Scars

A scar is the tissue the body lays down to close a wound. It is a repair, not a replacement: scar tissue is made of collagen arranged differently from normal skin, which is why scars have a different colour, texture and flexibility from the skin around them.

Scars can be improved. They cannot be erased. That is the honest starting point for this page, and any treatment discussion that does not begin there is not being straight with you.

Types of scar

Flat and pale (mature) scars

The usual outcome of a well-healed wound. Often pink or red at first, settling to pale over 12 to 18 months.

Hypertrophic scars

Raised, red and firm, but staying within the boundary of the original wound. Often improve slowly over a year or two.

Keloid scars

Raised scars that grow beyond the original wound, sometimes considerably. More common in darker skin and on the chest, shoulders, upper back and earlobes. Keloids are prone to recurrence after treatment - including after surgical removal, which can produce a larger keloid than the one removed. Anyone with a keloid tendency should say so before any elective procedure.

Atrophic scars

Depressed or pitted scars, where tissue was lost. Common after acne and chickenpox. See acne scars.

Contracture scars

Tight scars, usually after a burn, that can restrict movement. These are a functional problem and usually a surgical one.

Stretch marks (striae)

Scars from rapid stretching of the skin - growth, pregnancy, weight change. Red or purple when new, silvery-white when mature. Newer marks respond better than older ones.

What determines how a scar turns out

• How the wound was made and closed - a clean, well-approximated surgical wound scars better than a ragged or infected one
• Where it is - the chest, shoulders and back scar more heavily; the eyelid and face generally scar well
• Direction - a scar aligned with a natural skin crease is far less noticeable
• Tension - scars across joints or areas of movement tend to widen
• Your genetics and skin type - keloid tendency is largely inherited
• Age - younger skin heals faster but often scars more actively
• Infection, wound separation, smoking and sun exposure - all worsen the result

Timing

Scars change for a long time. A scar at six weeks is not the scar you will have at eighteen months - most continue to flatten and fade well into a second year.

That has a practical consequence: surgical revision is usually deferred until a scar has matured, generally 12 months or more, because operating on an active scar can produce a worse one. Non-surgical measures - silicone, massage, sun protection - are started early, because that is when they do most.

Treatments

Silicone gel and sheeting

The best-evidenced non-invasive measure for raised scars. Used consistently over months.

Massage and moisturising

Started once the wound is fully closed, helps soften and flatten a scar.

Sun protection

A new scar exposed to sun can pigment permanently. Sunscreen on the scar for at least a year is one of the cheapest and most effective things you can do.

Cortisone injections

Used for hypertrophic and keloid scars to reduce bulk, itch and redness. Usually a series rather than one injection.

Skin needling

Stimulates collagen; used mainly for depressed and textural scarring, in a course.

Laser

Fractional and resurfacing lasers improve texture in depressed scars; vascular lasers reduce redness in new and hypertrophic scars.

Peels and microdermabrasion

For superficial texture and pigmentation associated with scarring.

Dermal fillers

Can lift an individual depressed scar. The effect is temporary and needs repeating.

Surgical scar revision

Excising the scar and closing the wound more favourably - realigning it with a skin crease, releasing tension, or breaking up a straight line. Performed by our Specialist Plastic Surgeons. It replaces one scar with another, better-placed one; it does not remove scarring.

Camouflage make-up

Covers a scar without treating it. A reasonable choice on its own terms.

What results are realistic

Most treatments produce meaningful improvement in colour, height or texture. Depressed scars generally improve substantially with a course of needling or laser. Raised scars soften and flatten with silicone and cortisone. Keloids can be reduced but frequently recur.

No treatment returns skin to its pre-injury state. Improvement is usually gradual, measured over months, and usually needs a course rather than a single session. Individual results vary considerably.

Risks

• The scar not improving, or improving less than hoped
• Worsening of the scar - a real risk with surgical revision and with aggressive treatment of keloid-prone skin
• Recurrence of a keloid, sometimes larger
• Changes in pigmentation at the site, which can be permanent
• Skin thinning, dimpling or pigment loss after cortisone injection
• Redness, swelling, crusting and blistering after laser or needling
• Infection
• Pain during treatment

See risks and complications.

Cost

As at September 2024 and including GST, a skin assessment is $50, a Cosmetic Doctor consultation is $150 and a Specialist Plastic Surgeon consultation is $350. Dermal skin treatments start from $130. A treatment plan is quoted after assessment.

Cosmetic scar treatment is not covered by Medicare. Revision of a scar causing a functional problem - for example a contracture restricting movement - may attract a rebate. Me Clinic is not a no-gap provider.

Booking

Me Clinic, 4 Burke Road, Malvern East VIC 3145. Phone 1300 852 050 or (03) 9569 3511, or use the online consultation form.

Related: acne scars, mole removal and scarring, all skin conditions.

Individual results may vary. Any surgical or invasive procedure carries risks. Before proceeding you should seek a second opinion from an appropriately qualified health practitioner.