There is no single best treatment for scars because the right approach depends on the type of scar, its age, and its location. Newer scars respond well to silicone-based products and sun protection, while older or more severe scars often need professional treatments like laser therapy, steroid injections, or surgical revision. The good news is that most scars can be significantly improved with the right combination of treatments, even years after they form.
Why Scar Type Matters
Scars form when your body repairs damaged skin by laying down collagen fibers. The way those fibers organize determines what kind of scar you end up with, and each type responds to different treatments.
Flat, discolored scars are the most common. These result from cuts, surgical incisions, or minor burns. They sit level with the surrounding skin but may be pink, red, or darker than your natural tone. These are generally the easiest to treat.
Atrophic scars are indented or pitted, sitting below the surface of the skin. Acne is the most common cause. They form when the body doesn’t produce enough collagen during healing, leaving a depression behind. Ice pick scars (narrow and deep), boxcar scars (wider with sharp edges), and rolling scars (broad with sloped edges) all fall into this category.
Hypertrophic scars are raised and firm, staying within the boundaries of the original wound. They contain excess collagen and often feel thick or ropy.
Keloid scars extend beyond the original wound, growing larger over time. They’re more common in people with darker skin tones and can be itchy or painful. Keloids are the most difficult type to treat and have high recurrence rates.
Silicone Products for Newer Scars
Silicone is the most well-supported over-the-counter scar treatment available. Both silicone gel sheets and topical silicone gels have strong evidence behind them. They work by trapping moisture against the scar, which helps regulate collagen production and flatten raised tissue. International scar management guidelines recommend silicone as first-line prevention and treatment for abnormal scars.
For best results, start silicone therapy as soon as the wound has fully closed (no open areas or scabs). Sheets should be worn 12 to 24 hours per day, and gels should be applied twice daily. Most studies show meaningful improvement after 8 to 12 weeks of consistent use. Silicone products are most effective on newer scars, particularly those less than two years old, though they can soften and flatten older hypertrophic scars as well.
Sun Protection: The Simplest Step
UV exposure is one of the fastest ways to make a scar permanently darker. New scar tissue lacks the pigment-regulating abilities of normal skin, so even brief sun exposure can cause lasting discoloration. Applying a broad-spectrum sunscreen with SPF 30 or higher to any healing scar, and continuing for at least a year after injury, prevents hyperpigmentation that can make scars far more visible. This single step makes every other treatment work better.
Treatments for Raised Scars
Hypertrophic scars and keloids benefit from treatments that break down excess collagen or suppress the overactive healing response that created them.
Corticosteroid injections are the standard treatment for keloids and stubborn hypertrophic scars. A dermatologist injects a steroid directly into the scar tissue, which softens and flattens it over a series of sessions spaced four to six weeks apart. Response rates for keloids range from 50% to 80%, though recurrence is common, happening in roughly 9% to 50% of cases depending on the study. Combining injections with other therapies reduces that recurrence rate significantly.
Pressure therapy works well for large burn scars. Custom-fitted compression garments worn continuously (typically 23 hours per day for 6 to 12 months) reduce scar thickness and redness by limiting blood flow and collagen overproduction in the healing tissue. This approach requires serious commitment, but it’s effective for extensive scarring where other options aren’t practical.
Cryotherapy, which involves freezing scar tissue, can reduce keloid volume by 50% or more after several sessions. It’s sometimes combined with steroid injections for stubborn cases.
Treatments for Indented Scars
Atrophic scars, especially those from acne, need treatments that either fill in the depression or stimulate your skin to rebuild collagen from below.
Microneedling uses fine needles to create controlled micro-injuries in scar tissue, triggering a fresh wave of collagen production. Studies show an average improvement of 30% to 70% in acne scar depth after three to six sessions. It works well for rolling and boxcar scars but is less effective for deep ice pick scars. Sessions are spaced four to six weeks apart, and results continue improving for several months after treatment as new collagen matures.
Dermal fillers provide immediate improvement for indented scars by physically lifting the depressed tissue. Hyaluronic acid fillers are the most common choice. Results are visible right away but temporary, lasting 6 to 18 months depending on the product. Some evidence suggests that repeated filler treatments stimulate your own collagen production over time, making each treatment last a bit longer.
Subcision is a minor procedure where a needle is inserted beneath the scar to release the fibrous bands pulling the skin downward. It’s particularly effective for rolling acne scars and is often combined with microneedling or fillers for better results. A single subcision session can improve scar depth by 25% to 50%.
Laser Treatments
Laser therapy is one of the most versatile scar treatments, with different laser types suited to different problems. It can address texture, color, and thickness in both old and new scars.
Fractional lasers create thousands of microscopic columns of controlled damage in scar tissue, leaving surrounding skin intact. This triggers collagen remodeling while allowing fast healing. Fractional CO2 lasers and erbium lasers are the most studied options. For acne scars, a series of three to five treatments typically improves appearance by 40% to 70%. Recovery involves redness and peeling for five to seven days after each session.
Pulsed dye lasers target the blood vessels that give newer scars their red or pink color. They’re effective at reducing redness and can also soften hypertrophic scars. These treatments have minimal downtime, with most people experiencing only mild bruising for a few days.
Laser treatment tends to be most effective when combined with other approaches. For example, fractional laser followed by a topical treatment that promotes healing, or laser combined with microneedling, often outperforms either treatment alone.
Chemical Peels and Resurfacing
Chemical peels remove the outer layers of skin using acid solutions, prompting fresh, smoother skin to grow in its place. Medium-depth peels using trichloroacetic acid (TCA) are the most commonly used for scarring. They’re particularly effective for shallow acne scars and uneven skin texture. A series of three to six peels, spaced two to four weeks apart, can noticeably smooth mild to moderate scarring.
Deep peels produce more dramatic results but require longer recovery, often two to three weeks of significant peeling and redness. They carry higher risks of pigment changes, especially for darker skin tones, so they’re used more selectively.
Surgical Scar Revision
When a scar is wide, poorly positioned, or doesn’t respond to less invasive treatments, surgical revision is an option. A surgeon removes the old scar tissue and re-closes the wound under optimal conditions, using techniques that minimize tension on the skin. This doesn’t eliminate the scar entirely, but it can replace a prominent scar with a thinner, less noticeable one.
For deep ice pick acne scars, punch excision removes each individual scar with a tiny circular blade and closes the small wound with a stitch or skin graft. This converts a deep, visible pit into a fine line that’s much easier to treat with resurfacing techniques afterward.
Combining Treatments for Better Results
The most effective scar treatment plans almost always involve more than one approach. A common protocol for acne scarring might start with subcision to release tethered scars, follow with a series of microneedling or laser sessions to rebuild collagen, and use fillers for any remaining depressions. For keloids, combining steroid injections with silicone sheeting and sometimes radiation therapy after surgical removal dramatically reduces recurrence compared to any single treatment.
Timing also matters. Starting silicone and sun protection early, within the first few weeks of wound healing, sets the foundation. Most professional treatments work best once a scar has fully matured, which takes at least three to six months for surgical scars and up to two years for burn scars. Treating too early can sometimes worsen the outcome, while waiting allows you to see how much the scar improves on its own before committing to more aggressive options. A dermatologist or plastic surgeon can help sequence treatments based on your specific scar type and goals.