Scar revision (unsightly scar, keloid)

A scar can become troublesome: too wide, raised, red, contracted to the point of limiting movement, or poorly placed. A keloid is a particular form: the scar keeps growing beyond the original wound, itches and can recur. It is more common on darker skin and in certain areas such as the chest, shoulders or ears. Scar revision most often involves removing the damaged scar and closing the skin with a fine suture, without tension. When a scar pulls on a joint or the face, plasty techniques (such as a Z-plasty) can change its direction and release the contracture. A scar never disappears: the aim is to make it finer, flatter and less visible. For keloids, surgery alone often leads to recurrence. It is therefore combined with other treatments: corticosteroid injections into the scar, pressure dressings, silicone sheets and sometimes radiotherapy. Before operating again, a recent scar must also be given time to mature, often a year or more. These points are explained in consultation. At Clinique Pasteur Tunis, scar revision is performed by a plastic surgeon, often under local anaesthesia and as a day case, with prolonged monitoring of healing.