Old scars can be significantly improved, but rarely erased completely. The right approach depends on your scar type, and most treatments work by triggering your skin to rebuild collagen in the scarred area. Options range from at-home topical products to professional procedures like laser resurfacing and microneedling, with costs and recovery times that vary widely.
Why Your Scar Type Matters
Not all scars respond to the same treatments, so identifying what you’re working with saves time and money. Flat, discolored scars from cuts or acne are the easiest to treat. Atrophic scars, the pitted or indented kind common after acne, sit below the skin’s surface because the body didn’t produce enough collagen during healing. These often need professional treatment to fill in.
Raised scars fall into two categories. Hypertrophic scars are thick, pink-to-red, and stay within the boundaries of the original wound. They develop one to two months after an injury and sometimes flatten on their own over time. Keloid scars are more stubborn: red to purple, they grow beyond the original wound area and can appear months or even years later. Keloids never resolve without treatment and have a high recurrence rate even after professional intervention.
Contracture scars form after burns and tighten the surrounding skin, sometimes restricting movement. These typically require medical procedures rather than topical solutions.
Silicone Gel Sheets and Gels
Silicone is the most studied at-home scar treatment and a reasonable first step for raised scars. The sheets or gels work by sealing moisture into the outer layer of skin, which reduces water loss through the scar surface. This hydration effect appears to calm the cells that produce collagen, slowing down the overproduction that keeps raised scars thick and firm. Over weeks of consistent use, scars gradually soften, flatten, and fade in color.
For best results, silicone sheets need to stay on the scar for 12 or more hours a day over several months. This makes them practical for scars on the chest, arms, or legs, but tricky for areas like the face or neck. Silicone gels that dry into a thin film are a more convenient alternative for visible or hard-to-cover spots. Neither option works well on pitted or indented scars, since the problem there is too little tissue rather than too much.
Onion Extract and Vitamin E
Over-the-counter scar creams frequently contain onion extract, often sold under brand names like Mederma. The evidence is mixed. In a study on cesarean section scars, patches containing onion extract improved pigmentation, texture, and pliability when rated by clinicians, but only in women who already had scar tissue from a previous surgery. Women using the patches on their first surgical scar saw no measurable difference compared to those who used nothing.
Vitamin E is one of the most commonly recommended home remedies for scars, but clinical evidence supporting it is thin. Some dermatologists caution that vitamin E applied topically can cause contact dermatitis in certain people, potentially making the scar area look worse. If you want to try an at-home product, silicone has a stronger track record than either of these ingredients.
Chemical Peels
Chemical peels use acids to remove damaged outer skin layers, prompting the body to regenerate smoother tissue underneath. They work best on shallow, discolored, or mildly textured scars rather than deep pits or thick raised tissue. A study comparing glycolic acid peels to trichloroacetic acid peels for acne scars found both equally effective at reducing scar appearance when combined with microneedling, with glycolic acid also improving overall skin texture.
Superficial peels cause mild redness and peeling for a few days. Medium-depth peels penetrate further and require about a week of recovery but produce more noticeable results. Most people need a series of treatments spaced two to four weeks apart. Peels are generally affordable compared to laser procedures, making them a middle ground between at-home products and more intensive options.
Microneedling
Microneedling uses a device covered in fine needles to create tiny, controlled punctures in scar tissue. These micro-injuries trigger your skin’s repair process, calling collagen-producing cells to the area and releasing growth factors that coordinate tissue rebuilding. Your skin first lays down a flexible form of collagen, then gradually replaces it over the following weeks and months with the stronger, more structured type found in healthy skin.
Needle depth matters. Shallow depths work for surface-level texture issues, but remodeling deep acne scars requires penetrating 1.5 to 2.5 millimeters into the deeper layers of skin where the structural foundation lives. This is why at-home dermarollers with short needles rarely produce dramatic results on old, deep scars. Professional microneedling devices reach the necessary depth and are used under controlled, sterile conditions.
Most people see gradual improvement over three to six sessions spaced about a month apart. Recovery involves a day or two of redness and mild swelling, similar to a sunburn. Results continue developing for months after the final session as collagen remodeling progresses.
Laser Treatments
Laser resurfacing is one of the most effective options for old scars, particularly for texture, thickness, and discoloration. Two types are commonly used, and they do different things.
Pulsed dye lasers target blood vessels in scar tissue, reducing redness and itching. They’re especially useful for scars that are still pink, red, or purple. Fractional CO2 lasers work differently: they vaporize tiny columns of damaged tissue, which refines texture, reduces thickness, and improves flexibility in the treated area. For burn scars, combining both laser types in a single study cut scar severity scores by more than half. All patients in that study reported improvement and were satisfied with their results.
The average cost of laser skin resurfacing is around $1,829 per session, according to the American Society of Plastic Surgeons. Most scars need multiple sessions. Recovery ranges from a few days for non-ablative lasers (which leave the skin surface intact) to one or two weeks for ablative lasers like fractional CO2, which cause visible peeling and redness as the skin heals.
Surgical Options for Deep Scars
Some scars are too deep or too structured for surface-level treatments to reach. Ice pick scars (narrow, deep pits) and certain crateriform scars cannot be revised satisfactorily with laser or dermabrasion alone because those tools can’t penetrate deep enough.
Subcision is a procedure where a needle is inserted beneath a depressed scar to break the fibrous bands anchoring it to deeper tissue. Releasing these tethers allows the scar to rise closer to the level of surrounding skin. For ice pick scars, punch excision removes the scar entirely using a tiny circular blade (1 to 2.5 millimeters wide) that cuts down to the fat layer. The small wound is then closed or filled with a skin graft slightly larger than the hole, which heals flush with the surface.
These surgical techniques are often combined with dermabrasion to smooth the edges where the treated area meets normal skin, reducing the crateriform appearance. Recovery is relatively quick for such small wounds, but the results take months to fully settle as collagen remodels beneath the surface.
Protect Your Scars From the Sun
UV exposure can darken scar tissue and make it more prominent, regardless of what other treatments you’re using. Scar tissue is more vulnerable to hyperpigmentation and inflammation than normal skin, so even old, well-healed scars can become more noticeable after sun exposure. Apply sunscreen with SPF 30 or higher to any visible scars daily, even in winter or on cloudy days. This single habit prevents your scars from getting worse while you work on making them better.
Setting Realistic Expectations
Scars take 9 to 12 months to fully mature and complete their natural remodeling process. If your scar is newer than that, it may still improve on its own, and most surgeons won’t perform a scar revision until that window has passed. For older scars that have already stabilized, improvement is absolutely possible, but complete removal rarely is. Most professional treatments aim for 50 to 80 percent improvement in appearance, which in practice can make a scar far less noticeable.
The most effective strategies often layer multiple approaches: silicone or topical treatments for daily maintenance, sunscreen to prevent darkening, and a professional procedure matched to your scar type for the structural changes that topicals can’t achieve. A dermatologist can assess your specific scars and recommend the combination most likely to produce visible results.