Understanding Scars and Why They Form
Scars are a natural part of the body’s healing process after injury or surgery. However, some scars can become hypertrophic, keloidal, or otherwise aesthetically or functionally concerning. For many patients, improving the appearance, texture, or symptoms of scars—such as redness, itching, or tightness—is an important part of recovery and confidence.
Over the years, countless creams, gels, and devices have been marketed for scar prevention and improvement. Unfortunately, many of these products lack scientific support. In this guide, we summarize the treatments with proven results, based on high-quality studies and clinical experience.
Topical Scar Treatments
🧅 Onion Extract
Products such as Mederma® and Contractubex® contain onion extract (Allium cepa).
While some studies show modest improvements in scar height and itching, others demonstrate no significant benefit over moisturizers or silicone.
Recommendation: The evidence for onion extract is inconsistent and largely inconclusive.
💧 Vitamin E
Although Vitamin E is a popular home remedy, clinical studies reveal no meaningful scar improvement and a higher rate of allergic dermatitis.
Recommendation: Avoid Vitamin E for scar treatment—it may do more harm than good.
🩹 Silicone Gel and Sheeting
Silicone remains the gold standard topical therapy for both prevention and treatment of scars.
Multiple level I and II studies show that silicone gel and silicone sheeting:
- Reduce redness and pigmentation
- Improve pliability and texture
- Decrease pain and itching
- Lower the risk of hypertrophic scar formation
Recommendation: Use medical-grade silicone gel or sheets beginning about 2 weeks after surgery and continue for at least 3 months.
Laser Treatments for Scars
Pulsed Dye Laser (PDL)
PDL targets oxyhemoglobin to reduce vascularity, redness, and itching in hypertrophic scars.
Early treatment (within a year of injury) yields the best results.
Recommendation: PDL is highly effective for immature hypertrophic scars and safe for most skin types.
CO₂ and Er:YAG Lasers
These lasers resurface the skin, smooth irregular contours, and stimulate collagen remodeling.
They are especially useful for acne scars and textural irregularities.
Recommendation: CO₂ lasers offer deeper penetration and are best for established, uneven scars.
Injectable Treatments
💉 Corticosteroids, 5-Fluorouracil, and Bleomycin
For thick or raised scars, intralesional injections help soften and flatten tissue:
- Corticosteroids (Triamcinolone): reduce inflammation and collagen production.
- 5-Fluorouracil (5-FU): inhibits fibroblast proliferation.
- Bleomycin: reduces scar height and hardness.
Recommendation: Combination injections—steroids with 5-FU or PDL—achieve superior outcomes for hypertrophic and keloid scars.
Pressure Garments and Scar Massage
Pressure Garments
Post-burn and post-surgical scars may benefit from controlled pressure (≈ 24 mm Hg) to limit thickness.
Compliance is key—garments must be worn consistently to see improvement.
Recommendation: Effective for hypertrophic scars with high patient compliance.
Scar Massage
Regular, gentle massage (3 times weekly for 30 minutes) can reduce pain, itching, and stiffness.
It may also help prevent thickening in fresh scars.
Recommendation: Supported by clinical studies for pain and pruritus relief.
Emerging Molecular and Regenerative Therapies
Fat Grafting and Stem-Cell-Based Therapies
Autologous fat grafting enriched with adipose-derived stem cells (ADSCs) has demonstrated improved scar softness, elasticity, and texture.This regenerative approach promotes neovascularization and collagen remodeling.
Recommendation: Fat grafting is an evolving and promising treatment for improving scar pliability and appearance.
Surgical Revision and Technique for Scar Prevention
Some scars may not improve with non-invasive treatments and will require a surgical scar revision. The key when revising the scars is to perform the following maneuvers to optimize the results:
- Tension-free wound closure minimizes collagen overproduction.
- Wound edge eversion ensures flat, even healing.
- Occlusive devices such as silicone dressings can reduce scar width and visibility.
Recommendation: Proper closure technique and postoperative silicone use are proven to improve surgical scar outcomes.
Keloid Scar Management
Keloids extend beyond the boundaries of the original wound and have a high recurrence rate if treated with excision alone.
Best results are achieved with a multimodal approach, combining:
- Surgical or laser excision
- Intralesional corticosteroids
- Mitomycin C or bleomycin
- Silicone compression or pressure therapy
- Postoperative radiation (10–15 Gy within 72 hours)
Recommendation: Keloid treatment must be individualized and multimodal to minimize recurrence.
Striae Distensae (Stretch Marks)
Stretch marks share features with scars but lack effective medical treatments.
While laser and topical therapies such as tretinoin or cocoa butter have been tested, none consistently reverse the condition.
Recommendation: Prevention and maintenance (hydration, weight management, and gentle skin care) remain key.
Conclusion
Effective scar management relies on science, not marketing.
High-quality evidence supports silicone therapy, laser treatments, and meticulous surgical technique as the cornerstones of prevention and improvement.
For established scars, a personalized, multimodal approach—combining lasers, injectables, massage, and regenerative options—achieves the best outcomes.
If you’re concerned about a surgical or traumatic scar, consult Dr. Thomassen for someone experienced in evidence-based scar management.
At Thomassen Plastic Surgery, we tailor scar prevention and treatment plans using clinically proven therapies to restore comfort and confidence in your skin.
References
Evidence-Based Scar Management: How to Improve Results with Technique and Technology. Khansa, Ibrahim MD; Harrison, Bridget MD; Janis, Jeffrey E. MD, FACS. Plastic and Reconstructive Surgery 138(3S):p 165S-178S, September 2016.
Visit the American Society of Plastic Surgeons website for more information on scar revision procedures.