Best Procedure for 8 - 10 year old scar removal? (Photos)

Question

I have 8-10 year old scars that I want to get rid of as much as possible. I have three that are about 2 inches wide and raised/white. And I have a few others that are just flat white scars. I would like to diminish them as best as possible. What would be the best treatment? Microneedling, injections, or something else? Thanks!

Nelson Lee Novick, MD · Answer

I'm sorry that you are having this problem and understand that the visible presence of these scars serves as a continual painful reminder of their origin. 
Although mature scars, I.e. those over three months of age, can unfortunately seldom be entirely erased entirely, there are several tried and true approaches that have stood the test of decades of time for significantly improving them. To start with, the elevated portions can be flattened via the use of intralesional anti-inflammatory agents.
Once all are flattened, then a combination of mechanical manual microneedling (no need for the added expense and risks of adverse reactions from RF microneedling) accompanied by the application of Rx pigment promoting agents, such as tyrosine and latanoprost, can be used to improve the color. 
You would be wise to consult an experienced, board certified cosmetic dermatologist scar treatment specialist and best of luck. Once again sorry for your pain.

Anna Chacon, MD, FAAD · Answer

Thank you for sharing your photos and providing details about the age and appearance of your scars. The good news is that even scars that are 8–10 years old can often be improved. The challenge is that older scars typically require a tailored approach based on whether they are raised, flat, wide, depressed, red, or white.

From your description, you appear to have two different scar types:

Raised, wide, white scars (approximately 2 inches wide)
Flat white scars

Because these scar types behave differently, they often benefit from different treatments.

For the raised scars, I would first determine whether they are truly hypertrophic (still elevated and thickened) or simply widened scars with some residual elevation. If there is significant thickness, steroid injections such as Kenalog may help flatten them. However, since these scars are already many years old and white in color, injections alone are unlikely to provide dramatic improvement in texture or appearance.

For the flat white scars, injections generally do not provide much benefit. These scars are often characterized by a lack of pigment and altered collagen structure.

In my experience, some of the most effective treatments for older surgical or traumatic scars include:

Fractional CO2 Laser
This is often one of the most powerful options for improving texture, thickness, and overall scar appearance. It works by remodeling collagen and can significantly soften and blend scars over a series of treatments.

Microneedling or RF Microneedling
These treatments can stimulate collagen production and improve texture. RF microneedling may offer greater remodeling for thicker scars, although results tend to be gradual and require multiple sessions.

Scar Revision Surgery
For very wide scars, particularly those that are several centimeters wide, surgical scar revision may sometimes produce a better result than repeated non-surgical treatments. A revised scar can then be optimized with laser treatments during healing.

Laser Treatments for Color
If the scars have residual redness, vascular lasers such as V-Beam can help. However, since your scars are white rather than red, collagen-remodeling lasers are likely to be more beneficial than vascular lasers.

One important point is that white scars can be improved, but completely restoring normal skin color is often the most difficult part of treatment. Most procedures focus on improving texture, thickness, and blending the scar with the surrounding skin rather than making it disappear entirely.

If these were my scars, I would likely consider a combination approach, with fractional CO2 laser or RF microneedling as the cornerstone treatment, and evaluate whether the wider raised scars would benefit from scar revision or targeted steroid injections before proceeding with resurfacing treatments.

While no treatment can completely erase a scar that is 8–10 years old, significant improvement is often achievable, especially when multiple treatment modalities are combined thoughtfully.

Best Procedure for 8 - 10 year old scar removal? (Photos)

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