• 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 provided by the clinicians at Skinspirations, most scars can be improved. Available scar treatments include fractional ablative laser treatments, intense pulsed light (IPL), subcision (loosening the scar tissue under the skin that is pulling it inward), dermal filler, microneedling, and medications. Often a combination of these treatments provides the best results and the choice of treatments depends on the scar type. 

How do you know what treatment is best for your scars? Answer the following questions and we'll give you our experienced opinions. 

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 a scar disappears when you stretch the skin on either side of it outwards, then the indentation is due to scar tissue under the skin's surface that is pulling it inward.

Unless the fibers that are attaching the depressed area of skin to the muscle are released with a procedure called subcision, the indentation will remain scar subcision diagramno matter what types of surface treatments are performed.

Subcision is performed by using a needle to cut the bands to allow the skin to again be level at the surface. Blood acts like glue so a dermal filler injected after the fibers are cut help keep the skin from reattaching down on the muscle. 

Scars that are improved with the traction of the skin are usually rolling acne scars and some surgical scars.

Does the scar look indented even when the skin on each side is stretched outwards? 

Boxcar scars from acne on the cheekScars that do not appear improved by stretching them apart, like icepick, boxcar, surgical, and stretch marks, are due to defects in the surface of the skin, so they need a procedure that treats the skin's surface. 

For scars like these with indentations, fractionated ablative laser treatments provide the most improvement, and less aggressive treatments like microneedling or microinfusion skin stamping can soften the scars' appearance. 

Diagram illustrating fractional ablative laser effects on skinFractionated ablative lasers such as our Profractional laser, vaporize columns of fibrous scar tissue which are replaced with normal, soft, healthy skin that is level with the surrounding surface. Only a percentage of the scar can be removed with each treatment or the treatment itself could cause scarring. Most people see an average of about 20% improvement after each session. 


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

Scars elevated above surrounding skin often need several types of treatments.Hypertrophic scars are those that become thick and raised. They're caused by deep burns or incisions and are more likely to form if they're located in areas of pulling, like over a joint or around the eyes and mouth. Other risk factors for forming hypertrophic or keloid scars are darker skin types and age under thirty.

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), will help to flatten them. It can also be painted over the skin during a Profractional treatment where it will be carried down into each of the vaporized columns.

Surprisingly, a small amount of Botox injected around the perimeter of the scar will also help reduce any overgrowth of the scar.

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

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. Persistent redness usually responds well to IPL treatments. 

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

Has the scar contracted so that it's pulling on the skin?

Scar contractures occur in the final phase of wound healing and tend to form where there is mechanical tension. Because the scar tissue is tighter than normal skin it can limit movement or cause discomfort. Fractionated ablative laser treatments with lasers like our Profractional can restore normal movement, decrease pain and improve the appearance of contracted scars.

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 improvement in all of the scars. Many scars also have persistent redness so it's not uncommon to use IPL treatments along with other treatment modalities.

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