is it true not all scars are treatable? I have a 10+ years old scar on back of my hand (Photo)

Treating a 10-year-old scar with a combination of 5-Fluorouracil (5-FU) or corticosteroids, subcision, Platelet-Rich Plasma (PRP) therapy, and CO2 laser offers a multifaceted approach to scar revision. Here are the benefits of each treatment and their combined effects:
5-Fluorouracil (5-FU) or Corticosteroids
- **Reduction of Scar Tissue**: Both 5-FU and corticosteroids can help reduce the size and thickness of hypertrophic and keloid scars by inhibiting fibroblast proliferation and collagen production.
- **Anti-inflammatory Effects**: Corticosteroids can significantly reduce inflammation, redness, and swelling associated with scars.
- **Softening of Scar Tissue**: These injections can soften the scar, making it more pliable and less noticeable.
Subcision
- **Breaks Down Fibrous Bands**: Subcision involves inserting a needle under the skin to break up the fibrous bands of scar tissue, which helps to release tethered scars from underlying structures.
Platelet-Rich Plasma (PRP) Therapy
- **Enhanced Healing and Regeneration**: PRP is rich in growth factors that promote tissue repair and regeneration, accelerating the healing process.
- **Increased Collagen Production**: PRP boosts collagen synthesis, improving skin texture and elasticity, and reducing the appearance of the scar.
- **Reduction of Inflammation**: PRP can help to reduce inflammation, promoting a smoother healing process.
CO2 Laser
- **Precision Resurfacing**: The fractionated CO2 laser targets specific areas of the scar, leaving surrounding tissue untouched, which minimizes damage and promotes faster healing.
- **Collagen Stimulation**: It stimulates collagen production, improving skin texture and elasticity over time.
- **Scar Resurfacing**: The laser helps to smooth out the scar by resurfacing the skin and reducing scar thickness and visibility.
- **Comprehensive Scar Revision**: Each treatment modality addresses different aspects of scarring, from breaking down existing scar tissue to stimulating new, healthy tissue growth, providing a comprehensive approach to scar revision of your hand.
Find a scar expert. Good luck.
Jeff Rapaport MD FAAD
Realself Hall of Fame
Castle Connolly Top Doctor

Our office has many different treatments for scars depending on the depth of atrophy or hypertrophy. Scars require a combination approach using our HI DEF protocol which uses a combination of lasers, topical scar modulation, and RF treatments to pixelate scars, improve contour, reduce hyperpigmentation, and improve the visibility of the scars so that they are no longer visible in ambient light. Everyone has a unique pattern of scarring and we employ our HIDEF technique to improve texture, color, contour, and topography. We often use a combination of treatments that begin with a careful examination to examine the micro texturing of the acne scars. Atrophic scars and indented scars can benefit from injectable fillers such as Radiesse, Sculptra, and Restylane with or without subcision to remove tethered scars and atrophic depression. Hyper-redness in scars can be improved with V beam laser, Excel V, BBL, IPL, and Venus RF to improve the redness and reduce the visibility of deep scars. Fractional Thulium laser and clear & brilliant can also reduce the inflammation and redness of the scar when combined with topical therapy. Fractional lasers such as Fraxel, erbium, and CO2 laser can be combined with radio frequency and also fractional RF to improve textual issues and microtopography. Subcision and TCA cross are also used for deep ice pick scars and narrow valley scars in order to improve the micro texture. Above all, our combination approach with our clinical nurses and board-certified plastic surgeons can improve the quality of your skin by using at home Melarase creams combined with PRP treatments in our office to improve your skin quality and tone. I recommend getting a formal evaluation with an experienced team of experts in order to reduce your scarring.

Finally, hyperpigmentation of scars can be improved with at-home Melarase AM, Melarase PM, and Melapads to help reduce active PIH and melanin deposition.

Best,
Dr. Karamanoukian
Realself100 Surgeon

From the appearance of the scar in the photo, I see no reason not to attempt to treat it in order to improve its appearance. However, there is a time line for achieving optimal improvement in appearance. If an imminent scar is treated between the end of four weeks after the injury or surgery that caused it and the end of twelve weeks, there is a good chance for even "erasing" the scar. However after twelve weeks have elapsed, then improvement falls more into the range of 50-80 percent overall improvement. At the end of four weeks after wounding the imminent scar is strong enough to withstand treatment and after twelve weeks it is considered "mature" and not likely to achieve maximal improvement. The latter is the case here. However, a few treatment sessions of manual, professionally performed microneedling is likely to help the scar better blend in color and texture with the surrounding normal skin. Surgical revision is likely, however, especially in areas subject to a great deal of movement, to result in the formation of a stretch scar and possibly even tram track stitch tracks.
You would be wise to consult with a board certified cosmetic dermatologist scar treatment specialist. Best of luck.