This chapter focuses on the operative techniques for scar revision. All surgical incisions result in some sort of scar, and the various revision techniques trade a cosmetically unacceptable scar for one that is more acceptable to the patient. It is important for the reconstructive surgeon to have an understanding of the various scar revision technique principles, especially if the surgeon routinely performs advanced reconstructive procedures. If the revision surgery is performed prematurely, disruption of collagen, capillary and lymphatic maturation can adversely affect the final result. Revision surgery may not even be necessary for some elevated scars that are massaged with pressure over a few months. Careful assessment of the existing scar allows the surgeon to decide which scar revision technique will ultimately be most beneficial for the patient. Scar assessment, time to revise a scar, fusiform excision, trapdoor deformity repair, Z-plasty, running W-plasty, V-to-Y advancement flap are also discussed in this chapter.