Before discussing treatment, I would like to comment on the timing for the treatment of scars. In times past, the conventional wisdom was to allow any scar, whether traumatic or surgical (or from other causes) to mature. This essentially meant leaving the scar alone for at least a year. More than fifteen years ago, however, there were several papers published in the dermatologic surgery literature regarding a procedure known as "scarabrasion." It was found that dermabrading the traumatic wound or manually sanding it within a very narrow eight to twelve week interval ,following the trauma or surgery actually yielded far better results, sometimes resulting in near or total obliteration of the scar and that the results of treatment became increasingly less favorable the longer the interval between initiating treatment and the original wounding.
In cases of more mature scars, where the above window of opportunity is past and scar maturation has already taken place, if the disparity between the surface texture of the scar and the surrounding skin is troubling, a series of medical microneedling treatments might be considererd. Medical microneedling, which may be performed mechanically using rollers (e.g. Dermaroller) or electrically operated (Dermapen) essentially consists of going over the area with an array of needles that penetrate and break up the surface of the scar and of the underlying abnormal fibrous tissue.
Disrupting the surface of the scar allows for the possibility healing with a smoother surface texture to the scar. In addition, the use of the needles crossing between normal and scar areas allows for the possibility of micro-auto-transplantation of pigment cells from the normal periphery into the scar area, which may help to somewhat further even out the pigmentation. Breaking up the fibrotic scar collagen below the skin surface sets the stage for new, normal collagen synthesis (neocollagenesis), which softens the scar and improves its general characteristics. Following medical microneedling, the treated area may appear sun-burned for about 12-24 hours. There is little to no downtime, however, and I permit patients to return to routine skin care and makeup the following day.
Not all aesthetic physicians perform medical microneedling, so, should you wish to explore this simple, minimally-invasive option, you should screen carefully for a board certified aesthetic physician with training and expertise in the procedure.