Kare Plastic Surgery & Skin Health Center · Santa Monica & Los Angeles
Scar Revision Surgery in Los Angeles
Surgical Excision · CO2 Laser · Vbeam · Subcision · Atrophic & Hypertrophic Scar Treatment
Dr. Raffy Karamanoukian
A scar is not simply a cosmetic concern — it is a biological record of a wound that healed imperfectly, and in many cases that imperfect healing is not the patient’s fault or an unavoidable outcome of the original injury. It is frequently the direct consequence of a wound that was not closed correctly, not managed with the post-operative scar protocol that prevents thickening and discoloration, or not treated in the early vascular window when intervention produces the most complete improvement. Scar revision is the clinical discipline of correcting these suboptimal outcomes — using the precise combination of surgical technique, laser technology, injection therapy, and wound healing science that each scar type requires to achieve the most complete possible improvement.
At Kare Plastic Surgery & Skin Health Center at 804 7th Street in Santa Monica near Montana Avenue, UCLA School of Medicine graduate and dual board-certified plastic surgeon Dr. Raffy Karamanoukian, MD, FACS is a nationally recognized authority on scar revision surgery who treats the full spectrum of problematic scars — from atrophic acne and traumatic scars to raised hypertrophic and keloid scars, contracture scars limiting movement, and cosmetically visible surgical scars that patients carry as reminders of procedures they had precisely to improve their appearance.
Patient Result — Kare Plastic Surgery, Santa Monica
Forehead Scar Revision — Before & After
Actual patient of Dr. Raffy Karamanoukian · Darker skin tone · Individual results may vary
Scar Type Multiple traumatic forehead scars — darker Fitzpatrick skin type
Treatment Multimodal non-surgical scar revision protocol at Kare Plastic Surgery
Multiple traumatic forehead scars in a patient with darker skin tone — demonstrating Dr. Karamanoukian’s expertise in scar revision for Fitzpatrick skin types IV–VI where post-inflammatory pigmentation requires a specifically adapted treatment protocol alongside scar management
Why Scar Revision for Darker Skin Tones Demands Specialist Expertise
The before/after case above illustrates a clinical dimension of scar revision that is critically underrepresented in Los Angeles plastic surgery practices: scar treatment in patients with darker skin tones (Fitzpatrick types IV–VI). Patients with higher melanin density face a specific scar management challenge that does not exist in lighter-skinned patients — the same inflammatory response that drives scar thickening in any skin type simultaneously triggers melanocyte activation that produces post-inflammatory hyperpigmentation (PIH) in darker skin, creating a brown-to-black discoloration overlying the scar site that can be more visible than the scar architecture itself.
Laser choices, treatment parameters, and the sequencing of aggressive resurfacing treatments all require modification for darker skin types to avoid worsening hyperpigmentation. Dr. Karamanoukian’s management of scar revision in Fitzpatrick type IV–VI patients uses a pigment-protection protocol that prioritizes melanocyte stabilization alongside scar treatment — treating the pigmentation component and the structural scar component as distinct but co-managed processes rather than a single homogeneous scar problem.
12+ moMinimum scar maturation before elective surgical revision
4–6 wkOptimal Vbeam start window — early vascular scar phase
FitzpatrickSkin type assessment at every scar consultation — parameters adapted for all skin tones
MultimodalProtocol standard — single treatment rarely adequate for optimal results
Scar Types Treated at Kare Plastic Surgery Los Angeles
Atrophic Scars
Depressed, pitted scars from acne, chickenpox, or trauma where tissue volume was lost during wound healing. The skin surface sits below the surrounding level — the defining feature that distinguishes atrophic from hypertrophic scars. Ice-pick, boxcar, and rolling subtypes each require a different treatment approach.
→ Subcision, TCA Cross, CO2 fractional laser, filler, microneedling
Hypertrophic Scars
Raised, thickened, often red scars that remain within the original wound boundary. Driven by excessive collagen deposition during the proliferative healing phase. Most common after surgical closures under tension, burns, and lacerations in high-tension anatomical zones.
→ Vbeam laser, intralesional triamcinolone + 5-FU, scar excision, silicone therapy
Keloid Scars
Raised scars that extend beyond the original wound boundary, driven by aberrant fibroblast response. Higher prevalence in darker skin tones. Common on earlobes, chest, shoulders, and upper back. Require multimodal treatment and active recurrence prevention after excision.
→ Surgical excision + triamcinolone + 5-FU series + Vbeam post-excision protocol
Contracture Scars
Scars that tighten the overlying skin and underlying tissue, restricting movement. Most commonly following burns, but also from lacerations across joint surfaces. May require Z-plasty or W-plasty geometric rearrangement to release the contracture and restore functional range of motion.
→ Surgical Z-plasty / W-plasty, contracture release, skin grafting for severe cases
Traumatic / Facial Scars
Scars from lacerations, accidents, dog bites, or falls that were closed in an emergency setting without the cosmetic emphasis of a plastic surgeon. Wide, irregular, hyperpigmented, or depressed scars from suboptimal primary closure are among the most common scar revision presentations at Kare Plastic Surgery.
→ Surgical excision and re-closure, geometric scar revision, CO2 laser, Vbeam series
Post-Surgical Scars
Scars from prior surgeries — facelift, rhinoplasty, breast surgery, abdominoplasty, Cesarean section — that healed with greater visibility than the patient was led to expect. Early intervention with Vbeam and silicone produces the best outcomes; established wide or raised scars require surgical revision with deep tension-relieving closure.
→ Vbeam (initiated at 4–6 weeks), silicone, scar excision and re-closure, CO2 resurfacing
Scar Revision Options: Surgical and Non-Surgical
| Treatment |
Scar Type |
Mechanism |
Downtime |
| Surgical Excision & Re-closure |
Widened, irregular, hypertrophic, contracture |
Remove scar, re-close with layered tension-free technique |
7–14 days |
| Z-plasty / W-plasty |
Linear contracture, visible direction mismatch |
Geometric rearrangement to break scar line tension |
7–14 days |
| Vbeam 595nm Laser |
Red, raised, hypertrophic, post-surgical erythema |
Selective photothermolysis of scar vascularity |
None–minimal |
| CO2 Fractional Laser |
Atrophic, textured, post-acne, post-traumatic |
Ablative fractional resurfacing — collagen remodeling |
5–10 days |
| Subcision |
Rolling and boxcar atrophic scars |
Needle releases tethering fibrous bands below scar |
2–5 days (bruising) |
| TCA Cross |
Ice-pick and deep boxcar acne scars |
High-concentration TCA induces focal collagen remodeling in scar base |
5–7 days |
| Intralesional Triamcinolone + 5-FU |
Hypertrophic, keloid, raised active scars |
Anti-fibrotic + anti-inflammatory fibroblast suppression |
None |
| Morpheus8 RF Microneedling |
Atrophic, textured, stretch marks |
RF energy stimulates deep dermal collagen remodeling |
3–5 days |
The Right Choice: Plastic Surgery Scar Revision Los Angeles
General Dermatologist
- Appropriate for non-surgical scar management — laser, injection, topicals
- Limited training in surgical scar excision and geometrical revision
- No Z-plasty or W-plasty training in dermatology residency
- Standard single-layer skin closure without deep tension management
- No reconstructive flap or tissue rearrangement training
- Cannot perform surgical excision and re-closure in complex anatomical locations
✓ Plastic Surgeon — Dr. Karamanoukian at Kare
- Full surgical and non-surgical scar revision spectrum in one practice
- Z-plasty, W-plasty, geometric scar revision — formal UCLA reconstructive training
- Advanced layered deep dermal suture technique at every excision site
- Vbeam + CO2 + Morpheus8 + subcision + TCA Cross all available at Kare
- Fitzpatrick skin type assessment and adapted protocols for all skin tones
- Post-surgical scar management integrated into every operative case
“Scar revision is not one procedure. It is a diagnostic process first — understanding why this scar looks the way it does, what biological process produced it, and which of the available interventions addresses that specific mechanism. A scar that formed because of tension needs a different solution than one that formed because of vascularity, or atrophy, or pigmentation. Applying the correct treatment to the correct mechanism is where results come from.”
Dr. Raffy Karamanoukian · Kare Plastic Surgery, Santa Monica · Near Beverly Hills
Expectations: Scar Revision Consultation at Kare Surgery
Scar Assessment & Classification
Dr. Karamanoukian evaluates every scar against a comprehensive clinical framework: scar type (atrophic, hypertrophic, keloid, contracture, pigmented), age and maturation stage (active vs. mature), Fitzpatrick skin type and post-inflammatory hyperpigmentation risk, anatomical location and tension forces acting on the scar, and the patient’s prior treatment history. This classification directly determines the treatment recommendation — no scar is treated with a templated protocol, every plan is individualized to the specific biology of the scar in front of him.
Treatment Sequencing & Staging
Most optimal scar revision outcomes require a staged, sequential approach rather than a single-session treatment. The sequence matters: Vbeam before CO2 (address the vascular component before resurfacing), subcision before filler (release tethering before restoring volume), surgical excision before laser (structural correction before surface refinement). Dr. Karamanoukian designs a staged treatment plan that deploys each modality at the correct point in the healing and treatment sequence to produce additive rather than redundant results.
Timing: When to Revise
For post-surgical and post-traumatic scars, the optimal timing for different interventions differs significantly. Vbeam is initiated at 4–6 weeks (active vascular phase — most responsive). Surgical excision and re-closure is deferred until 12–18 months after the original wound (full scar maturation required before excision produces predictable results). CO2 laser is most effective after the active vascular phase has subsided — typically 6–12 months after injury. Dr. Karamanoukian communicates explicit timing recommendations for each modality at the initial consultation.
Post-Treatment Scar Management Protocol
Every scar revision treatment at Kare Plastic Surgery is followed by a structured post-treatment protocol: silicone gel or tape for scar hydration and TGF-β suppression; SPF 50+ sun protection for all treated areas (mandatory for pigmentation-prone skin types); Vbeam maintenance sessions for any residual erythema; and topical retinoid and brightening agents for post-inflammatory hyperpigmentation management in darker skin tones. The post-treatment protocol is often as important as the treatment itself in determining the final scar quality.
Frequently Asked Questions About Scar Revision Surgery in Los Angeles
When is the right time to have scar revision surgery?
The timing for scar revision depends on the scar type and the intervention planned. For early, active red scars: Vbeam laser can begin at 4–6 weeks after wound closure. For surgical excision and re-closure of established scars: we usually like to wait until the scar has settled. Operating on an immature scar before maturation produces unpredictable results because the tissue architecture is still actively changing. Dr. Karamanoukian provides specific timing recommendations for each type of scar.
Can a scar be completely removed?
Our goal is to reduce the visibility of your scar. We desire a meaningful improvement in scar quality: reducing visibility, improving contour, normalizing color and texture, and achieving a result that is significantly less conspicuous than the presenting scar. The degree of improvement achievable depends on the scar type, anatomical location, skin type, and the specific techniques employed. At the initial consultation, Dr. Karamanoukian provides a realistic assessment of the degree of improvement achievable for each patient’s specific scar presentation.
Does scar revision work on darker skin tones in Los Angeles?
We have protocols adapted for the specific risks of darker skin. The key modifications are: avoiding aggressive ablative laser treatments (high-fluence CO2 or erbium) and parameter reduction for Fitzpatrick types IV–VI; pre-treating with pigment-stabilizing topicals before treatment if there is a risk of hyperpigmentation; and incorporating topical retinoids and brightening agents to manage post-inflammatory hyperpigmentation concurrently with scar treatment.
Related Resources at Kare Plastic Surgery
Kare Plastic Surgery & Skin Health Center · Near Montana Avenue, Santa Monica
Schedule a Scar Consultation
Schedule a consultation with Dr. Raffy Karamanoukian, a graduate of the UCLA School of Medicine and dual board-certified plastic surgeon — a nationally recognized scar revision authority treating atrophic, hypertrophic, keloid, traumatic, and post-surgical scars in Los Angeles and Santa Monica.