Old self-harm scars can be significantly faded and softened, but no treatment will make them disappear entirely. Scars are permanent changes in skin structure, where the body replaced normal tissue with collagen fibers arranged differently from the surrounding skin. The realistic goal is reducing their visibility so they blend more closely with the skin around them. Several options exist, ranging from over-the-counter products to professional procedures, and the right choice depends on your scar type, skin tone, and how much improvement you’re looking for.
Why Old Scars Look the Way They Do
When skin heals from injury, it lays down collagen in a different pattern than the original tissue. The remodeling phase of healing lasts a year or more, during which the repaired tissue slowly strengthens and changes color over six to twelve months. After that window closes, the scar is considered mature. Mature scars are typically paler than surrounding skin, sometimes slightly indented or raised, and have a smoother, shinier texture because they lack the hair follicles and sweat glands found in normal skin.
Old self-harm scars often fall into a few categories: flat white lines, slightly raised (hypertrophic) ridges, or indented (atrophic) marks where tissue was lost. The type you have shapes which treatments will help most.
Silicone Gel and Sheets
Silicone-based products are the most studied topical option for scar management. They work by increasing hydration in the outer layer of skin, which signals the tissue underneath to slow down excess collagen production. Over time, this makes scars softer, flatter, and less noticeable. Clinical data shows silicone gel can produce an 86% improvement in texture, 84% in color, and 68% in height. It also reduces the itching and discomfort that some raised scars cause.
Silicone sheets are applied directly over the scar for several hours a day, while gel formulations can be rubbed on and worn under clothing. Both are available over the counter. For old, mature scars the results will be more modest than for newer ones, but consistent use over several months can still soften texture and improve how a scar catches light.
Onion Extract Gels
Products containing onion extract (sold under brand names like Mederma) are widely available and often marketed for scar fading. In a controlled study, once-daily application for eight weeks significantly improved overall appearance, redness, softness, and smoothness compared to untreated scars. The improvements were real but relatively subtle, with subjects rating the change lower than the clinical investigators did. These products work best on newer scars. For old, white scars, onion extract alone is unlikely to produce dramatic results, though it can be a low-cost starting point if you want to try something accessible first.
Microneedling
Professional microneedling, sometimes called collagen induction therapy, uses a device covered in fine needles to create thousands of tiny punctures in the scar tissue. This controlled injury triggers the skin to produce fresh collagen and remodel the scarred area. In clinical studies of atrophic scars, nearly 89% of patients achieved a good to excellent response, with 72% seeing their scar severity improve by two or more grades on a clinical scale.
Microneedling tends to work best on flat or slightly indented scars. Deeper, pitted scars show more moderate improvement. A typical treatment plan involves multiple sessions spaced several weeks apart. Professional treatments use longer needles and more precise devices than at-home dermarollers, so results from a dermatologist’s office will be considerably better than what you can achieve on your own.
Laser Treatments
Fractional laser therapy is one of the most effective options for changing the texture and appearance of old scars. The most commonly used type, fractional CO2 laser, works by creating microscopic columns of heat damage in the scar tissue. The body then replaces that damaged tissue with new, more normally organized collagen. This can improve both the texture and flexibility of scarred skin.
Most patients need between one and six sessions, spaced one to three months apart to allow the skin to recover between treatments. The procedure involves some discomfort and a recovery period of several days to a week, during which the treated skin is red and peeling. For flat white scars, laser treatment can help blend the texture with surrounding skin, though it won’t restore pigment to scars that have lost their color entirely.
Scar Camouflage Tattooing
Paramedical tattooing is a specialized procedure where a trained artist deposits skin-toned pigments into scar tissue to match the surrounding skin color. This approach is particularly useful for scars that are lighter than the surrounding skin, which is common with old self-harm scars. The process involves a consultation where the artist examines your scars and matches pigments to your natural skin tone, followed by typically two to three sessions of careful layering and shading.
Skilled practitioners can produce remarkably natural-looking results by replicating the texture and depth of normal skin. The scar itself remains underneath, but the color difference that draws the eye is minimized. This option works well for people who want a cosmetic solution without the downtime of laser or surgical procedures. Results can last several years before touch-ups are needed, and the technique is suitable for a range of skin tones.
Surgical Scar Revision
For scars that are deeply indented, raised, or wide, surgical revision may produce the most noticeable improvement. Techniques vary depending on the scar. Excision and direct closure removes the old scar entirely and creates a new, thinner, less conspicuous line. Z-plasty and W-plasty rearrange the scar into a different pattern that follows natural skin tension lines, making it less visible. For tethered or depressed scars, a technique called subcision releases the scar from deeper tissue, allowing it to rise to the level of the surrounding skin.
Patient satisfaction with surgical revision tends to be high. In one study using a dermal tube technique for tethered scars, 100% of patients reported improvement at 12 months. In another study of persistent raised scars, over 84% reported good outcomes. Surgery does create a new scar, but the goal is to trade a conspicuous one for a finer line that fades more easily. Recovery varies by technique but generally involves a few weeks of wound care.
Combining Treatments
Many dermatologists and plastic surgeons recommend combining approaches for the best results. A common strategy might involve laser treatments to improve texture, followed by scar camouflage tattooing to address remaining color differences. Or microneedling sessions paired with silicone gel between treatments to maximize collagen remodeling. The specific combination depends on your scar type, your skin tone, and your budget, since insurance rarely covers cosmetic scar treatments.
Setting Realistic Expectations
No treatment, even surgery, restores scarred skin to its original state. Scar tissue has a fundamentally different structure than normal skin. What these treatments do is reduce the contrast between scarred and unscarred skin, whether that contrast is in color, texture, height, or depth. For many people, getting scars to a point where they’re not immediately noticeable at a glance is an achievable and meaningful outcome.
If you’re considering treatment, a consultation with a dermatologist is the most useful first step. They can evaluate your specific scars, identify which type they are, and recommend the approach most likely to help. Many people start with less invasive options like silicone or microneedling and move toward laser or surgery if they want further improvement. The process takes time, often months of treatment and healing, but the cumulative effect of even modest improvements can make a real difference in how you feel about your skin.