Scar revision treatments

Published by Bupa's Health Information Team, October 2010.

This factsheet is for people who are having treatment to improve the appearance of a scar, or who would like information about it.

A scar is a line or a patch of tissue that replaces normal skin after injury or disease. Scar revision treatment aims to improve the appearance of scars. There are many scar revision treatments available and only the most common are discussed here.

About scars

Every time the skin or tissue is cut or damaged it will heal 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.

Causes of scars

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

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

The worse the initial damage is to the tissue, the worse the scar will be. Your skin colour, age and an unhealthy diet and lifestyle (for example smoking) will all affect how your skin reacts to the damage.

Types of scars

There are several different types of scar.

• Atrophic scar - a sunken or pitted scar. You may get this type of scarring after having acne or chickenpox.
• Contracture scar - this type of scar causes tightening of the skin and may affect movement in the affected area. You may get this type of scarring if you burn your skin and it can also occur in tissue around an implant (eg breast implant).
• Hypertrophic scar - a red, raised (lumpy) scar. You may get this type of scarring after surgery. They usually fade and soften spontaneously but this may take years.
• Keloid scars - a red, raised scar that extends beyond the original injury (may also be painful and itchy). These may never go soft or flat.
• Stretch marks - this is a type of scar that occurs when the skin is stretched rapidly (eg during a teenage growth spurt or pregnancy).

Deciding on treatment for scars

It is important not to rush into a decision to have scar revision treatment. It's sensible to discuss your options with a clinician who is suitably qualified. Before deciding to have treatment, discuss 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 the scar will be removed or won't re-occur.
• 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 re-occur after treatment and 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, offering 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 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 and you may choose to have scar 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 cause. 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. A single type of treatment may be enough or you might need a combination of treatments to achieve 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's no clinical evidence to suggest they are effective.

Silicone gel treatments do usually provide a positive response but they are a daily treatment that take months to show results, so continued therapy and patience are required.

Laser skin resurfacing

Laser resurfacing is very effective at reducing mild scarring.

A laser (a beam of high-energy light) is used to remove the outer layers of the 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 is not suitable for all skin scars.

Chemical peels

Chemical peels containing glycolic acid or lactic acid aim to improve and smooth the texture of the scar. Chemical peels remove the outer layers of your scar and stimulate the growth of new tissue. The procedure can take up to 30 minutes or longer, depending on the type of peel you're having.

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 a local anaesthetic. 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 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 reduce the size of your scar or reposition it. 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.

Prevention of scars

It is difficult to prevent certain scars however 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 helps to keep your skin healthy. The healthier your skin the better it will heal from an injury.

If you have acne or chickenpox, try not to scratch and pick at it. If you have suffered a burn or you are having surgery and have a family history of severe scarring. Tell your surgeon so that he or she can use methods to reduce your risk of forming keloid scars, such as using pressure dressing or silicone gel sheeting on the healing wound.

Moisturisers help restore the skin's smoothness, softness and flexibility by helping the skin retain moisture. Keeping your skin well moisturised during pregnancy may help to reduce stretch marks.

For answers to frequently asked questions on this topic, see Common questions.

For sources and links to further information, see Resources.