Scar revision treatments

About scars

Every time your skin and the tissue beneath it gets cut or damaged, it heals with a scar. Scars can happen outside and inside your body. For example, you may have a scar on your skin after an injury, but you can also have scars in deeper tissues or on your internal organs where a cut has been made during surgery. This factsheet focuses on external skin scars only.

Causes of scars

Any damage to your skin can cause a scar, including:

  • acne
  • chickenpox
  • burns
  • cuts or grazes
  • surgery

Usually, the worse the initial damage to the tissue is, the worse the scar will be. Your skin colour, age and site on your body all affect how your wound reacts to damage.

Types of scars

There are several different types of scars.

  • Sunken or pitted (atrophic) scars. This type of scarring is often caused by acne or chickenpox.
  • Scars that tighten your skin and affect your ability to move (contracture scars). Burns and implants can cause this type of scar.
  • Red and lumpy (hypertrophic) scars. You may get this type of scarring after surgery. They usually fade and soften on their own, but this may take years.
  • Red, lumpy, and sometimes painful and itchy scars that extend beyond the original injury (keloid scars). These may never go soft or flat on their own.
  • Stripy or silver scars (stretch marks). These are caused by a sudden growth spurt or pregnancy in women.

Deciding on treatment for scars

It’s important not to rush into a decision to have scar revision treatment. You may find it helpful to discuss your options with a clinician who is suitably qualified. Before deciding to have treatment, let him or her know what you're hoping to gain from the treatment and the result you can realistically expect. There are several points to consider when deciding on treatment.

  • Different types of scars respond to different treatments. A single type of treatment may be enough or you might need a combination of treatments to achieve the best results.
  • Timing of treatment is another important choice. Some doctors advise against any scar revision in cases of injury for a period that might extend to a year or more after the injury. This allows your body time to heal fully.
  • No treatment can guarantee that your scar will be removed or won't reoccur.
  • Some treatments (eg laser resurfacing) can cause changes in your skin pigment (colour), so the treatment may not be suitable if you have a darker complexion.
  • Your scar may reoccur after treatment and might even be worse than before.
  • It can take over a year to see the full results.
  • You may not be satisfied with the appearance of your revised scar.

There are many different places, such as hospitals, clinics and beauty therapy salons that offer scar revision treatments. However, many of the treatments available aren't regulated, so you need to do your homework. Find out as much as you can about any treatment you're thinking of having and what kind of training and experience the person who will give the treatment has. Speak to your GP, who may be able to recommend a suitably qualified surgeon or a health professional trained in aesthetic treatments.

It's also important to remember that clinics offering laser treatment have to be registered with the Healthcare Commission. Always ask for proof of registration before you have any treatment.

Treatment of scars

Scars are usually permanent, so you may choose to have a revision treatment. This doesn't guarantee that the scar will be removed, but the treatments aim to make it less obvious and reduce any tightness it may be causing. Your skin colour, age and the type of scarring will influence how much improvement you can expect.

The type of treatment you have will depend on the features of your particular scar, such as its size, location and if it's raised or depressed (sunken into your skin). A single type of treatment may be enough or you might need a combination of treatments to get the best results.

Some of the most common scar revision treatments are discussed here.

Skin creams and gels

There are certain skin creams available on the market that claim to soften or fade scars, but there is limited clinical evidence to suggest that they are effective.

There are, however, gels and dressings that can help prevent keloid scarring after surgery. These contain silicone and have been shown to reduce the formation of this type of scar. Some studies have also shown that other treatments, known as retinoids, may help to reduce keloid scars if used regularly for three months.

Laser skin resurfacing

Laser skin resurfacing is very effective at reducing mild scarring. A laser (which is a beam of high-energy light) is used to remove the outer layers of your skin and stimulate the growth of new tissue. As the area heals, new skin forms that is softer and less scarred. The procedure takes about 30 minutes. It’s not suitable for all skin scars and side-effects can include swelling, oozing, crusting and a burning sensation.

Chemical peels

Chemical peels remove the outer layers of your scar and stimulate the growth of new tissue. Different types of chemical peels are available. Chemical peels containing glycolic acid or lactic acid aim to improve and smooth the texture of superficial scars (ones that aren’t too deep). Stronger peels containing phenols or trichloroacetic acid can help treat deeper scars.

Dermabrasion

Dermabrasion uses a rotating wire brush or an electric razor to skim off layers of your skin. The procedure can take up to an hour and is often done under local anaesthesia. You may need to have ointment and a dressing placed over the treated area for several days.

An alternative to dermabrasion is microdermabrasion, which uses tiny crystals to remove the surface layers of your skin. It’s most suitable for removing acne scars and doesn't require anaesthesia, but you may need multiple treatments.

Steroids

A steroid-containing tape can be worn day and night for extended periods, or a strong steroid injected directly into the scar can help soften and shrink scar tissue. Steroid treatment can be used alone or in combination with other treatments to help reduce the appearance of a raised or red scar.

Surgery

Surgery can help reduce the size of your scar, reposition it or reduce it’s tightness to make it more comfortable. Sometimes this involves cutting out your scar and replacing it with a skin graft from a healthy part of your body. If a skin graft is used after a scar is removed, you will always have a different patch of skin there instead of the scar. All new scars will be initially red and gradually fade over six to 24 months.

Prevention of scars

It’s difficult to prevent certain scars, but there are measures you can take to reduce your risk of scarring. For example, eating a healthy diet, drinking sensibly, giving up smoking and staying covered up in the sun help to keep your skin healthy. The healthier your skin, the better it will heal from an injury. It’s important not to scratch, or pick at your skin if you have had acne or chickenpox.

If you’re prone to scarring, or have a skin type that is more at risk of keloid scarring, and are having surgery, your surgeon may recommend you use a preventive gel or dressing. This may be particularly useful if you’re having surgery on an area such as you’re chest, where keloid scarring is more common. Using a pressure dressing or silicone gel sheeting on the healing wound can help prevent keloid scars.

How is a keloid scar treated?

Answer

Fully formed keloids are very difficult to treat, but there are several treatment options worth considering. Your surgeon may suggest a combination of treatments to flatten or remove your scars.

Explanation

Keloid scars are an overgrowth of the scar tissue (collagen) that extends beyond the original injury. Keloid scars are most common in young people (aged 10 to 30) and people from Asia or Africa. Keloid scars are usually red and raised, and can be painful. They may flatten and become less noticeable over a period of several years.

If you have a family history of severe scarring, it’s important to tell your surgeon before you have an operation. There are a range of measures your surgeon can take to reduce your risk of forming keloid scars, such as using pressure dressing or silicone gel sheeting on your healing wound.

Fully formed keloid scars are very difficult to treat and have a tendency to reoccur. You may need to have repeat treatments every few years to improve the appearance of a keloid scar.

Treatment options include the following.

  • Steroids. A steroid-containing tape, worn day and night for extended periods, or a strong steroid injected directly into the scar can help soften and shrink scar tissue. Possible side-effects include thinning of the tissues beneath your skin, which can leave a depressed (sunken) scar.
  • Surgery. Cutting the scar out may form a narrower scar and reduce the tension, but the risk of a keloid reforming is very high.
  • Radiotherapy. This is sometimes used in combination with surgery to treat keloid scars. It can, however, carry a risk of bringing on the development of skin cancer, although with low dose therapy the risk is small. Skin pigmentation (where the colour of your skin is affected) and ulceration may also sometimes occur, but tend to get better over time.
  • Pressure therapy. This has been shown to be effective following surgery and has been most widely used for the treatment of earlobe keloids.
  • Experimental treatments. These include laser treatment, injection of chemotherapy agents (5-Fluorouracil) or interferon into the scar, and retinoids. These treatments have shown varying degrees of success.

Are there any creams that can help scars fade?

Answer

There are certain skin creams available on the market that claim to soften or fade scars, but there is no clinical evidence to suggest that they are effective.

Explanation

Retinoic acid (a naturally occurring form of vitamin A) and vitamin E promote collagen repair. Skin creams that contain retinoic acid and vitamin E may help relieve symptoms of a dry and itchy scar. They may also help soften the scar and therefore reduce any tightness. However, there is only limited evidence to suggest these skin creams help fade or remove scars, but if used regularly they may help prevent stretch marks.

Is it possible to tattoo over scar tissue?

Answer

Depending on the character of the scar (whether it's raised, smooth, dark or jagged) it may be possible to tattoo over it. You should see a professional cosmetic tattoo artist for advice.

Explanation

It may be possible to tattoo over an unwanted scar. For example, some women have the scars around their nipples tattooed to match their skin colour after breast augmentation. Areolas (the dark skin surrounding the nipple) are often tattooed onto reconstructed breasts.

If you're considering having a scar concealed by tattooing, it's important that you wait at least a year for the scar to heal fully, and then seek advice from a professional cosmetic tattoo artist who is experienced in treating scar tissue.