Scar treatment: An overview of modern methods of scar correction
Scar treatment focuses on the replacement tissue formed during wound healing, which is less elastic, lacks hair follicles and is often pigmented differently from the surrounding skin.
Table of Contents
Important note
This article is for information purposes only and is not a substitute for a medical diagnosis or advice. If you are unsure, or if you require a personalised treatment plan, it is essential that you consult a qualified specialist.
What is a scar? A brief overview
A scar is the end result of wound healing, in which the body replaces damaged, high-quality tissue with inferior, fibre-rich connective tissue (collagen). This replacement tissue differs from the original skin in both structure and function: it is less elastic, lacks hair follicles and sweat glands, and is often differently pigmented.
The realistic aim of any scar treatment is therefore not to „make the scar disappear“, but to significantly improve its appearance so that it becomes less noticeable, softer and flatter.
The crucial first step: what type of scar is it?
The choice of the right treatment depends fundamentally on the type of scar. There are three main types of scar that are relevant from an aesthetic point of view:
- Atrophic scars (sunken scars): In this case, not enough new connective tissue was formed during the healing process. The scar lies below the level of the surrounding skin, forming a dent or hollow. Typical examples include acne scars („ice-pick scars“, „boxcar scars“) or scars left by chickenpox.
- Hypertrophic scars (raised scars): In this case, too much connective tissue formed during the healing process. The scar is usually reddish, thickened and raised in a raised, bump-like manner. However, it remains confined to the area of the original injury and can often resolve spontaneously over time. Hypertrophic scars frequently develop in areas of the body where there is increased skin tension, such as the shoulders, the décolleté or the extensor sides of the joints.
- Keloids (excessive scarring): Keloids are also raised, but unlike hypertrophic scars, the scar tissue grows uncontrollably beyond the original edges of the wound and also invades healthy tissue. They can cause itching and pain, and have a very high recurrence rate following surgical removal, which is why surgery alone is rarely recommended. A combination treatment, such as with cortisone or radiotherapy, is usually considered.
Treatment options: from gentle to surgical
Modern scar treatment offers a sort of „treatment ladder“ which is used depending on the type and severity of the scar.
Conservative treatments (basic treatment & prevention)
These methods are particularly important during the scar maturation phase (the first 12–18 months).
- Silicone products (gels, plasters): The gold standard in conservative scar treatment. They improve moisture balance and have been shown to have a positive effect on the formation and appearance of hypertrophic scars and keloids.
- Consistent sun protection (SPF 50+): Absolutely essential for preventing permanent darkening (hyperpigmentation) of the fresh scar.
- Scar massage & compression: Regular, gentle massages and compression garments (particularly following burns) help keep the tissue supple.
Minimally invasive treatments (carried out by a doctor)
If conservative methods prove insufficient, these professional procedures are used:
| Method | Mechanism of action | Ideal for… |
|---|---|---|
| Medical microneedling | Targeted micro-injuries stimulate the reorganisation of collagen. | Atrophic scars (e.g. acne scars) |
| Laser therapy | Ablative lasers remove tissue, whilst non-ablative lasers stimulate collagen production deep within the skin. | Red, hypertrophic scars; atrophic scars; acne scars |
| Cortisone injections | The injected cortisone inhibits excessive collagen production and has an anti-inflammatory effect. | Particularly in the case of keloids and treatment-resistant, hypertrophic scars |
| Cryotherapy (freezing) | The extreme cold destroys the proliferating cells from the inside out. | Smaller keloids |
| Chemical peel (e.g. TCA peel) | An acid removes the uppermost layers of the skin, thereby smoothing out superficial scars. | Flat acne scars, superficial unevenness |
Surgical scar correction
In the case of severely contracted, wide or functionally impairing scars, surgical correction may be the best solution.
- Scar excision: The entire scar is excised and the wound is closed using a special, multi-layered suturing technique, applying minimal tension.
- Special techniques (e.g. W-plasty, Z-plasty): In the case of long, straight scars, the surgeon can break up the line of the scar using geometric incision patterns to make the scar less noticeable to the eye or to relieve tension.
As a major surgical procedure, surgical scar correction carries significant risks:
- Wound-healing disorders: Due to the tension and the location, these occur more frequently than with other procedures.
- Extensive scarring: Even with the most meticulous suturing technique, unsightly, wide scars may still occur.
- General surgical risks such as infections, post-operative bleeding or blood clots.
- Asymmetries in the results.
Treating such complications can be time-consuming and expensive. As health insurance often does not cover the costs of follow-up treatment following cosmetic procedures, a Consequential Costs Insurance an essential safeguard.
Risks and treatment cover
Any scar treatment involves an intervention on the skin and carries risks such as infection, impaired wound healing or a worsening of the condition (particularly in the case of keloids). The costs of complex treatments or necessary corrective procedures are often not covered by health insurance. A Consequential Costs Insurance can provide financial security should complications arise following a cosmetic procedure (which caused the scar or is intended to correct it).
Frequently Asked Questions (FAQ) on scar treatment
No, that is not biologically possible. Scar tissue can never return to being 100 % normal skin. The aim of any reputable treatment is to achieve a significant improvement, so that the scar becomes flatter, softer, lighter in colour and, as a result, less noticeable.
Conservative care (silicone, sun protection) should begin as early as possible. Invasive treatments such as laser therapy or surgical correction are often recommended once the scar has fully matured (approximately 6–12 months), as its appearance can still change significantly during this period. In cases of functional impairment or keloids, earlier intervention may be advisable.
The greatest benefit of scar ointments often comes from the massage that accompanies their application, which keeps the tissue supple. Medical-grade silicone is considered one of the most effective ingredients for scar care. Other active ingredients such as onion extract, allantoin or heparin are also frequently used; however, their effectiveness is less clearly proven than that of silicone.
A hypertrophic scar is thickened, but always remains confined to the boundaries of the original injury and may improve on its own over time. A keloid grows uncontrollably beyond these boundaries and does not resolve on its own.
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