Medical and Laser therapy for scared skin

Scars develop as a result of tissue damage such as trauma, burns, surgery, acne or infection. This damaged tissue is repaired and replaced with new collagen. This collagen appears as a scar. New scars are red (erythematous) and as they mature the scars become paler and white or, on occasion pigmented.  If there is too much collagen then the scar appears as a hard nodule and is called a hypertrophic or keloid scar. If there is too little collagen then the scar appears as a depression or indented area and is called an atrophic scar.

In summary therefore a scar can be described by its colour, its collagen content and its surface profile:

Colour of the scar

red (erythematous)



Amount of collagen in the scar

excess collagen: hypertrophic (keloid)

depleted collagen: atrophic (ice pick, box car and rolling scars)

Surface profile

Proud of skin




This classification system not only allows us to classify scars according to their appearance but also identifies targets and sites for intervention and therapy.

Newer red scars can be treated using vascular lasers that target the redness. This not only decreases the redness but also modifies collagen within the scar resulting in an improved end appearance.

The appearance of pale or pigmented scars can be improved using fractionated resurfacing lasers such as Fraxel, Resurfix or Active FX. These laser make thousand of tiny microscopic holes that heal leaving scars that are more pliable and have a more natural colour and appearance.

Hypertrophic or keloid scars can be flattened by injection into the scar of either a steroid or Isoptin, both of which cause localised shrinkage of the scar tissue. Often multiple treatments are required. Keloid and hypertrophic scars can also be improved using a high energy fractionated CO2 laser such as active FX. Hypertrophic scars have a tendency to recur. This tendency can be reduced by the regular application of a silicone gel such as Kelocote or Dermatix.

The surface profile of elevated scars can be improved in similar fashion by a combination of injection and active FX or Fraxel laser therapy.

Depressed or indented scars are caused by contraction of deeper scar tissue that pulls the scar downwards. There are 2 types of treatment for depressed scars that can be used alone or in combination. Filler injections can be placed under the scar to elevate it and are quick and give good short to medium term results. Depressed scars can also be elevated by a surgical procedure known as subcision. Subcision is carried out under local anaesthetic. A needle with a tiny blade at its tip is used to break the tethered bands which in turn releases the scar upwards.

Scars: Photo gallery

Erythematous atrophic scars with depression

Treatment: Subcision followed by 3 sessions of combined vascular laser(Nd-Yag) and Fraxel

Erythematous Hypertrophic scar        

Treatment: Triamcinalone injection on 2 occasions followed by 3 sessions of combination therapy of vascular laser (Nd-Yag ) and  Active FX and regular silicone gel application

Pale atrophic depressed scarring post acne

Treatment: 3 sessions of Fraxel followed by localised HA filler

Atrophic depressed scarring post acne

Treatment: Subcision followed by 4 sessions of  Fraxel laser