• a young man holding hands over face and peeking thru fingers

Specific Types of Scars Require Specific Treatments

Anyone with visible scars knows how debilitating they can be but with the technology & expertise found at Skinspirations, at least most scars can be improved. The staff at Skinspirations uses a combination of methods, depending on the type of scar, including lasers, light devices, microneedling, subcision (loosening the fibers under the skin that pull a scar inward) and medication injections. These treatments can improve the appearance of scars by up to 95%, depending on the type of scar.

If you're interested in treating a scar or scars, you can read our opinions about the best treatment options by reviewing the questions below. 

Does a depressed scar look smooth when stretched to the sides?

Scars that look smooth when pulled to sides, do best with subcision vs. laser

If the skin looks smooth when you stretch a scar from the sides, then the indentation is due to scar tissue below the surface, pulling inward, and no surface treatments like laser resurfacing or chemical peels will improve it.

Releasing the part of the scar under the surface that's tethering the skin inward, usually with a needle, is called subcision. For most scars, we use a much smaller needle than illustrated in this diagram.

The needle is advanced back and forth, or swiped side to side, under the skin's surface, to cut the interior scar tissue.

To prevent the scar tethers from reconnecting, a dermal filler is injected to separate the released skin from the scar while it heals. Another benefit to using a filler with subcision is that the filler contains an anesthetic to make the treatment very tolerable.

In most cases, only two or three treatments of subcision and a temporary filler are needed to produce permanent improvement in the scar, although a permanent filler like Bellafill can be used if desired.

Does the scar still look indented when stretched to the sides? 
Scars that do not appear improved by stretching them apart, like ice pick, boxcar, surgical and some chicken pox scars, are due to defects in the surface of the skin and aren't improved by subcision or fillers.

Boxcar acne scars

Boxcar scars are indented scars that don't look smooth when stretched

Depending on the type of defect, they can usually be improved by using a fractionated ablative laser, like our Profractional, that replaces a fraction of the fibrous scar tissue with normal, new soft skin.

Since a percentage of the scar is replaced by normal skin with each treatment, it usually takes several sessions to produce marked results, but most people see an average of about twenty percent improvement with each Profractional laser treatment.

Another treatment to help improve surface scars, and with only one day of downtime, is microneedling. Our SkinPen microneedling device produces thousands of tiny holes in the scar that are replaced with normal, soft skin. Best results are seen with a series of treatments.

Is the scar thicker & elevated above the level of the surrounding skin?

Scars elevated above surrounding skin often need several types of treatments.Scars can sometimes thicken and become raised, especially when located in areas of friction or pull, like over a joint. Other risk factors for forming hypertrophic or keloid scars are darker skin types, age under thirty, deep burns.

When the scars are elevated more than a couple of millimeters above the surrounding skin, a series of injections of a medication called 5-fluorouracil (5-FU) with or without a steroid medication, will help to flatten them. Surprisingly, a small amount of Botox injected around the perimeter of the scar will also help reduce the size of the scar.

If the scar is only slightly elevated or has been flattened previously with injections, painting on a solution of 5-FU during a Profractional laser treatment will help both with improving the texture and flattening the scar further.

Is the color of the scar different from the surrounding normal skin color?

Post inflammatory hyperpigmentation before and after chemical peel

It isn't uncommon for the color of a scar to be either darker (hyperpigmented) or lighter (hypopigmented) than the surrounding skin, or remain reddened for long periods. Hyperpigmentation or persistent redness can make scars more noticeable and often, improving the color makes the scar itself almost imperceptible.

Hyperpigmentation can usually be improved with prescription skin products, IPL treatments, and/or chemical peels. Persistant redness usually responds well to IPL treatments. 

Hypopigmentation is more difficult to improve but fractionated ablative lasers like our ProFractional are sometimes successful in restoring normal color where the pigment had been lost.

Combination Therapies for Scars

Many people with acne scars have a combination of boxcar, rolling and ice pick scars, so they may need a combination of treatment types to see overall improvement. We commonly combine several treatment modes in a single session and determine pricing based on the time that the treatment/s require.

If you'd like our opinion on the best strategy for your scars, contact us for a complimentary consultation by registering online here or by calling 727-571-1923.

Before & After

  • Before and after scar subcision with dermal filler