Scar Treatments

A scar is permanent connective tissue that forms during the repair of an injury affecting the dermis. Not all scars are the same: they can be flat, raised, depressed, red, dark, hard, painful, or contracted. Therefore, there is no single "scar treatment.".

Scar remodeling continues for months, and in some scars it may take 12-18 months or longer. Redness and hardening in the early stages may be normal. The timing of treatment varies depending on the type of scar; it is not necessary to wait 6 months for every scar.

In new scars, appropriate wound care, photoprotection, and the use of silicone gel or sheets in selected patients may be beneficial. There are systematic reviews showing that silicone may be beneficial in the prevention and treatment of hypertrophic scars; however, studies are limited by heterogeneity and bias.

For red scars, vascular-targeted lasers, especially PDL; for tissue and contracture components, fractional ablative/non-ablative lasers; and for sunken atrophic scars, microneedling, subcision, fractional laser, and selected filler methods can be used. The treatment is chosen according to the morphology of the scar.

In hypertrophic scars and keloids, multimodal approaches such as intralesional corticosteroids, 5-FU, silicone implants, compression, laser, and in some cases surgery may be necessary. Keloids and hypertrophic scars should be discussed in detail in P81.

Surgical scar revision does not completely erase the existing scar; it aims to create a new scar that is better oriented, thinner, or less taut. In contractures, surgical techniques such as Z-plasty can provide functional gain.