided directly or coordinated as part of a structured scar management plan.

What to Expect at Assessment

Scar assessment at Doctor Stitch begins with a focused clinical review of the scar, your healing history, and any previous treatments. Not all scars require active intervention. Some benefit most from a structured conservative programme, while others are best addressed surgically. Where multiple treatment modalities are appropriate, a staged plan is discussed and agreed with you before anything is started.

A photograph sent via WhatsApp in advance is helpful and allows Dr Ng to give a preliminary view on suitability and likely treatment direction before your appointment.

A Note on Timing

The timing of scar intervention matters. Most scars continue to mature for twelve to eighteen months after the original injury or surgery, and intervening too early, particularly with surgical revision, can produce a result no better than the original, or worse. Steroid injection and silicone therapy, however, are most effective when started early in the scar maturation process (if indicated). An early assessment allows the right treatment to be started at the right time, even if surgical revision is planned for a later stage.

Pricing

Pricing varies depending on the number, size, location, and complexity of the scar(s) using the Singapore MOH Table of Surgical Procedure (TOSP) fees as a guide. Consultation and follow-up, as well as medications and further tests (such as X-ray if joint contracture has developed), if necessary, are charged separately. A clear cost estimate is provided before any treatment is initiated.

Frequently Asked Questions

1. Can keloid scars be permanently removed?
Keloids are among the most challenging scars to treat and have a significant recurrence rate after any single treatment. The most effective approach combines surgical excision with adjuvant steroid injection and silicone therapy. Realistic expectations are an important part of any keloid treatment discussion. Significant improvement is achievable in most cases, but a guarantee of permanent removal cannot be given for keloid scars.

2. How many steroid injections will I need?
Most patients require a course of three to five injections at four to six week intervals, depending on the size and response of the scar. Improvement is usually visible after the first or second session.

3. Is surgical scar revision painful?
The procedure is performed under local anaesthesia and is not painful during the surgery itself. Post-operative discomfort is generally mild and manageable with simple analgesia. There is a period of wound healing after revision surgery during which the new scar will initially appear red before gradually fading.

4. How long does it take to see results from scar treatment?
This depends on the treatment. Steroid injections typically produce visible flattening within four to six weeks of the first session. Laser results develop over two to three months as collagen remodelling occurs. Surgical revision produces an immediate change in scar shape, with the final result visible at six to twelve months.

5. Will my insurance cover scar revision?
This depends on your policy and the indication. Scar revision for functional reasons - for example, a scar causing restricted movement - is more likely to be claimable than purely cosmetic revision. We can provide documentation to support an insurance submission where appropriate.

6. Can I be seen if my original surgery was done elsewhere?
Yes. We regularly assess and treat patients whose original surgery or injury was managed by another provider, whether locally or overseas. There is no obligation to have been a previous Doctor Stitch patient.

References

Ogawa R, Akita S, Akaishi S, Aramaki-Hattori N, Dohi T, Hayashi T, Kishi K, Kono T, Matsumura H, Muneuchi G, Murao N, Nagao M, Okabe K, Shimizu F, Tosa M, Tosa Y, Yamawaki S, Ansai S, Inazu N, Kamo T, Kazki R, Kuribayashi S. Diagnosis and Treatment of Keloids and Hypertrophic Scars-Japan Scar Workshop Consensus Document 2018. Burns Trauma. 2019 Dec 27;7:39. doi: 10.1186/s41038-019-0175-y. PMID: 31890718; PMCID: PMC6933735.
Ward J, Odili J. Dermatofibrosarcoma protuberans (DFSP) arising from a keloid scar: a case report. JPRAS Open. 2018 Oct 2;18:65-69. doi: 10.1016/j.jpra.2018.09.002. PMID: 32158839; PMCID: PMC7061627.
Mustoe TA, Cooter RD, Gold MH, Hobbs FD, Ramelet AA, Shakespeare PG, Stella M, Téot L, Wood FM, Ziegler UE; International Advisory Panel on Scar Management. International clinical recommendations on scar management. Plast Reconstr Surg. 2002 Aug;110(2):560-71. doi: 10.1097/00006534-200208000-00031. PMID: 12142678.
Ragoowansi R, Cornes PG, Glees JP, Powell BW, Moss AL. Ear-lobe keloids: treatment by a protocol of surgical excision and immediate postoperative adjuvant radiotherapy. Br J Plast Surg. 2001 Sep;54(6):504-8. doi: 10.1054/bjps.2001.3656. PMID: 11513512.
Chen Z, Gao J, Li L. New challenges in scar therapy: the novel scar therapy strategies based on nanotechnology. Nanomedicine (Lond). 2024;19(28):2413-2432. doi: 10.1080/17435889.2024.2401768. Epub 2024 Sep 26. PMID: 39325688; PMCID: PMC11492664.

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