Q&A: What are the best treatments to improve old scars?

In general, after a wound heals, scars will improve without any treatment over the next year and beyond. Many natural or at-home remedies claim to further reduce or get rid of old scars, but most of them lack any scientific evidence that they work. Here are some common questions my patients ask.

Do over-the-counter scar treatments like Mederma help?

Mederma is a popular scar repair brand that primarily sells creams and silicone sheets as a scar treatment. My advice: Be skeptical of any over-the-counter scar treatment because there’s no proven solution, and there’s money to be made taking advantage of our anxiety about bad scars. I do not recommend Mederma or any similar products to my patients because there is little evidence that they help. Some doctors may recommend these products, but I think it’s mostly because they want to be able to offer some kind of solution rather than nothing. Scars often improve by themselves, so if someone’s scar improved with Mederma, it’s probably a coincidence.

What treatments are there for painful scars and keloids?

Keloids are scars that essentially don’t know when to stop growing. These are scars that grow beyond the original wound edges and can become large, painful, itchy, and unsightly. They are more common in African Americans — though researchers do not fully understand why — and often appear on the ears, chest, back, shoulders, and face.

Large scars like keloids are difficult to treat because any new trauma can induce a scar or keloid. Actually, if we surgically remove a keloid, there’s a risk a new keloid can form — possibly one that’s even bigger than the first. So, we generally try to first inject these scars with steroids to thin them and address symptoms. Surgeries to treat keloids are considered carefully and usually only in combination with injections. Also, in selected patients, radiation therapy can be an effective treatment, though that comes with longer-term increased risks, including cancer.

Can scars be changed or revised?

In the long term, there are many potential procedures for improving or revising scars, though any procedure can cause scars itself, cost money, and have its own side effects. Some options include scar revisions (cutting the scar out, and letting a new scar form), steroid injections (to thin scars), and other procedures (dermabrasion, laser resurfacing, microneedling) that work by causing minor intentional injuries in an effort to allow improved rehealing.

Make sure you consult a board-certified physician, a dermatologist, or plastic surgeon for reliable advice on what options may be best for you.

In many cases, even after repeated treatments and thousands of dollars, the scar may be only minimally improved, so it’s important that you know what you’re getting yourself into.

Aside from sun protection and that “tincture of time,” unfortunately there isn’t good evidence that anything else helps.

Jules Lipoff is an assistant professor of dermatology at the University of Pennsylvania Perelman School of Medicine.