Options to Reduce Old, White Cigarette Burns and knife Scars?

Hi! I have numerous cigarette burns and some knife wounds that are very old (approximately 15 years). They have faded as much as possible, but are now much whiter than the rest of my skin (which is very fair), so they are still quite visible. None are keloid and most are not raised to any significant degree, although a few are.

I have not had any consultations yet, but spoke to a plastic surgeon friend who does not specialize in this area. He said Fraxel might help somewhat, but didn't think the results would be spectacular. I used some sort of silicone strip (scar-ease?) about 5 years ago for several months, but the scars were already white and pretty flat, and I didn't see any real improvement. Other than that, I haven't tried much besides just giving them years to heal. I can't find a lot of research on this.

What type of procedure do you think is most likely to lead to satisfactory results? How do I find a U.S. doctor who specializes in this sort of skin repair? I know experience is the most important thing when selecting a physician, but I can't seem to find anyone (at least looking online) who specializes in this sort of thing. I'm okay with some sort of scarring, so long as it's not obvious what it was from. That is, I don't care so much about my skin being aesthetically pleasing, so long as it's not embarrassing in this particular way.

Doctor Answers (10)

Correction of old wide scars

+2

After a full thickness wound is sustained, a scar continues to change and mature for 8-12 months during which time it MAY be able to be modified by external factors. Once it becomes white (like Stretch Marks do) the small blood vessels inside it were replaced by stable white scar tissue and nothing much can be done. WYSIWYG.

While SOME lasers may reduce vascularity in scars (making them whiter sooner) and others can "sand" the top or blur the edges - NO LASER will make a scar vanish.

Your BEST option is to have the most offending scars REVISED (excised and repaired properly). This means you will go through another healing period, as they mature. But the result will be much better than what you have now, If you are happy with the way these look, then you may want to revise the others.

On a side note - if you smoke, I would seriously suggest you stop, if you want the results to be the best they can be. Smoking seriously lowers skin blood blow and destroys healing.

Dr. P. Aldea


Memphis Plastic Surgeon
5.0 out of 5 stars 61 reviews

Few options for old white scars

+2

Unfortunately, what you are describing is as good as mother nature can do given the injuries you had. No lasers or other treatments will help at all and excising the scars and revising will turn them into visible lines that will take years to become white again. If there are just a few that really bother you, however, that might be the best option.

So see a plastic surgeon for possible "scar revision" but realize that scar revision doesn't mean "scar erasure."

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon
5.0 out of 5 stars 48 reviews

White scar treatment

+2

Unfortunately, old white scars are very difficult to treat. So far, a series of Fraxel Restore treatments will sometimes help blur the edges. The results from excimer laser treatments were not good. Keeping the normal skin as light as possible with sunscreens and bleaching agents helps. Sometimes a topical retinoid (Retin-A type) cream will help blend the edges. This is a very difficult problem.

Margaret Weiss, MD
Baltimore Dermatologist
4.0 out of 5 stars 5 reviews

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Treatment options for 'old white scars'

+1

Needless to say, prevention would be the best approach, e.g. sun protection and avoidance of trauma and other inciting triggers. Combination of topical retinoid and fractional co2 laser resurfacing can be helpful to facilitate blending in of color and texture. Seek out an experienced board-certified dermatologist for a multi-prong approach.

William Ting, MD
Bay Area Dermatologic Surgeon
5.0 out of 5 stars 8 reviews

Options to reduce old white scars

+1

"Old white scars" imply that the pigment has been lost in the skin where the scar or trauma insulted the skin. The reality is that the color of these scars is virtually impossible to change. You can have a plastic surgeon excise them but I would caution you that the risk of making the scar worse may happen with this approach.

Steven Hacker, MD
West Palm Beach Dermatologic Surgeon
5.0 out of 5 stars 4 reviews

Treatment for old white scars

+1

The white scars from the burns are from 2 things. The scar tissue being very dense does not allow the fine capillaries to give the skin it's pink color. The melanocytes (pigment producing cells) could have been damaged in a deep burn and this also adds to the pale or white color of the scar. Fraxel laser can help in some cases (acne scars) but have a limited benefit in white scars. Scar excision works by cutting the scar out and bringing together the surrounding healthy skin. It's a trade off between a white flat circular scar for a small linear scar. Depending on where the scar is and the laxity of the skin the results can vary.

Chester K. Cheng, MD
Bay Area Plastic Surgeon
4.0 out of 5 stars 12 reviews

Getting rid of old white scars on the body using scar revision techniques

+1

Stable white scars can be dramatically improved using a technique known as serial excision in which the chronic scar is removed using an incision that is hidden within the scar itself.  This would be of much use in your condition. 

Raffy Karamanoukian, MD, FACS
Los Angeles Plastic Surgeon
5.0 out of 5 stars 47 reviews

Get rid of old scars

+1

After so many years of healing, light procedures will probably not do much. I would recommend looking into scar revision or maybe silicone sheeting. Consult with a surgeon or doctor and she what other options they suggest.

Kimberly A. Henry, MD
Greenbrae Plastic Surgeon
5.0 out of 5 stars 2 reviews

Combination approach for old, white scars

+1

Hello,

Old scars are harder to improve than those earlier in the healing cycle. For wider white scars, scar revision will probably help. You can always try silicone sheeting and massage for any scar. Light treatment are probably a waste of money though.

John P. Di Saia, MD
Orange Plastic Surgeon
5.0 out of 5 stars 23 reviews

Options for old white scars

+1

The reason you do not find a lot of experts for hypopigmented (white) scars is that there are not a lot of viable treatments. We do not believe that Fraxel treatments will help at all and think that the only possible viable solution for you would be some form of surgical revision.

While a surgical revision may be time intensive and still leave linear scars, it may get rid of the white skin that is bothering you. Best to contact a plastic surgeon in your area for a consultation. Good luck.

Harold J. Kaplan, MD
Los Angeles Facial Plastic Surgeon
5.0 out of 5 stars 6 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.