“No surgeon is a magician who can make a scar completely disappear,” says Dr. Sandra Lee, a dermatologist in Upland, CA. That said, cosmetic surgeons and dermatologists have plenty of tricks for reducing the appearance of those unsightly reminders of injuries past. Here’s how they handle the most common types of scars.
Depressed, sunken scars. This type of scar is usually a result of the natural healing process of the skin: As injuries heal, the body lays down excess tissue before eventually taking it away. This loss of tissue can leave a depression, creating shadows that make the scar more apparent. A facial plastic surgeon can elevate the base of a depressed scar using fillers normally injected into wrinkles.
Acne scars. These scars tend to be sunken too, usually because some of the scar tissue has attached to the muscle or fat in the layers under the skin. In a minimally invasive procedure called a subcision, a surgeon can reach under the skin with a small needle and disconnect the tissue that is pulling the scar down.
Keloid scars. While what causes keloids—which are scars that grow beyond the edges of the original injury to look like raised nodules or lesions—isn’t clear, keeping inflammation in check seems to be an effective solution. A dermatologist can inject corticosteroids into the scar tissue, which will shrink and often completely remove the scar (though sometimes these scars do return after treatment).
Straight scars. Our bodies have lots of curves and very few straight lines, so scars that are straight can be more noticeable. If your scar is straight or contains a straight section longer than 1/3 of an inch, a doctor can break that line up into smaller segments. While these “new scars” may seem more obvious at first, as they fade, the smaller segments will be harder to see.
Severe scars. Remaking a scar completely is yet another option.A wound created by a tree limb or a car dashboard won’t heal as well or as evenly as one created by a surgeon, so surgeons often excise scar tissue then reposition or reshape a wound using techniques that have been shown to heal in a favorable way. “These advanced techniques result in the minimum amount of tissue injury and permit a thin and more desirable eventual scar,” according to Dr. Spiegel. A surgeon can also change the direction of a scar so it fits into natural lines on the face.
Other scars. For all other types of scars, consider laser treatment. “We’ve had success with lasers to minimize scars, in particular the pulsed dye laser to minimize redness and fractionated CO2 lasers to ‘sand’ down scars and make them less apparent,” says Lee. Abrading the skin around the scar with a laser makes skin look more even and can help fade the scar into the surrounding areas.