Scar treatment / revision

A modest amount of research indicates that silicone gel sheets can reduce raised (hypertrophic) scars if worn regularly over the scar area for at least several weeks. While more research is needed to confirm and quantify these effects, this inexpensive simple method may be worth a try for a raised scar. This method seems to work better for freshly formed scars of modest size.

Chemical peels

Chemical peels, such as TCA or glycolic acid peels, are sometimes used to reduce acne scarring. To improve acne scarring, moderate (or stronger) chemical peels are usually needed. Such peels should be applied by a dermatologist or another comparably qualified health professional. See also our article on chemical peels.

Dermabrasion

Dermabrasion may be useful in reducing raised scars. Essentially Dermabrasion is a high-speed "sanding" with special abrasive materials. It also requires special equipment and usually involves local or general anesthesia.

Steroid injections

Hypertrophic and keloid scars can sometimes be reduced/flattened by injections of steroid hormones directly into the scar. This procedure is typically performed by a dermatologist or plastic surgeon. Usually several injections (performed at 4-6 week intervals) are required for noticeable improvement.

Dermal fillers

Atrophic scars can be treated with dermal fillers, which are injected to fill gaps and invaginations in the dermis. Some dermal fillers are based on biodegradable substances, such as hyaluronic acid or collagen, while other are synthetic polymers resistant to degradation. Biodegradable fillers tend to be safer because the consequences of misapplied injection often resolve spontaneously (injected substance gradually degrades on its own). The downside is that biodegradable fillers have to be injected repeatedly. Non-biodegradable fillers may produce a good permanent correction after a single treatment. On the other hand, the misapplication of a non-biodegradable filler may be more difficult to reverse. (For details on specific agents, see our section on dermal fillers.)

Laser revision

Laser-based methods are used in treating different types of scars. There are numerous variants of laser/light based scar treatments. Unfortunately, the research on their effectiveness and optimal use remains limited. Here are some of the more common approaches:

• Carbon dioxide lasers are used to vaporize excess tissue in hypertrophic and keloid scars.
• Carbon dioxide and/or Erbium:YAG lasers are sometimes used to recontour atrophic scars. (For details on specific methods, see our section on ablative laser resurfacing.)
• Vascular lasers can reduce the redness of the scar area. Vascular lasers work at the wavelength absorbed by hemoglobin, the oxygen carrying protein of the red blood cells. As a result, they can selectively ablate small blood vessels without damaging the surrounding tissue. (For details on specific methods, see our section on nonablative laser treatments.)
• Pulsed dye lasers, particularly at the wavelength 585 nm, are used to treat hypertrophic, keloid and even "normal" surgical scars. They seem to work by stimulating tissue remodeling (particularly recycling and more regular deposition of the skin matrix) thereby leading to smoother texture. Pulsed dye lasers also reduce redness because the 585 nm wavelength is close to the hemoglobin absorption maximum. (For details on specific methods, see our section on nonablative laser treatments.)
• Nonablative infrared lasers, fractional photothermolysis (Fraxel) as well as laser skin resurfacing (usually with carbon dioxide and/or Erbium:YAG lasers) are sometimes used to treat acne scars. (For details on specific methods, see our section on noninvasive treatments and the article on ablative laser resurfacing.)

Surgical revision

Scars can be treated by surgical excision or subcision. The procedure is called surgical scar revision. However, surgical intervention creates a wound, which results in some scarring of its own. Therefore, surgical revision is usually considered for relatively sizeable scars where the post-revision scar is likely to be much smaller than the original one.

Cryosurgery

Cryosurgery is sometimes used for hypertrophic and keloid scars. It works by freezing the top skin layers, which leads to blistering and necrosis of the scar tissue. A few small research studies indicate that cryosurgery may have better risk/benefit profile than regular surgical revision for well-selected cases of hypertrophic and keloid scars.