the best treatment
for scars is a lot easier than it used to be. While they
cannnot always be completely fixed, the appearance of scars can be
improved through many of the methods listed below. Scar appearance and
treatment is based on the type, size, depth, blood supply to skin area,
thickness and scar color.
Scars are broken down into components such as the color, elevation or depression. Brown or red color dictates the type of laser used. If the scar is elevated it is probably a Keloidal or Hypertrophic scar. These scars can be injected, lasered or even treated with Botox. If a scar is depressed, it can be elevated with fillers.
For acne pimples that leave scars, lasers, fillers, and techniques such as PRP (platelet rich plasma) can be used to fill in scars making skin look younger and better.
Scars can also be removed surgically and grafted. Lasers can then be used to make the scars less visible. Most treatment plans use more than one method.
If you have just gotten a scar, talk to your Doctor about wound care during the healing process as this can help.
In addition to methods described above there are many other techniques for scar treatment such as steroid injections to reduce inflammation and dermabrasian (sanding off the scar). There are also a number of over the counter products on the market that will improve the look of your scars in a very short time.
Don't live with scars since there are many new approaches to minimizing and camouflaging their appearance."
Video: Treatment for Scars
Dr. Lycka, a cosmetic surgeon, discusses the latest approaches of treatment for scars and scar correction. He discusses how lasers, fillers and platelet rich plasma can be used to fill in scars to make skin look younger and better.
Scars Treatment Depends On Type
To understand what treatment for scars will best work for you, you need to know or understand how your scar is classified. The same classification is used for acne scars (acne vulgaris).
The four scar types are:
Pale, brown or red flat marks
Mild Atrophic and Hypertrophic Scars
Raise or sunken scars. Not visible at distances of 50 cm or more
Moderate atrpphic and hypertrophic scars
Visible at distances of greater than 50 cm, can be camouflaged or evened out by skin stretching
Severe atrophic and hypertrophic scars
Visible at distances greater than 50 cm, difficult to camouflage or hide, does not even out when skin is stretched
Scars are also classified by severity:
Keloid Scars are the result of healing gone awry with the production of too much collagen. The scar goes beyond the injury site forming thick mounds of scar tissue that are darker than surrounding skin.
Asians and blacks are prone to these types of scars. The scars do not regress over time and can occur anywhere on the body
Keloid Scar Treatment
Steroid Injections (intralesional corticosteroids) are used to stop the formation of collagen and to reduce inflammation. An alternative is an injection of Five-flourouracil (5-FU). Surgerical excision is also an option if injections fail. Surgical revision can also be used to reshape a scar area with skin grafting or scar-lengthneing flaps.
Treatment will also help with symptoms such as itch and redness.
Hypertrophic Scars are raised, red and thick scars that stay within the area that was injured. They are similar to Keloid scars, but do not extend beyond the injury site. These types of scars occur in people that have a fair complexion.
The scars may regress over time and are more common on the ankles, knees and shoulders. Collagen tends to be thin.
Hypertrophic Scar Treatment
- Steroids are the mainstay treatment. A Doctor may recommend injecting steroids into the scar site. It can be used along with other treatments. Sometimes an injection is proceeded by light cryotherapy to improve distribution of the steroid.
- Pulsed Dye Laser: studies show encouraging results. It words by decreasing the proliferation of fibroblasts and collagen fibers.
- Crotherapy using liquid nitrogen improve scar appearance, particularly in smaller and younger scars.(1)
- Surgery may aid healing or to improve the appearance of the scar area.
- Using Silicone Gel is also one of the move effective and common solutions. It is not fully understood why it works.(1) The gel is applied for 8 weeks, 2x a day, for as long as 12 to 16 weeks.
- Surgery is used to correct large facial scars. Techniques include skin grafts and transpaltns
- Topical over-the-counter products such as the all-natural Revitol can be used to improve cosmetic appearance.
Other acne scar treatment approaches:
- Elastic compression
- Intralesional injection of 5-fluorouracil
Contractures are the result of scar maturation and aren't a classification per se. These types of scars are usually the result of a burn or major injury (called scar contraction). These types of injuries cause the skin to tighten, which pulls the scar edges together. It may affect the deeper tissues, muscles and nerves, hindering the patients movement.
Contracture Scar Treatment
Surgery is commonly used for contracture scars. The scar is surgically removed and then replaced with a skin graft using techniques called W or Z plasty.
Other approaches include scar resurfacing, where lasers (light) or dermabrasian (sanding) are used to improve the appearance of the scar by smoothing it out.
Scars that are lower than than the skin surface can be improved with collagen injection.
Acne Atrophic Scars
Acne scars come in as many forms as the kind of acne you may have. Scars may range from pitting to wavelike scars. They form in areas with the underlying condition.
Treatment depends on the type of acne scars you have:
- Rolling Acne Scars: Looks like raised waves or broad sloping edges.
- Boxcar Acne Scars: Pores dot the skin. Sharply defined edges.
- Icepick Scars: look like small skin punctures, are narrow with deep sharply marginated tracts that extend vertically to deep in the skin. Visibly narrow and pitted.
- Hypertrophic and Keloidal: thick and lumpy scars
Acne Scar Treatment
To hide acne scars, several acne scar treatment methods are available including:
- Scar cream and fillers
- Skin Needling: Needling punctures the skin using a roller containing sharp needles. The needles penetrate the skin, developing multiple microbruises that trigger growth and collagen production. Results start to be seen in 6 weeks and will improve over 12 months. Most patients see some improvement.
- Surgery to reduce size of scars so they can heal or dermal grafting or face lifting. Grafts are used on a bed of scar tissue They are used to repair unstable scars or to camouflage acne scars.
- Tissue augmentation: There are many agents that can be injected into scars.
- Laser skin resurfacing (deep boxcar scars) such as Fractional photothermolysis. Patients with rolling scars or box-car scars are candidates for laser treatment. There are different types of lasers (ablative, nonablative) that are used depending on the scar. Ablative Lasers help to abrade the surface of the scar and tighten the collagen fibers. Nonablative lasers do not remove tissue, but help stimulate new collagen formation and tighening of the skin.
Scar revision surgery is frequently used via laser (ablative laser, erbium YAG and carbon dioxide). PDL lasers (Pulse Dye Laser) can help to improve skin color.A new type of laser INTRAcel has produced good results using a microneedle. The Plasma needle has also shown good results.
- CO2 laser resurfacing is also used to treat acne scars wiht a 50% to 80% improvement (1). Non-ablative lasers have fewer side effects and have become more popular.
- Fractional photothermolysis is a new laser skin therapy which creates microscopic thermal wounds to achieve uniform thermal damage at a specific skin depth. It is particularly effective in the treatment of acne scars and on dark skinned individuals where hyperpigmentation (skin color change) is a risk.
- Deep acne scars can be treated with what is called the punch technique.
- Chemical peels: application of chemicals to the skin to destroy the outer damaged layers. Best results are seen in rolling, icepick and macular scars. Several hydroxy acids are used such as Glycolic acid, Jessner's solution, Pyruvic Acid, Salicylic Acid (one of the best peeling agents for acne scars), Trichloroacetic Acid.
- Microdermabrasian (removes outer skin layer) and Dermabrasian (gradual removal of outer skin layer with blade) Both are facial resurfacing techniques that remove damaged skin in order to promote the formation of healthy skin. Both approaches are highly effective in the treatment of scars (1).
Microdermabrasian can be repeated in short intervals, does not require anesthesia and is painless with less severe and rare complications than Dermabrasian.
- Combined Therapy: This approach combines two therapies, peeling and then subcision or removal. The therapy takes 12 months with both procedures taking place 2 to 3 months apart.
Hypertrophic or keloid acne scars tent to reappear after treatment, even when the treatment is effective.
Video: Platelet Rich Plasma Treatment
How PRP or Platelet Rich Plasma can be used to treat acne scars.
You will always have your scar(s), as they are a natural function of your body healing after an injury. Several factors that will have an impact on the characteristics of the scar include the size of the wound, how deep it is, where it is located on your body, your age, sex and ethnicity. These factors will dictate how your scar heals.
In other words, no two people will react the same way when healing, and no two people will have the same kinds of scars or need the same kind of treatments. Scars are as unique as we are as people, despite that fact that they may all look alike.
Some scars may stretch and pull the skin, some may be almost invisible, some may be pitted and disfiguring and some may be overgrown past the injury site.
Scars may also be accompanied by other syjmptoms such as pruritus (itch), pain and tenderness.
Treatment for Scars 1 Week After Surgery
This scar home remedy is to help keep scar tissue from forming.
- 1/4 teason turmeric
- 1/4 teaspoon myrrh
- Pinch of saffron
- Mix above with warm water and honey if needed for sweetness. Drink mixture 2x per day.
Treatment for Scars after They Have Formed
Scar treatment options range from over the counter topical products, surgery, injections and more. While scars can't be eliminated, the goal is always the same, to improve skin appearance.
Scar treatment is based on the scar type:
Use topicals along with silicone based gels. Lasers can be used (fractional, vascular and pigment)
Microneedling and lasers (pigment, vascular and fractional)
Possible case for scar revision. Fractional and ablative lasers.
The most popular options that are used for treatment for scars are described below:
Scar Creams and Coverups
Creams and over the counter scar treatments are primarily used for scars caused by an injury, surgery or a skin trauma or wound.
- Over-the-counter or prescription creams, ointments or gels: can help to reduce the appearance of scars. Popular products, such as Revitol use all-natural
ingredients to fortify the skin with proteins and vitamins in order to
reduce the appearance of scars caused by acne and burns.
is the #1 Doctor and pharmacist recommended choice for making scars
less noticeable through softening and smoothing.. It is used to reduce
the appearance of acne scars, burn scars, surgical scars, and scars
- Calendula Gel or Cream: this product is made from flowers that can reduce inflammation and promote wound healing..
Scar Itch Treatment
Products for scar itch treatment include over the counter antihistamine creams and hydrocortisone cream.
Scar Revision (Surgical Options)
When a scar is more visible, such as a deep scar or burn then surgical procedures are often the best treatment for scars choice. Surgery works best on scars that are long or wide. Surgery is often used together with steroid injection.
- Laser surgery (ablative laser resurfacing or non ablative laser). An ablative laser erodes the skin A non ablative laser leaves the outer layer of the skin untouched. Lasers are used along with other treatments.
Side effects of scar laser surgery or swelling, infection and redness It can also cause skin crusting, scaling and peeling. Skin can swell for one week after treatment. Darker skin individuals have a risk of a change in skin color.
- Surgical removal or excision: this approach is not often used, as it can result in a larger scar forming when the surgical removal heals. Microdermabrasion is a similar procedure where crystals are "blasted" against the skin to shape the surface.
- Skin grafts: skin is moved from another area of the body to the scar area, such as when a person's skin is burned.
- Dermabrasion (skin planing): in this type of procedure the skin is frozen and then sanded down.
If a scar goes beyond the boundaries of a wound, it is referred to as a Keloid scar or Hypertrophic scar. For these types of scars, a Doctor might recommend treatment for scars that use steroid injections. This type of therapy helps to reduce scar redness, flattens the scar and helps with symptoms such as itch.
- Steroid injections such as gluccorticoids can help to reduce scar sensitivity and size.
- Cryotherapy: the scar is frozen using nitrogen and then injected with triamcinolone.
- Collagen injections or restylane vital can be used to fill in a scar skin depression.
- Other “filler” injections
Other Treatment Options
- Silicone gel sheeting is a method where a thin plastic sheet is used to seal moisture into the scar. These covers are available over the counter in products such as ScarAway. The sheets help to reduce itch, redness and thickness.
- Massage: A massage therapist or yourself can use a technique called "rolling" to break off scar tissue from scars that have healed. The therapist will start at one end of the scar and using a pinch between forefinger and thumb, move up the length of the scar, rolling the scar between the fingers. Do this for 1 to 2 minutes for new scars and 3 to 4 minutes when treating older scars. Apply vitamin E oil after each rolling treatment. Do not continue if the scar area worsens in terms of soreness or redness.
- Aromatherapy: Among the natural treatment for scars is this scar aromatherapy suggestion. Rose hip seed oil can be helpful in treating scars such as chickenpox scars and keloids (large elevated scars).
- 1 ounce of rose hip seed oil
- 1 drop of rose oil
- 2 drops everlast oil (also called immortelle or helichrysum
Store oil mixture in a dark glass bottle. Apply to scar after shower or bath.
Important: Note that oils can cause skin irritation in people with fair or freckled skin, so be sure to test a bit on an out of the way skin area using a cotton ball before regular use. Apply to the inside of your wrist or inner elbow covered with a band aid for 24 hours. If no irritation occurs, then you are not sensitive to essential oils.
- Vitamin E: This vitamin can be purchased in a Vitamin E oil that is rubbed directly on a scar. Note that in some cases Vitamin E will have no benefit and may worsen the scar's appearance. Check with your Doctor before trying this approach.
- Cocoa butter: Cocoa Butter such as Palmers can help to smooth and blend the appearance of Scars into surrounding skin areas.
- Onion Extract: Onion extract is an anti-inflammatory. One study shows that onion extract is no more effective than over-the-counter treatment options.
If you have had surgery, be sure to consult with your Doctor regarding treatment for scars options. If you see your scar changing in appearance or bleeding, be sure to consult a Doctor.
by: Andrew C. Krakowski MD; Christine R. Totri MD; Matthias B. Donelan MD
by: Carol C. Williams; MD; Sandy De Groote; MLIS
by: Daniel Chang, Medical Director, Academy of Aesthetic Medicine, Korean Medical Aesthetics Clinic
Treatment for Scars References:
(1) Acne Scare: Pathogenesis, Classification and Treatment. Gabriella Fabbrocini, M. C. Annunziata, V. D’Arco, V. De Vita, G. Lodi,, M. C.Mauriello, F. Pastore, and G.Monfrecola; 17 March 2010, Dermatology Research and Practice, Volume 2010, Article ID 893080, 13 pages
(2) Management of Acne Scarring; Daniel Change, October 15, 2017, Academy of Aesthetic Medicine, Korean Medical Aesthetics Clinic, Singapore
Gale Encyclopedia of Medicine; Swain, Liz; Longe, Jacqueline L.