Scars - Treatment 

Treating scars 

People seek help for scars if they are painful or itchy, if they are unsightly, or if they restrict movement.

Although scars cannot be removed completely, they can often be made less visible. However, more research is required to assess the effectiveness of the different treatments.

Your GP may refer you to a dermatologist or a plastic surgeon for treatment.

Some treatments - such as laser therapy - are not widely available on the NHS, so you will need to pay for them privately.

Corticosteroid injections

Corticosteroid injections are used to treat some keloid and hypertrophic scars.

Multiple small injections are made into the scar to reduce any inflammation (swelling) and to flatten the scar. Depending on the type of scar, these may need to be repeated. Usually injections are given on three occasions at 4-6 week intervals to assess your body’s response. Sometimes treatment may continue for several months if the scar is improving.

This treatment cannot remove scars, but it can improve their appearance.

Silicone gels or sheets

Silicone gels or sheets are available from some pharmacies. They are used on healing skin (not open wounds) to reduce redness and try to minimise hypertrophic or keloid scars.

To be effective, silicone gels or sheets should be placed over the scar for 12 hours a day, for at least three months.

You can ask your GP, dermatologist or pharmacist for further advice about a range of silicone-based scar treatments.

Surgery

Sometimes, surgery can improve the appearance of scars. Surgery can be used to:

  • change the positioning of the scar
  • change the width or shape of the scar
  • release a tight scar that is close to a joint, to improve movement

Be aware that having surgery on your scar will leave a new scar that will take up to two years to improve in appearance. If surgery is used to treat a hypertrophic scar, there is a risk that the scarring may be worse after the surgery.

Surgery alone is not advised for keloids as they tend to grow back larger. Surgery for keloids is often combined with corticosteroid injections at the site of the removed scar immediately after the surgery. Some plastic surgeons also add other treatments, such as X-ray therapy and oral antibiotics to try and minimise recurrence of a keloid that has been surgically treated. You can talk to your surgeon about this.

For some pitted scars, laser surgery (laser re-surfacing) is used. This involves using a laser to remove the top layers of skin, stimulating collagen production in the deeper layers to try to make the scar flatter.

Pressure dressings

The aim of pressure dressings is to flatten and soften scars. They are most often used for large burn scars or after some skin grafts.

Pressure dressings are usually made from a stretchy, elastic material. They are worn over the scar 24 hours a day, for around six to12 months. They can also be used in combination with silicone gel sheeting to improve the appearance of scars over a long period of time.

Pressure dressings are usually used under specialist supervision.

Make-up

Cosmetic camouflage (make-up) can help cover up scars and can be particularly useful for facial scars. Some are waterproof and can stay in place 2-3 days.

Camouflage make-up that is specially designed for covering up scars is available over the counter at pharmacies. Alternatively ask your GP for advice.

Please note that camouflage colour testing (to get a good colour match for your skin type) can be a lengthy process, sometimes taking over an hour, and needs to be performed by somebody who is qualified.

Other treatments

Laser or light therapy (pulses of light) can reduce the redness in a scar by targeting the blood vessels in the excess scar tissue.

Dermal fillers are injections (often of a man-made acid) used to 'plump up' pitted scars. Treatments can be costly and the results are usually temporary. Repeat treatments are needed to maintain the effect.

Skin needling, which involves rolling a small device covered in hundreds of tiny needles across the skin, is also reported to be helpful, but repeat treatments are often needed to achieve an effect and results vary considerably.

Page last reviewed: 04/09/2012

Next review due: 04/09/2014

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Comments

The 11 comments posted are personal views. Any information they give has not been checked and may not be accurate.

ias said on 23 April 2014

ClarisUK,

I refer to your comments regarding your daughter's keloid. Has a dermatologist confirmed that it is a keloid? I ask this as there is so much ignorance when it comes to this area - as their is a Keloid and there is a Hypertrophic scar - totally two different things that does not get mentioned often - so people go untreated.

As someone currently getting treatment in the NHS, I have grown extremely frustrated at the level of consultancy in this area of laser treatment to a scar I have.

I have now been seeing this consultant for over a year - when I was told by a private sector consultant it will be done in three-months. Also, the NHS consultant keeps missing out bits that should be undergo the laser. When I make a point of this, I am told "we have be careful". But, I have understood the objectives from the outset! Imagine I have to wear a pad on my forehead in my professional life too - as I direct result of this attitude in the NHS.

So, frustrating and stressful!

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kokollie said on 20 November 2013

@lou53 - Hi, I know your comment was a few years ago now but I really hope your daughter got the treatment that she deserves, your GP was very wrong (that's a polite way of putting it!) in turning her away that way. If anyone else find themselves in the same position please, please, please either immediately ask to speak another Dr/ get a second opinion or change surgery any Dr, Consultant, GP has the right and power to petition your local PCT (or whatever it is now) to fund a treatment not otherwise available on the NHS as long as you can prove that whatever your treatments for it's having a detrimental effect on your physical or mental health or both. Before your initial appointment it might be an idea to write down just how much of an affect it is having on your life, how it makes you feel day to day, how it affects your self esteem, how you feel about yourself because it and take that with you, it can be extremely daunting and quite frankly horrible having to talk about something so personal so having something written down can be extremely helpful it also means you don't forget anything and you get everything across the way you want it to come across, I know I've been there.
I've suffered from Acne since I was 20 thanks to PCOS, I had completely clear skin all through my teens, barely even had one spot, it started on my back and within a couple of years it "spread" to my face. My back is covered in scars, it looks like someone's splattered me in dark pink paint and now my face is going the same way but I can't really do anything about the scars until the Acne has cleared up, something I have a bit of an NHS "grudge" about. Sorry for the long ramble lou53's comment compelled me to say something.

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dcssalman said on 03 May 2013

Almost everyone experiences some degree of acne problem at some point in their lives. Fortunately, in most cases, acnesubside at age 25, but if acnes become severe, they can leave permanent ugly scars.

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ClarisUK said on 28 March 2013

Lou53, you say it is "unfortunate that I am not allowed by the rules to mention names" but I have just read the rules and the only thing I can find is this:
"Comments deemed to be advertising a product or service will be removed.
We may remove references to specific medical products or medicines if the context is not appropriate."
I do not think that suggesting places that carry out work the NHS is failing to do is advertising. It can only be helpful to readers. If the NHS are not offering the same service it cannot be deemed as competition or advertising surely? What say you NHS?
I for one would love to know more about the laser surgery sites you have visited. Although my daughter whom I am researching for isn't dark skinned she is far darker than an English Rose and many of her scars are keloid.

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ias said on 21 October 2011

Lou53, I read your comments, and agree that so much ignorance exists out there about skin products suitable for different skin types and laser treatment. There is so much positive opportunities with skin treatments, I am both perplxed and stressed at the fact that many times it is NHS related people who lack the correct advice or support.

Given that Acne is a skin problem that can affect ones self-esteem and confidence, as well as the decisions one makes in their lives, it is therefore important to get the right advice.

Personally, I have found that the Private Sector is so much more experienced in this area of skin treatment - for all skin types. It is unfortunate that I am not allowed by the rules to mention names, but one need to do their homework - far beyond the NHS in some cases.

Yes, having to pay for this treatment out of pocket can be expensive. However, it is always a positive step knowing that possibilities and answers exist for the chnges that one need to overcome the barriers in life.

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lou53 said on 11 October 2011

My 19 year old daughter had bad acne on her forehead when she was 15. The doctors insisted Roaccutane was a good idea despite my protests. I cannot begin to tell you the nightmare she went through with her skin from then on. The acne soon covered her whole face and pustules were so bad people asked her in the street if she had been in a fire. The doctors insisted she carried on with the treatment until finally they agreed to take her off it as it was clearly making things worse, not better. She now has severe scarring and we have tried everything there is, but nothing has helped. Going back to the doctor to ask for scar treatment on the nhs, he was AGHAST! like how dare we. I told him in no uncertain terms it was due to doctors putting her on this roaccutne in the first place that caused her all this misery. All her teenage years. He said we cant afford this sort of cosmetic treatment on the nhs! I am so angry, but there is nothing we can do. Maybe we should change doctors.

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ias said on 29 September 2011

I have made a few comments on this website that I feel are necessary in order to inform others.

I do hope that NHS Choices are reading my comments, as I strongly believe that my contributions should be taken seriously and improvements made to this website to ensure that the anxieties of your readers are not further deepened by the lack of information on this website. Ignorance must not become the benchmark!

My own frustrations about the NHS, and its relationship with Scar Treatments, was deepened further yesterday.

In my aim to find a NHS Surgeon who is skilled in using a C02 Laser, and on dark skin types to treat a scar, I was informed that a C02 laser was recently bought and shared by two Hospitals in London, but it is not known whether the NHS has a surgeon skilled in using this laser - especially on dark skin patients. I am awaiting the outcome of these enquiries.

I am perplexed given that the NHS own existence is due to the taxable income of our diverse communities - all skin types, that when one is of darker skin type and seeking a skin treatment, the NHS ignorance and underdevelopment begins to show.

For me, and I am sure others too, this is a failing that I never knew existed within the NHS. It almost seems that if you are of darker skin type and in need on skin-related laser surgery, it becomes such a long-winded and exhausting wait to see whether the NHS can find a surgeon skilled at treating dark skin types.

This is shameful!

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abibr said on 11 September 2011

I'm afraid I have to concur with these comments. I found the NHS and GPs very uninformed and unsympathetic about the facial scarring I suffered 10 years ago as the result of a car accident. I had 80 stitches across my face, my eyelids were ripped to pieces, the skin under my right eye torn, my nose sliced open and my forehead cracked right across. I had 3 operations to repair and correct the damage. The focus was consistently upon the physical effects - the functioning of my eyes. Of course this is the priority, but I was 27 years old and was left feeling devastated, ugly, isolated and with no self-esteem. My relationship ended and I have been single ever since despite countless dates and attempts to get 'back to normal'. I'm told the scarring is now barely noticeable, but the psychological effects will never go. A proactive attempt by my doctor to understand, offer emotional support and counselling would have been helpful. Doctors need more training in this area and this website could acknowledge the psychological trauma more effectively and offer ideas for support, at the very least.

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L0R3N said on 22 July 2011

I just had to double check the date on my computer to ensure that it is in fact 2011, and not the 1950's. This is the official NHS treatment guide to scarring?! Bewilderingly unhelpful. The psychological damage caused by scarring, particularly on the face, can ruin people's entire lives, and yet many of the types of scarring and their solutions fall under the 'cosmetic' category. I'm sorry, but this is appalling.
Speaking from personal experience, I suffer with a food allergy (milk), which was never diagnosed, investigated or even mentioned as a possible cause, despite numerous visits to both doctors and dermatologists. The skin inflammations caused by this allergy have left me with deeply pitted scarring on my face. Since eliminating milk from my diet seven months ago I've only broken out on the odd occasion where I have slipped up and consumed milk unknowingly. After years of antibiotics, antidepressants, feeling suicidal, lesions upon lesions, scars upon scars and spending thousands on various treatments, it was as simple as just not eating milk. And now I have to bear these scars until I have a couple of thousand pounds saved up in order to afford private scar revision treatments. That would all be well and good, if functioning normally to earn that kind of disposable income came easily to someone who feels like the elephant man. The shame and embarrassment of having a face full of scars makes it torturous to be around other people a lot of the time. My confidence and self-esteem are shot to pieces. I expect people to dislike me based solely on my prematurely weathered, pock-marked skin. The turmoil caused to my family and all my interpersonal relationships is immeasurable, and when you look to the National Health Service for help and advice you're advised to what? Slap some make-up on and get over yourself?
Wouldn't want to be chipping away at the income of all the cosmetic practitioners by offering effective acne scar treatments though, would we?

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DaniAllen said on 11 January 2011

I agree with ias. Also some parts of the article are very discouraging. Affirmations like: having surgery on your scar will leave a new scar... Mmmm, yes, of course, but only if they hire a butcher instead a experient surgeon... (cuts, cuts and more cuts).

They should have a database of before and after pictures of various cases to help people decide whether the surgery is worth... I know each case is different, but people would get a more realistic idea.

I've seen amazing results in many laser treatments.

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ias said on 11 December 2010

I am deeply surprised that there is No mention of Laser Scar Revision from the NHS. You don't even mention the vast improvements and successes of laser treatments - now available to treat dark skin types too. Shocking!

Camouflage make-up, while successful in its aim, only covers-up the scar and the phycological challenges one may face. It does nothing to deal with reducing or improving the presentation of the scar for the patient.

So much ignorance still remains about skin toning and laser treatment for dark skin types. As someone of dark skin, I am struggling to find NHS products that can help me to tone my skin prior to laser treatment. Though it is available on the privatised market, it is also expensive. Why does the NHS seem so far behind with its treatments? Very frustrating for someone who who seeks support in skin toning. Obagi range of products are very good - the benefits are clear! But teh NHS does not seemt to use toning products that can help to tone dark patches with light. Why is this? If you do, please provide this information on this site.

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Support groups

Scarring can affect a person both physically and psychologically. There are a number of support groups and organisations that provide help and advice to people who are living with scarring.

Support organisations include: