Old Scar Treatment: Matching Method to Scar Type

Old scar treatment should be chosen according to the type of scar, not simply how long the scar has been present. A raised or keloid scar needs a different approach from a flat, discoloured scar, while pitted acne scars may need resurfacing, microneedling, subcision or a combination of treatments. Stretch marks also require a different strategy.

The realistic aim is to improve the appearance of a scar rather than erase it completely. Treatment may make a scar flatter, smoother, softer or less noticeable, but no procedure can guarantee that previously scarred skin will look exactly like uninjured skin.

What are the different scar types, and how are they told apart?

A scar can be flat, raised, depressed, stretched or mainly different in colour from the surrounding skin. Some people have more than one type of scar in the same area.

Raised or keloid scars

A hypertrophic scar is raised and usually remains within the boundaries of the original wound. A keloid can extend beyond the original injury and may continue growing over time.

Raised scars may feel:

• Firm or hard
• Itchy
• Tender or painful
• Tight
• Smooth or shiny

Keloids can develop weeks, months or even years after an injury. They can occur after cuts, burns, surgery, acne or piercings.

Flat and discoloured scars

Some scars are relatively flat but remain red, brown, darker, lighter or otherwise different in colour from the surrounding skin.

Here the main problem may be colour rather than texture.

Treatment therefore needs to address the visible colour difference rather than automatically treating the scar as a depressed or raised scar.

Sun exposure can also make colour differences more noticeable, so protecting the scar from ultraviolet exposure is important.

Pitted or depressed scars

Depressed scars sit below the normal skin surface and are commonly associated with severe acne or chickenpox.

Acne-related depressed scars are generally described as:

• Boxcar scars
• Rolling scars
• Ice-pick scars

These scar patterns are not identical, so they should not automatically be treated with the same procedure. The American Academy of Dermatology specifically notes that different acne-scar types can require different treatments.

Stretched scars

Stretch marks, or striae, develop when the skin stretches and the supporting tissue changes.

They may occur after:

• Pregnancy
• Rapid weight gain or loss
• Growth during puberty
• Significant muscle gain
• Other situations involving rapid skin stretching

They can initially appear red, purple or darker before becoming lighter with time.

Which treatment suits a raised or keloid scar?

Raised scars require a different approach from depressed scars because the problem is excess scar tissue rather than a loss of tissue.

Possible treatments include silicone, corticosteroid injections, cryotherapy and selected laser treatments. Combination treatment is sometimes used for keloids because they can be difficult to control and may return after treatment.

Silicone sheets and gels

Silicone sheets or gels can help improve the appearance of raised scars. They may reduce redness, hardness, swelling, itching and stiffness when used consistently.

They generally require regular use over an extended period rather than a few applications.

Corticosteroid injections

Corticosteroids can be injected directly into a raised scar or keloid.

They can reduce scar size and symptoms such as itching and pain. The AAD reports that corticosteroid injections can reduce the size of some raised scars by 50% or more, although results vary and more than one treatment is often required.

Cryotherapy

Cryotherapy freezes scar tissue and can be used for some raised scars and keloids.

The AAD reports that, in some cases, one treatment can reduce scar size by 50% or more, although further treatment may be needed.

Laser treatment

Laser treatment can be used for selected raised scars and may help with features such as redness or thickness. It can also be combined with injections or other treatments.

Treatment needs to be selected according to the scar and the patient’s skin characteristics rather than simply choosing a laser because it is available.

Surgery for keloids

Surgical removal of a keloid does not automatically mean the problem is solved.

Keloids can return after surgery, which is why surgery may be combined with other treatments designed to reduce recurrence. The NHS notes that surgery for keloids is not usually recommended as a stand-alone approach because the scar can grow back.

Which treatment suits a pitted or depressed scar?

Pitted scars need treatment that addresses the depression or tethering beneath the skin.

Microneedling

Microneedling creates controlled micro-injuries that stimulate collagen production during healing. It is used for depressed acne scars and may be combined with other procedures.

The AAD states that microneedling is considered safe for all skin tones when appropriately performed.

Laser resurfacing

Laser resurfacing can improve the appearance of depressed acne scars by stimulating collagen and elastin as the skin heals.

Some lasers require several sessions, and recovery depends on the type of laser used.

Subcision

Some rolling scars are attached to deeper tissue by fibrous bands. Subcision releases these attachments so that the depressed area can rise.

It may be combined with another procedure when additional resurfacing or collagen stimulation is needed.

Chemical peels

Selected chemical peels can make some depressed scars less noticeable by stimulating changes in the skin. The strength and number of treatments depend on the scar and the patient’s skin.

The AAD notes that mild and medium chemical peels may require multiple sessions.

Scar surgery

Certain deep scars may benefit from a surgical technique designed to release, lift or remove a particular scar. This is usually considered when the scar structure makes less-invasive treatment unlikely to provide sufficient improvement.

For deeper acne scarring, see the information on deep scars treatment and deep boxcar scar treatment.

What can be done about scar colour rather than texture?

A scar does not have to be raised or depressed to be noticeable.

A flat scar may remain:

• Red
• Pink
• Brown
• Darker than surrounding skin
• Lighter than surrounding skin

When colour is the main issue, treatment needs to be directed at pigmentation or redness rather than simply resurfacing the texture.

Sun protection is particularly important because ultraviolet exposure can make some scars more noticeable. Broad-spectrum sunscreen with SPF 30 or higher is recommended for exposed scars.

A clinician should also determine whether the colour is actually part of the scar or represents another skin condition before treatment.

How should the treatment be matched to the scar?

The following guide provides a practical starting point. The exact procedure and number of sessions must be decided after examination.

Scar type	Recommended approach	Sessions	Realistic improvement	Maintenance
Raised / hypertrophic	Silicone, steroid injections, cryotherapy or selected laser treatment	Often several treatments	Flattening, softening and reduced redness/itch are realistic goals	Follow-up and recurrence monitoring
Keloid	Combination treatment may include injections, silicone, cryotherapy or laser	Often multiple treatments	Reduction in height, hardness and symptoms; recurrence remains possible	Long-term monitoring may be needed
Flat and discoloured	Pigment/redness-focused treatment and strict sun protection	May require a series	Colour contrast may become less noticeable	Continued sun protection and pigment management
Boxcar	Resurfacing, microneedling, scar surgery or combinations	Usually a series	Reduced depth and shadowing; complete removal is not expected	Further treatment may be required
Rolling	Subcision, often combined with resurfacing or collagen-stimulating treatment	Often several sessions	Reduced tethering and smoother surface	Depends on response
Ice-pick	Targeted focal treatment, selected resurfacing or surgical techniques	Often staged treatment	Deep narrow pits may become less noticeable; complete removal is not guaranteed	Assessment for additional treatment
Stretched	Selected laser, microneedling or resurfacing approaches	Usually multiple sessions	Texture and colour may improve, but stretch marks generally remain visible	Results vary and maintenance may be considered

The table is a guide rather than a treatment prescription. A person can have several scar types at the same time, particularly after acne, and a combination approach may therefore be appropriate.

How many sessions does scar treatment take?

There is no universal number of sessions for old scar treatment.

The treatment course depends on:

• Scar type
• Scar depth or height
• Scar size
• Location
• Skin tone
• Age of the scar
• Previous treatment
• How the skin heals
• Whether there is active acne or inflammation

Raised scars may require repeated injections or combination treatment. Depressed acne scars often need a series of procedures rather than one session.

For example, the AAD notes that mild chemical peels may require 3 to 5 treatments, usually spaced 2 to 4 weeks apart. Other procedures have different schedules.

The correct number should therefore be decided after examining the scar rather than promised in advance.

How much can scars improve?

This is one of the most important questions to answer honestly.

There is no single improvement percentage that applies to every scar.

For selected raised scars, dermatology guidance provides some measurable examples. Corticosteroid injections can reduce scar size by 50% or more in some patients, and cryotherapy can also produce a 50% or greater reduction in scar size after one treatment in some cases. These figures describe particular treatments and selected raised scars; they should not be interpreted as a guaranteed 50% improvement for every patient.

For boxcar, rolling and ice-pick scars, the response depends heavily on the scar’s depth and structure. A shallow rolling scar may respond differently from a deep ice-pick scar.

A more honest way to measure improvement is to look for:

• Less visible depth
• Reduced shadowing
• Smoother skin texture
• Reduced redness
• More even pigmentation
• Less obvious scarring under normal lighting

Collagen-remodelling treatments may continue producing changes after the treatment session, so the final result may take time to assess.

Does treatment work on scars that are years old?

Yes, an old scar can still sometimes be improved.

The age of the scar is only one part of the assessment. Its structure, depth, colour and type are more important when deciding which treatment may help.

The AAD notes that both the type of scar and how long it has been present can affect treatment decisions.

An old scar may therefore still be suitable for treatment, but its age alone cannot predict the final result.

Can old scars be removed completely?

Usually, no.

The term scar removal can create an unrealistic expectation because most treatments improve the appearance of scar tissue rather than erase it.

The NHS states that scars cannot be completely removed, although treatment can improve how they look.

For keloids, complete removal is particularly difficult because the scar can return after treatment. For depressed acne scars, procedures can make the skin considerably smoother or less noticeable, but the original skin structure is not guaranteed to be restored completely.

The realistic goal is therefore visible improvement.

Which scars respond best?

There is no single scar type that is guaranteed to respond best.

A relatively shallow scar may require less intensive treatment than a deep or tethered scar. Similarly, a flat colour change needs a different approach from a raised keloid.

The important point is that the scar must be diagnosed correctly first.

The AAD recommends examining the scar before treatment because different scar types require different approaches.

Do silicone sheets and creams help?

Silicone sheets and gels can be useful particularly for raised scars and keloids.

They may help reduce:

• Hardness
• Redness
• Itching
• Swelling
• Stiffness
• Overall visibility

They need consistent use and are not an appropriate substitute for every type of scar treatment.

Many scar creams are also marketed with ingredients such as vitamin E, vitamin A or onion extract. Evidence for many non-prescription scar products is limited, so they should not be assumed to work for every scar.

Will the scar come back after treatment?

It depends on the scar type.

Recurrence is particularly important with keloids. Even after treatment, a keloid can return, which is why combination treatment and follow-up may be recommended.

With acne scars, the treated scars may improve, but new scars can develop if active acne continues. Controlling ongoing acne is therefore an important part of preventing additional scarring.

What happens during a scar consultation?

A proper consultation starts with identifying the scar rather than immediately selecting a procedure.

The clinician may assess:

1. Whether the scar is raised, flat or depressed
2. Whether it is a keloid or hypertrophic scar
3. The depth of a depressed scar
4. Whether a rolling scar is tethered
5. The colour of the scar
6. The size and location
7. How long it has been present
8. Previous treatments
9. Skin tone and tendency to develop pigmentation
10. Whether active acne or inflammation is present

The clinician can then decide whether one procedure or a combination is appropriate.

The AAD specifically recommends diagnosis of the scar type before selecting treatment.

When should a scar be checked before cosmetic treatment?

A mark that looks like a scar should be medically assessed if you do not remember an injury that caused it, or if it changes unexpectedly.

Seek assessment if a scar or scar-like mark:

• Grows
• Bleeds
• Becomes increasingly painful
• Becomes warm or swollen
• Produces pus
• Develops a new or unusual appearance

The AAD notes that some skin cancers can resemble scars, so an unexplained scar-like lesion should be examined before cosmetic treatment.

Frequently Asked Questions

Matching the treatment to the scar

The most important part of old scar treatment is identifying what type of scar you actually have.

A raised or keloid scar may need flattening treatment such as silicone, injections, cryotherapy or selected laser treatment. A boxcar, rolling or ice-pick scar may need resurfacing, microneedling, subcision, focal treatment or a combination. A flat discoloured scar requires a different approach focused on colour, while stretch marks need their own treatment strategy.

There is no single scar removal option that works for every patient.

For more information about deeper scarring, see the clinic’s deep scars treatment information. For boxcar scars, see deep boxcar scar treatment. If the main problem is a raised scar, the guide to laser for raised scar treatment provides more specific information.

For acne-scar treatment options in Surat, you can also explore the clinic’s acne scar laser treatment service information.

The most realistic expectation is not perfect removal. It is a scar that is flatter, smoother, less discoloured or less noticeable than before, with the treatment plan selected according to its individual type and structure.