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

Question

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.

William Ting, MD · Answer

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.

Raffy Karamanoukian, MD, FACS · Answer

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.

Harold J. Kaplan, MD · Answer

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.

Steven Hacker, MD · Answer

"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.

Chester K. Cheng, MD · Answer

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.

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

Answers (10)