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, and surgery with fat grafting.
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.
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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.
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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.
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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.
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2. Lasers
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.
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3. 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.​
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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 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.
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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.
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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.
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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 lesion in accordance with Singapore MOH Table of Surgical Procedure (TOSP) fees. Consultation and follow-up, as well as medications and further tests (such as X-ray and/or CT, MRI), if necessary, are charged separately. A clear cost estimate is provided before any treatment is initiated.
Frequently Asked Questions
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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.
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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.
To arrange an assessment, contact us via WhatsApp.
Same-day appointments are available subject to scheduling.
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