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The Best Scar Treatment for Atrophic, Hypertrophic, and Keloid Scars

Time may heal all wounds, but it's not so good at erasing them. Scars occur when an injury slices through the top layer of skin and penetrates the dermis, says Neal Schultz, M.D., a dermatologist in New York City. What happens next depends on your body's collagen response. If it generates just the right amount of this skin-repairing protein, you'll be left with a flat, faint scar. If your body can't drum up enough collagen, you'll wind up with a sunken scar. And if your body churns out too much, you're stuck with a raised scar. That's not to say you'll develop the same type of scar every time you're injured, "but people tend to be predisposed to scarring a certain way," says Diane Madfes, M.D., an assistant professor in the department of dermatology at Mount Sinai Medical Center in New York City. In other words, if you have one raised scar, you're more likely to have another in the future. Injury location factors in as well—scars on the chest tend to be especially obvious because the skin there is so thin, and skin trauma below the waist can scar badly because cell turnover is slower and there is less blood flow to the lower body.

Fortunately, no matter what kind of scar you have, there are new and effective ways to prevent being left with a permanent mark. (Or just rock your scar with pride, à la Victoria's Secret model Martha Hunt, who bares her scars to remind women that imperfection is beautiful.)

Sunken Scar

Sunken (Atrophic) Scars

Atrophic scars occur when you lose skin tissue and your body can't regenerate it, so you're left with a depression. They often stem from a bad case of acne or chicken pox—or from having an abnormal mole removed. Getting rid of these dents depends on the type of atrophic mark you have.

Ice pick scars: They are small, deep, and narrow, and are typically treated by cutting them out. "There are vertical bands of scar tissue anchored to the bottom of the scar, connecting it to deeper parts of the skin," says Dennis Gross, M.D., a dermatologist in New York City. Your doctor will numb the area, cut around and remove the scar, and close the incision with a single stitch. But here's the catch: This procedure will leave a scar.

"You're trading an ice pick scar for a nice flat scar," Dr. Gross says. You can also inject the scar with a filler, such as Juvéderm or Belotero Balance. "This will help fill the 'pit,'" says plastic surgeon Sachin M. Shridharani, M.D., founder of Luxurgery in New York City. "But the filler will last for only six to 12 months." Depending on how many scars you have, filler typically costs $700 to $2,000.

Boxcar scars: They have steep, defined borders and a flat bottom. One treatment is subcision, which involves popping the scarred skin back up with a needle so the area is no longer depressed. This costs $300 to $500 depending on the size, and you could have some bruising for about a week.

Another option: ablative lasers (meaning that they cause damage to the surface of skin) called CO2 or erbium, "which can give you great results," Dr. Gross says. They both work by making holes in the scar tissue to induce new collagen formation. Treatments start at around $600; most people need three. Lasers can hurt, but a numbing cream takes the edge off. "And you'll have some redness and crusting for up to 10 days if you had a CO2 treatment or up to seven in the case of erbium," Dr. Madfes says. (And ICYMI, in 2015 the FDA approved a new procedure specifically for acne scars.)

Rolling Scars: The last atrophic scar, a rolling scar, is broad and craterlike with rolling edges. "CO2 or erbium lasers are often used when the scarring is severe, but if scarring is more superficial, fraxel or picosecond lasers can be effective," Dr. Shridharani says. These nonablative lasers work by tightening skin and stimulating collagen growth. Since they don't perforate the skin, you'll just have some temporary redness, and they cost about the same as the CO2 and erbium.

Keloid Scar

Keloid Scars

These are keloids, which are not only raised but also take up extra real estate that's often significantly wider and longer than the original wound.

Keloids can be tough to treat, so sometimes people throw everything at them," Dr. Schultz says. "It can't hurt to try a topical scar cream," Dr. Gross says. Once a day, massage a thin layer over the scar (try Mederma Scar Cream Plus SPF, $16, mederma.com).

In eight weeks you may see some improvement. Silicone sheets and lasers can be effective too, Dr. Gross says, but cortisone shots tend to work better. You can also inject keloids with both cortisone and 5-fluorouracil (5-FU), a cancer drug that prevents the proliferation of cells called fibroblasts, which produce collagen, Dr. Madfes says. A recent study in the Journal of Dermatology and Therapy showed significant improvement on keloids with this combo therapy. Last option: Cut them out. Since you're usually removing such a big area, you will be left with another, hopefully smaller, scar, which can then—you got it!—be treated with a laser. (That's not all—here's more info on keloid scars and how to get rid of them.)

hypertrophic scar

Raised (Hypertrophic) Scars

Raised scars are hypertrophic scars. Your body should switch off collagen production once an injury heals, but sometimes it doesn't get the memo and keeps pumping out collagen until you're left with a raised mark. The good news is that hypertrophic scars know their boundaries—they don't extend beyond the original footprint of the wound. They can either be pink (meaning the scar is fresher and newer) or match your skin color.

OTC silicone patches like ScarAway Silicone Scar Sheets ($20, walgreens.com) can help flatten the scar "by applying pressure to the area and infusing it with hydration," Dr. Schultz says. You'll need to leave the adhesive sheet on the scar overnight, every night, for about three months. You can also have your derm inject cortisone directly into the scar.

"Cortisone seems to slow down collagen production and melt away excess collagen," Dr. Schultz says. Cost: $250 to $500 per session (know that you may need two). CO2 and erbium lasers can be handy as well because although they increase collagen, they also remodel it, which decreases puffiness. "It's like rebooting a computer—it starts proper healing," Dr. Schultz says. (Or consider an out-of-the-box option: scar tattoo art.)

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