Creator: Dr. Liu Ta-Ju
Published: 2025-12-24
Keywords: scar treatment, atrophic scars, keloid, scar classification, treatment strategy

Scars Are Not One Disease, But a Group of Problems

The most common mistake in scar treatment is using the same method for all scars. Atrophic scars, hypertrophic scars, keloids, and surgical scars each have different causes and characteristics, requiring targeted treatment. This article provides detailed classification and treatment strategies for each scar type.

Scar Types Overview

Atrophic Scars (Indented Scars)

Common Causes

• Post-acne inflammation

• Chickenpox

• Trauma

• Surgery

Atrophic Scar Subtypes

Treatment Strategies

Laser Treatment Options

> 💡 Dr. Liu's Advice: "Atrophic scars usually require multiple treatments and combination approaches. Expecting major improvement from a single session is unrealistic—20-30% improvement each time is already good."

Hypertrophic Scars

Characteristics

• Raised above skin surface

• Limited to original wound boundaries

• Reddish color

• May be itchy

Difference from Keloids

Treatment Strategies

Steroid Injection

Keloids

Characteristics

• Raised and extends beyond original wound

• Continues to enlarge

• May be itchy or painful

• Prone to recurrence

High-Risk Groups

• Darker skin tones

• Teenagers to middle-aged adults

• Family history of keloids

• Common sites: ears, shoulders, chest

Treatment Strategy (Combination Therapy)

Optimal Combination Protocol

> ⚠️ Important: People with keloid tendency may form new keloids from any wound. Surgery is not recommended unless necessary; if surgery is needed, always combine with adjunctive treatments.

Surgical Scars

Factors Affecting Scar Appearance

Prevention Strategies

Post-Surgical Scar Care Timeline

Pigmented Scars

Types

Treatment Strategies

Hyperpigmentation:

• Sun protection (most important!)

• Brightening products (Vitamin C, arbutin)

• Laser (Picosecond, Q-switched)

• Usually fades over time

Hypopigmentation:

• Difficult to treat

• Fractional laser (stimulates pigment)

• Concealer (makeup)

• Micropigmentation (permanent)

Contracture Scars

Characteristics

• Scar contracts and tightens

• Affects movement and function

• Common after burns

Treatment

• Physical therapy (stretching)

• Pressure garments

• Surgical reconstruction (Z-plasty or W-plasty)

• Skin grafting

Treatment Methods Summary

Non-Surgical Treatments

Surgical Treatments

Choosing Treatment by Scar Type

Frequently Asked Questions

Q1: Can scars be completely removed?

A1: Unfortunately, scars cannot be "completely removed." Treatment goals are to make scars:

• Lighter

• Flatter

• Softer

• Less noticeable

Expecting "completely invisible" is usually unrealistic.

Q2: How many laser treatments are needed?

A2: Depends on scar type and severity:

• Mild atrophic scars: 3-5 sessions

• Moderate atrophic scars: 5-8 sessions

• Severe atrophic scars: 8-10+ sessions

Each session is spaced about 4-8 weeks apart.

Q3: Can keloids be cured permanently?

A3: Keloid is a constitutional issue—"cure" is difficult. Combination therapy can:

• Remove existing keloids

• Reduce recurrence rate to 10-20%

• But cannot change constitution

Avoiding unnecessary wounds is the best prevention.

Q4: Do silicone products really work?

A4: Yes, substantial research supports silicone product effectiveness:

• Softens scars

• Reduces thickness

• Prevents hypertrophy and keloids

But requires:

• Daily use 12+ hours

• Continued use for 2-6 months

• Cannot combat severe scars

Q5: How soon after surgery can I do laser treatment?

A5:

Laser too early may stimulate scar growth.

Conclusion