Scar Treatments

While the formation of scars is a normal and common part of the healing process, sometimes the new tissue that grows after an injury, surgery, or acne can become distressing.

Some scars develop into keloids. These are thick, raised scars that extend beyond the original area of the wound. They often appear on the earlobes, shoulders, cheeks or chest due to an over-production of type I and III collagen during the healing process. This differs from a hypertrophic scar, which remains inside the bounds of the original injury and may fade over time.

Acne scarring occurs when severe acne lesions, such as cysts or nodules, damage the skin’s underlying tissue. This damage leads to an abnormal healing process in which the body produces either too little or too much collagen, resulting in either depressed scars (atrophic) or raised scars (hypertrophic and keloid). Acne scars can be stubborn, but their prominence may be lessened through a range of treatments, from minimally invasive procedures to surgery.

In general, treatments that can help to reduce the prominence of scars include topical applications (like silicone gels and sheets), injectable therapies (such as steroids or fillers), various procedures (like laser therapy or microneedling), and in some cases, surgical interventions.

While prominent scars may be an aesthetic concern, they can also cause functional issues such as restricted movement, pain, and sensitivity in the affected area. To determine which treatment is best for you, discuss all your aesthetic and functional concerns during an in-depth consultation with your physician. Be sure to ask about all the benefits and risks of various procedures as you develop a personalized plan of care.

Here are some of the most common procedures that your dermatologist or plastic surgeon may recommend to lessen the prominence of scars. While non-surgical approaches may not render scars invisible, they can significantly enhance their appearance and texture, thus lessening distress or discomfort caused by the scar’s appearance.

• Topical treatments, such as silicone gels or sheets, can be applied to minimize scar thickness and discoloration in the early periods of development. These treatments work by creating a protective barrier over the scar, keeping it hydrated, and maintaining a favorable environment for healing.
• Chemical peels can improve the texture of scars by exfoliating the top layer of your skin. These treatments vary in their intensity and depth.
• Microneedling creates controlled “micro-injuries,” stimulating collagen production and remodeling scar tissue. This procedure requires multiple sessions to see results.
• Laser therapy is another non-surgical option in which various laser technologies can reduce redness, improve texture, and stimulate collagen production, resulting in smoother skin. Fractional laser treatments are often recommended one month after the initial event to help minimize scar formation.
• Injectable treatments, such as corticosteroids or dermal fillers, may flatten raised scars or improve volume irregularities.
• Dermabrasion is an intensive skin resurfacing procedure that can improve the appearance of raised scars.
• Subcision uses a needle or specialized tool to break up and release the fibrous bands tethering down a scar. This is particularly useful for acne boxcar scarring. It may require multiple sessions and simultaneous use of fillers or fat grafting to achieve optimal results.
• Skin grafting involves taking skin from another area of the body and grafting it onto a severely scarred area. This can be useful for extensive scarring associated with burns and other major injuries.
• Surgical scar revision provides a more robust alternative for addressing larger, more visible or deeper scars. Scar revision surgery can involve a linear excision, in which the scar is surgically removed and the skin edges are meticulously closed to create a finer, less noticeable line. Other techniques, such as Z-plasty or W-plasty, involve reorienting the tissue to minimize the scar’s appearance and improve its alignment with the natural skin folds.

Before you go

During your consultation with a dermatologist or plastic surgeon, they will assess your scar’s size, location, type, and maturity to determine the best treatment approach.

Key topics to discuss include the effectiveness and risks of proposed treatments, expected recovery time, potential side effects, and the number of sessions required. Additionally, you should inquire about your physician’s experience with similar scars, view before-and-after photos of previous patients, and ask about the costs involved. Understanding these factors helps set realistic expectations and ensures you receive personalized, effective care.

During the procedure

On the day of your scar treatment procedure, you will have another chance to review the planned approach with your physician.

For steroid injections, the area is cleaned, and the medication is injected directly into the scar to reduce inflammation and flatten it, typically without anesthesia. Laser treatments involve applying a topical anesthetic before using laser energy to resurface the skin and stimulate collagen production. Subcision, which breaks down scar tissue, and surgical repair, which involves excising the scar and reorienting the tissue, often require local anesthesia.

After the procedure, post-treatment care instructions will be provided to ensure optimal healing and results.

Scar Treatment Aftercare 

For less invasive scar treatments (i.e. steroid injections, microneedling), there is little to no downtime, and you can expect to see initial results within the first few weeks. Follow-up appointments and repeat treatments can occur as early as four to six weeks.

For more invasive treatments (i.e. subcision, surgical treatments), you can expect to have tenderness, swelling, and bruising that will be worse on the day following the procedure, with improvement on each day following.

If you have a surgical excision or skin grafting, downtime will depend on the type of sutures used and the location. Expect to take it easy for around two weeks by avoiding strenuous activity and heavy lifting.