Scars are magnified in visibility by four main causes; they are too wide, they have surface irregularities (scar level above or below the surrounding skin level), they have unnatural color to the surrounding skin (brown pigment, white scar, or red due to small blood vessels), or they lie unnaturally against the relaxed skin tension lines. Most scars have one or more of these problems.
As a result of the different reasons for prominent scarring, surgical scar revision is really the use of a variety of different surgical techniques to address the specific components of the scar problem. There is no one universal surgical scar revision technique. Scar revision techniques consist of either simple excision and reclosure or some form of geometric rearrangement. These scar revision techniques are primarily based on changing the orientation and shape of the scar through an angular geometry approach.
Scar revision techniques have a long history in plastic surgery and are used as much today as they were many decades ago. While many patients think of scar revision as being done with a laser, like a magic eraser, the reality is that surgical excision and rearrangement of adjacent tissues is often more effective and is the backbone of most scar revision approaches. Such scar revision techniques often have names that visually describe how the scarred tissues are rearranged.