Cosmetic Dermatology

Scar Revision

Scars are one of the most common aesthetic concerns that cause embarrassment and anxiety. Scarring can result from any injury to the skin, including surgical scars, and acne. Once a scar is formed, it is permanent. While it cannot be completely erased, it can be made less visible and more cosmetically acceptable. The types of treatments used will vary from patient to patient and scar to scar.

Scar revision therapy is intended to minimize the scar’s appearance, making its texture more consistent with the surrounding skin tone and texture. Scars can be raised, recessed, different in color, texture, shape, size or location. Treatment options are determined by the type and degree of scarring, the scar’s location, its thickness, how long a patient has had the scar and the skin type of the patient.

Types of Scar Revision Therapies

Laser scar revision, dermal fillers, microdermabrasion, chemical peels and fat transfer therapy are typically used in combination to significantly improve appearance.

Dermal fillers are beneficial to fill a depressed or concave scar. Depending on the filler used, results may last months or years. Therapy must be repeated to maintain results.  Injected steroid compounds are used for keloids and hypertrophic scars, to soften and shrink these hard scars and alter the appearance, size and texture of raised scars.

Fat transfer therapy is an effective method to smooth out the surface of the skin. Injections of your own fatty tissue can fill imperfections. Importantly, there are no allergic reactions to this therapy. The fat is taken from the thighs, buttocks, or lower abdomen, and injected in the areas to be treated. A few treatments may be needed to achieve correction.

Microdermabrasion and chemical peels are used to make rough or elevated scars less conspicuous by removing the top layer of skin. The skin will regenerate improving the scar’s appearance, making it smoother and less visible.

Certain lasers are used for certain types of scars. Thick, red, large, indented, raised scars can be treated with vascular lasers to reduce the discoloration. Pulsed dye lasers are used first, and are often followed by a CO2 laser to reach the depth of the scar.

A combination of treatments works best for acne scars. Depressed scars are best treated with subcision (a minor surgical procedure), releasing the hard and fibrous scar tissue, lifting the depression.  If needed, a filler can be injected to raise any remaining remnants of the scar.

Laser skin resurfacing with ablative fractional lasers is the treat of choice for acne scars because the laser can penetrate and break down thick scar tissue, without damaging healthy skin. It stimulates collagen to naturally fill and re-contour depressed scars. If there is hyperpigmentation, it can be treated with IPL photofacials, and/or topical creams. Pitted scars are the result of cystic acne. They are best treated with laser skin resurfacing, and TCA peels. Hypertrophic and Keloid scars are often treated first with steroid injections, and may be followed by surgery when the scar’s appearance fails to improve with non-surgical techniques.

For deep scarring, the gold standard is surgical revision. Scars under tension may benefit from surgery to release the tension. Of course it is a tradeoff, since surgery will leave a scar. But the surgical scar will be less visible and more cosmetically acceptable than the defect that was removed.

Today we have a variety of successful approaches to improve the appearance of scars.

By using a combination of techniques, Dr. Mehr can improve the quality and appearance of the scar, to make it less noticeable. Dr. Mehr will tailor the precise techniques to the specific scar and its location.


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