American Society of Plastic Surgeons
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John Marshall
5 years ago
Answered

Scarring

What is the best treatment for atrophic scars? Is there a certain product that reduces the appearance of scars?

Procedure: Dermal Fillers

Replies 7

Jason Petrungaro
ASPS Surgeon
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Scars can take on many shapes and sizes. Hypertrophic scars are typically raised, widened, and sometimes discolored red or purple and stay within the borders of the original incision or cut. Keloids are like hypertrophic scars but worse because they will extend or "grow" outside the original incision or cut.

You mentioned atrophic scars. These are typically thin, wispy, and sunken in as opposed to their hypertrophic counterparts. There are a few options for treatment. You can have dermal filler injected underneath the scar to fill or plump up the sunken-in area. This is a temporary fix considering most fillers are not permanent. One can also inject fat cells into the area, which would be a permanent filler. The other option for the scar would be scar revision surgery, which is basically cutting out the entire scar and closing the wound again with the intention that the new scar will look better. For a fresh scar, I often recommend silicone gel sheets or ointment.

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Katerina Gallus
ASPS Surgeon
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Hello and thank you for your question. There are many options for treating scars and it can be dependent on the location of the scar and the quality of the surrounding tissue among other factors. If the scar is atrophic, meaning indented and/or thin and stretched out, then the options include excision and reclosure or stimulation of collagen remodeling with a modality such as CO2 laser or microneedling. If the scar is depressed it may benefit from filler with a hyaluronic acid filler or fat grafting. I recommend that you seek an opinion in person from a board-certified plastic surgeon to create a plan that meets your needs and expectations.

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Dimitrios Karypidis
ASPS Int. Surgeon

Atrophic scars are a real challenge. Some of the factors that play a huge role in the prognosis and treatment include the etiology, elapsed time, location and severity. Treatment goals: a) improve the quality of extracellular matrix (e.g. the type and quality of collagen and elastin fibers in the scar area), b) promote a more effective remodeling and re-epithelialization, c) provide viable support and volume and d) improve local tissue oxygenation (blood supply). A multi-modality approach is usually more effective than a single modality. The combination of a superficial skin resurfacing / collagen induction technique (e.g. fractional laser, microdemabrasion, micro-needling) could be combined with iPRf (platelet rich fibrin) injections, mesotherapy using hyaluronic acid with oligopeptides and vitamins. In more severe cases, subcutaneous subcisions and nano fat grafting may have a role. Close examination by a board certified plastic surgeon is always imperative.

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Jon Ver Halen

Dear John,

I would echo most comments on this thread already:

1) Scars are all different. Unattractive scars can be classified as hypertrophic, keloid, hyperpigmented, or atrophic.

2) There are a variety of treatments for atrophic scars, including filler injection, fat grafting, scar revision, and laser resurfacing.

I would add that one technique gaining popularity is microneedling and platelet-rich-plasma application to scars. This may be worth looking into, as it improves the superficial appearance of the scar, while fat grafting or filler can improve the deep tissues.

Good luck!

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Sachin Shridharani
ASPS Surgeon

Atrophic scars are on the spectrum of unsightly scarring and can result from several different types of issues during the healing process. Treatments traditionally have included lasers and dermal fillers (Juvederm family, Restylane family, etc...). Surgically, fat grafting can be performed to improve the contour and quality of the scar. Alternatively, one can have the scar formally revised (a process of removing the atrophic scar and repairing the resultant wound). Recently, microneedling with PRP has become an emerging treatment option with minimal downtime and promising results. Typically, the best treatment involved a series of treatments and a combination of procedure options.

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Mario Carranza-Garcia
ASPS Int. Surgeon

i join the words off my colleagues .and the best tretment is a micture of surgery and kenacort

15 day each application,for a long time maybe months

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Michael Kulick
ASPS Surgeon
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There are may treatment options for scars, including atrophic scars. See the link below for scar treatment options. The problem for providing you sound advice vs. discussing all pathways for treating scars is that I do not know what your scar looks like. Best for you to see a ASPS doctor in your area to actually look at you scars and provide you options based on your clinical exam. That should be your next step.

Michael Kulick MD

Board Certified Plastic Surgeon

Member of ASPS, ASAPS

Recipient of the Klingbeil Award – Teaching Safe Techniques and Advanced Technologies

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