Types of Spinal Scars · Los Angeles
Types of Back and Spinal Surgery Scars Treated at Kare
Not all spinal surgery scars look or behave the same way. Understanding the scar type guides the selection of the most effective treatment approach.
Wide or Spread Scars
Wide or spread scars result when the edges of the surgical incision are pulled apart during healing by the constant movement and tension of the back musculature. These scars may be pale or flesh-colored but become highly visible because of their width. Surgical excision with layered, tension-free closure is the primary treatment for wide spinal scars, repositioning the wound edges under minimal surface tension to produce a narrower final scar.
Hypertrophic Scars
Hypertrophic scars are raised, red, and firm, but remain within the original incision boundary. They develop most frequently in areas of high tension such as the upper and mid back and are more common in patients who are genetically prone to overactive collagen production. Steroid injections, Vbeam pulsed dye laser, and fractional CO2 laser are the primary treatments, and surgical excision with improved closure is used when the scar has not responded to non-surgical management.
Keloid Scars
Keloid scars from spinal surgery extend beyond the incision boundary and continue to grow over time. The back and shoulders are among the most keloid-prone areas of the body. Spinal surgery keloids require combination treatment including surgical excision, postoperative steroid injections, laser therapy, and in some cases radiation therapy. Learn more on our keloid treatment page and our keloid surgery page.
Contracture Scars
Contracture scars tighten across the back, restricting the range of motion and causing pulling, discomfort, or limited flexibility during bending and lifting. Z-plasty and W-plasty are the preferred surgical techniques for releasing contracture along the spine, as they redirect the scar across a different tissue plane and interrupt the linear tension that causes the restriction.
Symptomatic Scars
Many patients with spinal surgery scars experience persistent itching, aching, sensitivity to touch, or pain in and around the scar. These symptoms result from abnormal nerve regeneration within the healing scar tissue and from the ongoing inflammatory activity in hypertrophic and keloid scars. Treatment of the underlying scar type reduces symptoms in most cases, and neuroma excision is considered in cases of localized, point-tender nerve pain beneath the scar.
Discolored or Pigmented Scars
Spinal surgery scars can develop post-inflammatory hyperpigmentation or remain persistently red due to ongoing vascular activity. Vbeam pulsed dye laser specifically targets the red color and excess vascularity in these scars. CO2 laser resurfacing addresses surface texture and pigmentation irregularities. Chemical peels are used as adjuvant treatment for diffuse discoloration in the scar area.
Kare Plastic Surgery · Santa Monica, Los Angeles
Schedule Your Spinal Scar Revision Consultation with Dr. Karamanoukian
Surgical and Laser Scar Revision Techniques for Spinal Surgery Scars
Dr. Karamanoukian selects the technique or combination of techniques based on a thorough evaluation of the scar type, its location along the spine, its age, and the patient's skin tone and history. The four primary approaches used at Kare Plastic Surgery for spinal and back surgery scars are described below.
Surgical Excision and Re-closure
Surgical excision removes the existing scar in its entirety using a precisely planned fusiform or elliptical incision. The wound is then closed in meticulous layers using deep absorbable sutures to eliminate surface tension, which is the primary factor responsible for scar widening after spinal surgery. The superficial skin is closed with fine sutures or skin adhesive strips that minimize the risk of suture mark scarring. Excision is the most effective treatment for wide spinal scars, persistently raised scars that have not responded to non-surgical treatment, and scars where the original closure was of poor quality. The orientation of the excision is planned along relaxed skin tension lines whenever possible to position the final scar in the most favorable direction.
Z-Plasty for Contracture and Scar Redirection
Z-plasty is a surgical technique in which two triangular tissue flaps are created at angles on either side of the scar. When these flaps are transposed, they change the direction of the scar along the spine, interrupt the straight-line tension that causes tightness, and lengthen a contracted scar to restore normal skin flexibility and movement. Z-plasty is particularly useful for long, linear spinal scars that feel tight during bending, for scars that have crossed the midline at an unfavorable angle, and for any scar that is restricting the normal range of motion of the back and torso. W-plasty is a related technique that creates multiple small interdigitating flaps along the scar length for a similar redirection effect without a single long flap.
Fractional CO2 Laser Resurfacing
Fractional CO2 laser resurfacing creates thousands of tiny micro-columns of controlled ablation in the scar tissue, removing damaged collagen while leaving surrounding tissue intact. The surrounding skin responds by producing new collagen and elastin that fills in the treated columns and progressively smooths, flattens, and remodels the scar surface. CO2 laser is particularly effective for raised or textured spinal scars where the surface irregularity is the primary concern. It can be used as a standalone treatment for mild to moderate scars, and is frequently combined with surgical excision in a sequential program where excision addresses the structural scar and laser refines the surface result in the months following surgery. Downtime for CO2 laser is approximately one week.
Vbeam Pulsed Dye Laser
The Vbeam laser delivers pulsed light energy in the 595 nm wavelength that is selectively absorbed by the oxyhemoglobin in the blood vessels within a scar, causing those vessels to collapse and reducing the red or pink color that makes many spinal surgery scars so visible. Beyond improving color, Vbeam laser also reduces the inflammatory activity within the scar that drives ongoing redness, hypertrophic growth, and itching. Multiple sessions are typically needed, spaced four to six weeks apart, and Vbeam is most effective for red, vascular, early or actively maturing scars. It is frequently combined with steroid injections for an additive effect on raised, red hypertrophic spinal scars, and with CO2 laser for a comprehensive surface improvement protocol.
Steroid Injections
Intralesional triamcinolone injections are delivered directly into raised, hypertrophic, or keloid spinal surgery scars to suppress the fibroblast activity and inflammatory response driving collagen overproduction. The injections flatten and soften raised scars over a series of sessions spaced four to six weeks apart and are frequently combined with laser treatment for an additive effect. Steroid injections can be started early in the post-surgical healing period, typically six to eight weeks after the spinal procedure, to help suppress abnormal scar growth before it becomes established. Intraoperative steroid injection at the time of surgical scar revision also significantly reduces the risk of the hypertrophic scar reforming after excision.
Silicone and Compression Therapy
Medical grade silicone sheets or gel applied daily over a healing or maturing spinal scar help maintain moisture at the surface and reduce the inflammatory activity that drives collagen overproduction. Silicone therapy is most effective when started early and used consistently for at least two to three months, but has also been shown to improve more mature scars. Compression garments or binders over the back and torso add a mechanical suppressive signal to the healing scar tissue. Dr. Karamanoukian recommends silicone therapy as a daily home treatment used between in-office procedures at Kare Plastic Surgery to support and extend the results of each session.
Timing of scar revision after spinal surgery: Most plastic surgeons recommend waiting six to twelve months after spinal surgery before pursuing formal surgical scar revision, to allow the scar to mature and to determine how much it will improve on its own. Laser treatments and steroid injections can be started earlier, typically at six to eight weeks, to actively guide the scar during its most active remodeling phase. Dr. Karamanoukian at Kare Plastic Surgery evaluates each scar individually and advises on the most appropriate starting point for treatment. Call (310) 998-5533.
"A scar from spine surgery is a reminder of something serious that the patient went through. My responsibility is to take that reminder and make it as inconspicuous as possible."
— Dr. Raffy Karamanoukian · Board-Certified Plastic Surgeon · Kare Plastic Surgery, Los Angeles
Frequently Asked Questions
When should I have my spine surgery scar revised?
Most plastic surgeons recommend waiting at least six to twelve months after spinal surgery before pursuing formal scar revision, to allow the scar to mature. Non-surgical treatments such as steroid injections, laser therapy, and silicone sheets can be started earlier, typically six to eight weeks after surgery. Dr. Raffy Karamanoukian at Kare Plastic Surgery evaluates each scar individually and advises on the most appropriate timing. Call (310) 998-5533.
What is Z-plasty and how does it help spinal scars?
Z-plasty is a surgical technique in which two triangular tissue flaps are created on either side of a scar and then transposed, changing the direction of the scar, releasing contracture tension, and interrupting the straight-line appearance that makes scars most visible. For long midline back scars that are tethered, tight, or running against natural skin tension lines, Z-plasty can significantly improve both appearance and flexibility. Dr. Karamanoukian performs Z-plasty at Kare Plastic Surgery in Los Angeles. Call (310) 998-5533.
Does scar revision remove the scar completely?
No scar can be completely removed. Scar revision aims to make the scar less visible, less raised, less symptomatic, and better aligned with natural skin lines. Patients who have realistic expectations consistently report high satisfaction with their results. Dr. Karamanoukian at Kare Plastic Surgery sets clear, honest expectations at every consultation. Call (310) 998-5533.
Is back surgery scar revision covered by insurance?
Scar revision may be covered by PPO insurance when the scar is causing functional problems such as restricted range of motion, pain, contracture, or wound breakdown, rather than being purely cosmetic. Dr. Karamanoukian's team can assist with documentation for insurance review in appropriate cases. Call (310) 998-5533 at Kare Plastic Surgery in Los Angeles.
How many treatment sessions are needed for a spinal scar?
The number of sessions depends on the type of scar and the treatments used. Steroid injections are typically given every four to six weeks for three to six months. Vbeam laser requires three to five sessions for most patients. Surgical excision is usually a single procedure, followed by a postoperative maintenance program of injections and laser. Dr. Karamanoukian designs each patient's program individually. Call (310) 998-5533.
Schedule Your Spinal Scar Revision Consultation