Scar Treatment - how can I flatten a raised, hard forehead scar? (Photo)

Question

Hello 34 year old female here. I was injured a year and a half ago which resulted in a small gash on my forehead. It healed raised and hard. Over the past months I’ve been doing scar massage and using silicone scar tape. I did do a few Microneedling sessions where I did see improvement. Sometimes the scar looks flat and other times it looks raised as in this photo. Why is that and what can I do to truly flatten the scar?

Anna Chacon, MD, FAAD · Answer

Thank you for your thoughtful question. Raised scars, particularly on the forehead, can be stubborn due to the skin’s limited fat cushion and frequent muscle movement in the area.

Why the Scar Sometimes Looks Raised
The appearance of the scar fluctuating—sometimes flat, sometimes raised—is actually quite common. This is often due to:

Inflammation or fluid retention (can worsen with stress, weather, or skin irritation)

Vascular changes (blood flow can make scars appear redder or more prominent)

Lighting and movement (forehead muscles can make the scar more noticeable depending on facial expression)

These variations are normal, but the underlying structure of the scar may still benefit from further treatment.

How to Truly Flatten the Scar
Since you've already used scar massage, silicone sheeting, and microneedling with improvement, you're on the right path. Here are additional and more targeted approaches:

1. Intralesional Corticosteroid Injections
Ideal for raised, hard (hypertrophic) scars.

Helps reduce collagen overgrowth and flattens the scar.

Typically done every 4–6 weeks for a few sessions.

2. Laser Therapy (Fractional CO₂ or Pulsed Dye Laser)
Can help both texture and pigmentation.

Reduces scar thickness and improves the blend with surrounding skin.

Works well when combined with silicone treatment or injections.

3. Microneedling with Radiofrequency (RF)
More effective than standard microneedling for firm or deep scars.

Helps remodel collagen and soften scar tissue more aggressively.

4. Topical Treatments
Products containing tretinoin or onion extract (like Mederma) may continue to help with scar maturation.

Consider pairing with silicone gel or pressure therapy for added effect.

5. Surgical Scar Revision (if persistent)
In rare cases where conservative methods fail and the scar is cosmetically disruptive, surgical excision with meticulous closure can offer improvement.

Post-surgery care is essential to avoid recurrence.

Summary
Your forehead scar may continue to improve gradually, but for permanent flattening, steroid injections and/or fractional laser treatments are often the most effective next steps. These therapies can significantly reduce scar height and hardness, especially when combined with the consistent care you’re already providing.

Raffy Karamanoukian, MD, FACS · Answer

Fractional laser is an amazing and highly effective treatment in our office. We use the laser treatment to help with acne scars, large pores, fine wrinkles, tissue collagen loss, scars, sebaceous hyperplasia, active acne, and for brightening dark pigmentation. Although there are very strong fractional lasers such as CO2 laser, we use lighter treatments for corrective skincare and maintenance of results. Our Thulium fractional laser, clear and brilliant laser, and Ultra Thulium laser are excellent options in our clinic. We also perform CO2 fractional and erbium depending on skin tone and tolerance for downtime. Patients do have to use a Melarase cream before and after treatment to help further reduce pigmentation after laser.  Melarase AM, Melarase PM, and Melapads can seriously improve surface sun damage and UV related pigmentation. Dark spots can improve with these treatments. I recommend fractional laser for incisional scars as well, especially after plastic surgery.  
Best,
Dr. Karamanoukian 
Realself100 Surgeon

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