Listed below are the main recognised scar therapies that are used by the medical profession to improve the appearance of scars. More information is available from your doctor or dermatologist.
Any surgical removal will always leave a new scar that will take up to two years to mature. Surgery will never remove a scar but can be used to alter its position, alignment or shape. Sometimes, surgery will actually make the scar longer; although its appearance is improved overall. This is particularly important to bear in mind when the scar is in a visible location (e.g. face). Surgery may be necessary to release a tight scar near a joint that is restricting movement. In the case of hypertrophic and keloid scars, there is a very high risk of recurrence of excessive scarring following surgery.
Laser Surgery & Resurfacing
Like surgery, the role of laser surgery in the management of scars is limited. The colour of a red scar may be improved by management with a vascular laser. It has also been suggested that removing the surface layers of the skin with a carbon dioxide laser may help to flatten scars. However, there are very few long-term studies to prove the effectiveness and safety of this therapy. It is important to establish that a fully trained medical practitioner carries out any laser therapy with experience in improving scars.
A course of steroid injections will help to soften and flatten a hypertrophic or keloid scar. The steroid is injected into the scar itself and very little is absorbed into the blood stream, so side effects are minimal. Injections are repeated at 4 to 6 week intervals and are given under medical supervision.
Pressure Garments are only used under the supervision of a medical profession. They are most often used for Burn Scars and very often applied 3-4 weeks after the burn when the wound has healed. Pressure Garments are made to fit like a second skin of elastic fabric and are usually made to measure. They work best when worn 24 hrs a day for 6-12 month, and very often in combination with silicone gel sheeting. Mode of Action is not fully understood, though it may be that continuous pressure on the surface blood vessels play a part over a period of months, the scars become softer, flatter and become paler. Jobskin Made to Measure pressure garments have been used clinically for more than 30 yrs.
Low-dose, superficial radiotherapy may reduce the recurrence rate of hypertrophic and keloid scars after surgery. It is effective in about 70% of cases but is reserved for the most serious cases because of the possibility of long-term side effects.
Cryotherapy is a technique that uses specialist equipment to freeze the scar tissue using liquid Nitrogen. Research suggests that this technique is only effective in around 30% of cases and it is mainly used to improve scars on the shoulders or back.
Dermabrasion can be used to reduce irregularities in the skin surface associated with scarring. This involves the removal of the surface of the skin with specialist equipment and usually involves a general anaesthetic. It may be helpful where the scar is raised above the level of the surrounding skin but is less useful when the scar is sunken or pitted.
Liposuction involves the removal of normal fat from beneath the skin. This has a limited role in evening out the contour around a sunken scar.
Collagen can be injected beneath a sunken scar in order to build up the level of the skin. However, the effect is temporary and injections need to be repeated at regular intervals. There is also a risk of allergic reactions.
Silicone Gel Sheets
Widely used in the therapies of red and raised scars by occupational therapists, dermatologists, physiotherapists, plastic surgeons and other medical professionals. See under Therapies for Self Use for more information.