Old scars can’t be completely erased, but most can be significantly improved with the right approach. The key is matching your treatment to your scar type, because a method that works well on a flat, discolored scar may do nothing for a deep pitted one. Scars finish their natural remodeling process about 9 to 12 months after the original injury, so anything older than that is unlikely to improve on its own without intervention.
Identify Your Scar Type First
Before spending money on any product or procedure, figure out what kind of scar you’re dealing with. Old scars generally fall into a few categories, and each responds to different treatments.
Flat, discolored scars are the most common. They sit level with the surrounding skin but appear darker, lighter, or redder than the tissue around them. These are the easiest to treat and often respond well to topical products alone.
Atrophic (depressed) scars sit below the surface of the skin. Acne scars are the classic example, including deep narrow “icepick” scars, wider “boxcar” scars with sharp edges, and shallow “rolling” scars that give the skin an uneven, wave-like texture. These need treatments that rebuild tissue from below.
Hypertrophic scars are raised and firm, pink to red in color, but stay within the boundaries of the original wound. They sometimes flatten on their own over time and tend to respond reasonably well to treatment.
Keloid scars are also raised and firm, but they grow beyond the edges of the original wound and appear purplish-red. They can develop years after an injury, rarely resolve on their own, and are significantly harder to treat than other scar types.
Topical Treatments You Can Start at Home
For mild scarring, especially flat or slightly raised scars, over-the-counter products can make a meaningful difference over several months of consistent use. None of these will work overnight, and none will fully erase a scar, but they can visibly soften its appearance.
Silicone Gel and Sheets
Silicone is the most studied topical scar treatment available. Silicone sheets are sticky, flexible strips you place over the scar for several hours a day. Silicone gel works similarly but dries into a thin film, making it more practical for visible areas like the face or hands. Both work by hydrating the scar tissue and creating a protective barrier that helps regulate collagen production. For best results, plan on using them consistently for at least two to three months. They’re most effective on raised scars (hypertrophic and some keloids) but can also improve the texture and color of flat scars.
Retinol and Retinoids
Retinol increases skin cell turnover and boosts collagen production, which can reduce the appearance of acne scars and stretch marks over time. It works by pushing new, healthy cells to the surface faster while encouraging the deeper layers to produce fresh collagen. Start with a lower concentration (0.25% to 0.5%) a few nights per week to let your skin adjust, since retinol commonly causes dryness and peeling early on. Prescription-strength retinoids work faster but carry more irritation risk. Retinol is best suited for shallow atrophic scars and overall texture improvement rather than deep pitting.
Onion Extract Products
Products containing onion extract (the active ingredient in Mederma, for example) have some clinical support. A study on cesarean section scars found that patches containing onion extract and allantoin improved pigmentation, relief, and pliability of scars after just four weeks of use. However, in that same study, patients themselves didn’t report noticing significant changes, suggesting the improvements may be subtle. These products are worth trying for mild scars, but don’t expect dramatic results on older, thicker scar tissue.
Vitamin E
Despite its popularity, vitamin E has weak evidence for scar improvement. Some people find it moisturizing, which can temporarily improve the look of dry scar tissue, but there’s no strong clinical data showing it remodels old scars. A few studies have even found it can cause contact dermatitis in some users. It won’t hurt to use it as a moisturizer, but don’t rely on it as your primary treatment.
Professional Treatments for Deeper Scars
When topical products aren’t enough, professional procedures can reach the deeper layers of skin where old scar tissue is anchored. Most of these require multiple sessions spaced weeks apart, and improvements continue developing for months after treatment as new collagen forms.
Microneedling
Professional microneedling uses a device with fine needles to create hundreds of tiny punctures in the scar tissue. This triggers your body’s wound-healing response, activating the cells that produce collagen and elastin. As new collagen fills in from below, depressed scars gradually rise closer to the level of surrounding skin. Most people need three to six sessions, spaced about four to six weeks apart, to see meaningful improvement. Adding radiofrequency energy to the needles (RF microneedling) pushes heat deeper into the skin, further boosting collagen production and producing stronger results on stubborn scars. At-home dermarollers exist but can’t match the depth, precision, or sterility of professional devices.
Laser Resurfacing
Two types of lasers dominate scar treatment, and they do very different things. Fractional CO2 lasers create microscopic columns of damage in the skin, prompting the body to replace old scar tissue with new collagen. This improves texture, reduces thickness, and increases pliability of the treated area. Pulsed dye lasers target the blood vessels feeding the scar, which reduces redness and itching. The vessel damage also triggers collagen remodeling, replacing thick, coarse fibers with looser, more normal-looking ones. Some practitioners combine both laser types on the same scar for better overall results. Expect redness and swelling for several days after CO2 laser treatment, with full results developing over three to six months.
Subcision
Rolling and atrophic scars often look depressed because fibrous bands are literally tethering the skin’s surface down to deeper tissue. Subcision involves inserting a small needle or cannula beneath the scar to physically cut those tethers, allowing the skin to lift. It works best on rolling acne scars and broad depressed scars. Bruising and swelling are common afterward and can last one to two weeks. Subcision is frequently combined with other treatments like microneedling for better outcomes.
Chemical Reconstruction (TCA CROSS)
For narrow, deep icepick scars that don’t respond well to surface treatments, a concentrated acid solution is applied directly into the scar channel using a fine applicator. This destroys the scar tissue from the inside and stimulates new collagen to fill the gap as it heals. The treated spots form tiny scabs that peel off over about a week. Multiple sessions are typically needed, but each round builds more collagen into the scar. This technique is specifically designed for icepick and small boxcar scars and is often done alongside broader treatments like microneedling or laser.
Treating Raised and Keloid Scars
Raised scars require a different strategy than depressed ones. Instead of building collagen, the goal is to break down the excess collagen that makes the scar thick and prominent.
Steroid injections are the first-line treatment for both hypertrophic and keloid scars. The injections reduce inflammation and slow the overactive collagen production that keeps the scar raised. You’ll typically need monthly injections for up to six months before seeing the scar flatten. Hypertrophic scars generally respond well and may flatten significantly. Keloids are more stubborn and often recur even after treatment, so they frequently require combination approaches: steroid injections paired with silicone sheeting, laser therapy, or other techniques.
For keloids that don’t respond to injections, surgical removal is sometimes considered, but it carries a real risk of the keloid growing back even larger. Surgeons often follow excision with immediate steroid injections or radiation therapy to the site to reduce recurrence.
How to Choose the Right Approach
The best starting point depends on what your scar looks like and how much it bothers you. For flat, discolored scars, start with silicone products and retinol for three to four months before considering professional options. For shallow acne scars or uneven texture, microneedling or fractional laser treatments are typically the most effective route. Deep icepick scars benefit most from TCA CROSS combined with microneedling. Rolling scars that create a wavy appearance usually need subcision to release the tethered tissue before other resurfacing treatments can work properly.
Multiple sessions of any professional treatment are the norm, not the exception. Most improvement happens gradually as collagen remodels over months. It’s also common for dermatologists to combine two or three techniques across a treatment plan rather than relying on a single approach. The combination of subcision, chemical reconstruction, and microneedling, for instance, has been shown to produce higher patient satisfaction and faster healing than any single procedure alone.
Sun protection matters throughout any scar treatment process. UV exposure can darken scar tissue and undo the progress of treatments targeting pigmentation. Daily sunscreen on exposed scars is one of the simplest things you can do to improve their long-term appearance.