The aim of these treatments is not to erase the scar but to make it as inconspicuous as possible and to correct any change in texture or function it has left behind.
The approach depends on the type: hypertrophic scars stay raised but within the edge of the wound; keloids cross it and tend to recur; atrophic scars are sunken and typical of acne or chickenpox; and there are also pigmented scars and contracted ones, which restrict movement.
The techniques available are corticosteroid injection, fractional laser, microneedling, medical silicone sheeting, chemical peels and surgical excision when the raised tissue does not respond to conservative treatment. Combining several is the norm.
Results are not immediate: some effects show within a few weeks, but the deep remodelling of the tissue can take up to a year to settle, and the protocol is adjusted at each review.
Aftercare shapes the result: avoid direct sun and keep SPF 50 protection on the area all year round. In patients prone to abnormal scarring, preventive measures start from the surgery or the injury itself.
Scars can become a source of concern, aesthetic and functional alike. In many cases these marks on the skin are not only visible: they can also cause pain, itching or a loss of elasticity that affects the patient’s quality of life. At the Instituto de Cirugía Plástica del Mediterráneo in Valencia we specialise in scar revision through advanced treatments adapted to each clinical case.
Below we explain in detail what scar revision means, which treatments are most effective today, how the best therapeutic approach is chosen for each patient, and what results can be expected.
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Scar revision is a set of medical procedures designed to improve the appearance, texture and function of a scar. The goal is not to erase the trace of an injury or an operation completely, but to make it look as discreet and natural as possible, keeping any aesthetic or functional disturbance to a minimum.
Healing is the body’s natural way of repairing tissue after an injury, but in some cases the process is not a controlled one. The result may be a hypertrophic scar, with excess collagen in the area, or a keloid, which goes beyond the edges of the original wound and produces a larger, thicker, raised and sometimes painful lesion.
Improving a scar means more than treating how it looks on the surface: it means working at depth in the tissue, in order to correct structural abnormalities and encourage more orderly healing.
What separates a hypertrophic scar from a keloid is not how far it rises, but whether it respects the edge of the wound: the hypertrophic scar is raised but stays inside it; the keloid crosses it and invades skin that was never injured, which is why it tends to come back after treatment. Atrophic scars are the opposite — they are sunken — and they are the ones typical of acne and chickenpox. The distinction is not academic: it decides the treatment, because injected corticosteroid and silicone sheeting act on excess tissue, whereas a sunken scar needs collagen production to be stimulated. Original diagram by the Instituto de Cirugía Plástica del Mediterráneo, simplified for general readers.
Which scars can be treated
At our clinic we treat different types of scar, recent or old, surgical or traumatic. The commonest are:
Hypertrophic scars: raised, but confined to the edge of the wound.
Keloids: they grow beyond the original area and tend to recur.
Atrophic scars: sunken, typical of acne or chickenpox.
Pigmented scars: a change in colour, either hyperpigmentation or hypopigmentation.
Contracted scars: they affect the movement of the skin or of the area next to it.
Scars with an irregular surface: caused by poor healing or by tension in the skin.
The treatment is decided according to the type of scar, how long it has been there, where it sits anatomically, the patient’s medical history and their expectations.
Advanced methods for improving scars
The most effective approach rests on combining personalised medical techniques. Some of the therapeutic options we use are:
1. Corticosteroid injection
Particularly indicated for keloids and recent hypertrophic scars. The corticosteroid reduces inflammation, the proliferation of fibroblasts and the excessive production of collagen. Sessions are a month apart and results are visible within a few weeks.
2. Ablative or non-ablative fractional laser
Laser treatment remodels the deeper collagen, reduces thickness and evens out pigmentation. It works on raised and sunken scars alike, and can be combined with other techniques. It requires a precise dermatological assessment and several sessions for the best results.
3. Microneedling or dermapen
This technique makes many tiny perforations in the skin, which stimulate the natural regeneration of collagen and elastin. It is particularly useful in atrophic scars and acne scars, improving texture and evenness of the skin. It can be used on its own or together with active ingredients such as hyaluronic acid or growth factors.
4. Medical silicone sheeting
These sheets or gels are placed over the scar for several hours a day and work by applying constant pressure, keeping the area hydrated and encouraging controlled remodelling. It is a treatment recommended for recent scars, particularly after surgery, to prevent them becoming hypertrophic.
5. Medical peels
A chemical peel helps remove the surface layers of the skin, smoothing it and improving the tone. In pigmented or atrophic scars it can be an effective addition to the overall treatment. Its strength and depth have to be matched to the skin type and to the particular scar.
6. Surgical excision
Where the shape or the raised surface of a scar cannot be corrected with conservative treatment, surgical excision may be the option. The procedure uses advanced suture techniques to keep the final mark as small as possible. It is a common choice in recurrent keloids and in disfiguring scars.
The initial personal assessment
Every treatment begins with a specialist medical assessment. At our clinic we carry out a detailed clinical examination looking at:
The type of scar and where it is.
How long it has been there.
Associated symptoms such as pain or itching.
The response to any previous treatment.
The patient’s skin type and history.
What can realistically be expected.
This assessment lets us draw up an individual treatment plan that may involve a single technique or a deliberate combination of several, to achieve both aesthetic and functional results.
Expected results and follow-up
Scar revision treatments do not take full effect straight away. Some effects can be noticed within a few weeks, but the deep remodelling of the tissue can take up to a full year to settle.
Medical follow-up is essential for adjusting the treatment as the scar evolves. The initial protocol may well be supplemented with extra sessions or a change of technique to get the best result.
The effects our patients value most include:
A reduction in the volume or thickness of the scar.
Better colour and more even skin.
The disappearance of itching or associated discomfort.
Recovery of movement or elasticity where these were restricted.
Less aesthetic impact and better self-esteem.
Aftercare and prevention
If the surgery is recent, there is a window worth not missing. On a scar less than three months old we can act with a post-surgical protocol of CO₂ laser and intense pulsed light, whose benefit the literature places precisely in that period: from the third month onwards it stops being significant.
An essential part of a successful treatment is the aftercare. In every case we recommend:
Avoiding direct sun on the scar.
Applying SPF 50 sun protection all year round.
Not picking or scratching the treated area.
Using the products prescribed (silicone, regenerating creams).
Keeping to the schedule of medical reviews.
In patients prone to abnormal scarring, preventive measures should be taken from the first moment after surgery or injury, to reduce the risk of developing keloids or hypertrophic scars.
At the Instituto de Cirugía Plástica del Mediterráneo we offer advanced medical treatments for improving scars, with visible results and a human approach. Our priority is a solution that is tailored, safe and grounded in science — one that improves not only how the scar looks, but also helps the patient recover their sense of well-being.
We have latest-generation medical technology, a highly experienced team and a protocol of individual care. If you have a scar that worries you, or you would like to explore what can be improved, you can request a medical assessment with no obligation.
We are in Valencia, ready to help you feel confident in your skin again.
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No. It can be improved, sometimes greatly, but a scar does not disappear: the skin repairs itself with tissue that is different from the original, and that is permanent.
What can be changed is practically everything else: the colour, how raised it is, its width, its texture, its flexibility, the itching and pain if there are any, and in some cases the direction of the scar, through surgery, so that it falls into a natural crease where it shows less.
The realistic goal is that it stops drawing the eye, not that it ceases to exist. Anyone promising the second is promising something they cannot deliver.
When can a scar start to be treated?
Earlier than most people think. The most recent systematic review of surgical scars — 20 studies and 1,089 operated patients — concludes that early intervention and the use of several treatments in combination give better results than waiting.
That does not mean acting on an open wound. It means that, once it has closed, the period in which the scar is still maturing is the one in which how it ends up can most be influenced; and that a scar that is years old can be improved, but you are starting further back.
The specific care of a recent scar — silicone, sun, pressure, and when each of them starts — is set out in our scar protocol after surgery.
Which treatment does what? They are not interchangeable
This is the part almost nobody explains, and it is what decides whether a treatment will help you. Each technique shifts a different dimension of the scar. According to that same review of 20 studies:
Treatment
What the evidence says it acts on
Silicone gel or sheeting
Pigmentation and flexibility in hypertrophic scars
Fractional CO₂ laser
Flexibility and texture, with stable improvement
Pulsed dye laser
Height and the vascular component: the red, raised scar
Botulinum toxin
Moderate to strong efficacy in areas under high tension, such as the face and chest
Two practical conclusions follow. First: a red flat scar and a white sunken scar are not treated the same way, and anyone offering the same thing for both is not looking at the scar. Second: the review itself indicates that combining techniques achieves more than persisting with one, because each fixes something different.
(Botulinum toxin is a prescription medicine. It is mentioned here because it appears in the published evidence; whether it is indicated is always decided in consultation, and no regimen is given here.)
Which scars respond poorly?
It is worth knowing before you start, so as not to spend time and money on the wrong expectations:
The very old and already mature ones change less than recent scars, though they do change.
The sunken and wide ones — an atrophic or stretched scar — respond less well to treatments that only work on the surface: often what they need is surgery to close them again without tension.
Those under constant tension because of where they sit tend to widen again, and there the first thing to resolve is the tension.
Keloids have their own answer, in the next question.
A scar can also have a component you cannot see: adhesions to the deep layer that pull and cause discomfort. That is found on examination, not in a photograph.
Does a keloid come back if it is operated on?
If it is operated on and nothing else is done, very often yes. That is the central fact in treating keloids and it explains why simply cutting one out usually ends up worse than before: the new scar can grow larger than the one that was removed.
What changes the outlook is what is added to the surgery. A 2026 systematic review bringing together 21 studies and more than 8,627 patients gives these recurrence figures according to the adjunct treatment:
Adjunct to surgery
Published recurrence
Post-operative brachytherapy
3.1-15%
External beam radiotherapy
14-29.3%
Compression therapy
10.66-14% (particularly useful on the earlobe)
Corticosteroid injection (triamcinolone)
6.6-33%, depending on the protocol
5-fluorouracil
Reduces recurrence compared with surgery alone
The authors themselves point out that they could not carry out a meta-analysis, because the protocols differ so much between studies, so these ranges guide but do not predict. And their practical conclusion is clear: combinations of treatments work better than any one on its own.
ICPM does treat keloids, and the conversation starts exactly there: not with whether it comes out, but with what is added to it so that it does not come back.
If you are prone to keloids, say so before any surgery, whatever it is for. It changes the planning.
Do you see the result straight away?
No, and this is the commonest source of discouragement. A scar matures over months, and along the way it goes through a phase in which it is redder, harder and more marked than it will be at the end. Judging a treatment after a few weeks is judging it too soon.
That is why follow-up uses comparable photographs and scoring scales — the same ones the studies use — rather than the impression of each visit: visual memory is a poor judge of slow change.
Sources and clinical review
McGinty S, Siddiqui WJ. Keloid. StatPearls, NCBI Bookshelf, updated July 2023. NBK507899. The criterion that separates a keloid from a hypertrophic scar: keloid tissue extends beyond the site of the injury, whereas a hypertrophic scar remains confined to the injured area. It also records the high recurrence rate after excision alone.
Ogawa R. The Most Current Algorithms for the Treatment and Prevention of Hypertrophic Scars and Keloids: A 2020 Update. Plastic and Reconstructive Surgery, 2021. PMC8687618. Intralesional corticosteroid and silicone gel sheeting among the options for treatment and prevention, and how a scar evolves over the months.
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