Scar removal on arm, age 23 - What procedure is needed? (photo)

Thank you for your question and for sharing your concern.

Scars that have been present for several years—like those from adolescence—can be challenging to completely erase, but there are several treatments that can significantly improve their appearance. The choice of treatment depends on the type, depth, and texture of the scars (e.g., raised, flat, discolored, or indented).

Here are common and effective options:

Laser Therapy – Fractional CO₂ or pulsed dye lasers can reduce discoloration, smooth out texture, and stimulate collagen remodeling over time.

Microneedling with PRP (Platelet-Rich Plasma) – This treatment helps with skin resurfacing and improving the tone and texture of older scars by stimulating collagen production.

Chemical Peels – Medium-depth peels may help fade superficial scarring and hyperpigmentation.

Steroid Injections – If the scar is raised or keloidal, intralesional corticosteroid injections can flatten and soften it.

Surgical Revision – For certain types of scars, surgical removal or revision may be an option, often followed by adjunct treatments like laser or silicone therapy.

Topical Treatments – Prescription creams with retinoids or silicone-based gels and sheets can help with ongoing scar management and prevention of worsening.

While complete scar removal is rarely possible, substantial improvement in texture and pigmentation is achievable with consistent treatment. A tailored approach combining two or more therapies often yields the best results.

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

We would recommend the 1540 laser, also known as a fractional laser. It is used for acne scarring as well as surgical scarring and other scars. Three to five treatments are recommended. Possibly more needed depending on the severity.
The laser penetrates deep to break up and help soften scar tissue over time.
The area is numbed with topical lidocaine for about 30 minutes first. Then we do several passes over the affected area. Area will have erythema and edema, which means redness and some swelling. This will go away from a few hours to a few days. Treatments are done about a month apart. Over time scarring will improve but may not be fully gone.

At least from the photo provided, it would appear that the primary issue here is one of a hypopigmented scar that is not particularly either raised or indented. If this is indeed so, then professionally performed manual microneedling (no need for the added expense or risks for adverse reactions of RF microneedling) accompanied by the topical application of prescription strength pigment enhancers, such as tyrosine and latanoprost can be used to better blend the color and texture of the scar with that of the surrounding normal skin. Realistically, for any scar over three months of age, I.e. a "mature scar" (which this certainly is) a sixty to eighty percent (not 100 percent) overall improvement is the best that can be expected from any legiitimate treatment or combination of treatments currently available.
No doubt in your research you will be offered all kinds of expensive, "bells and whistles" light and energy-based gizmo treatments, such as fraxel lasers, RF machines, etc.. However, you would be wise to exercise a whole lot of "buyer beware" caution when it comes to these, since the hard science to back up the use of these devices unfortunately lags well behind the heavy marketing hype and social media buzz to promote the.
You would be wise to consult a board certified cosmetic dermatologist scar treatment specialist and best of luck.