Surgical Scar Treatment, Where Should You Start? A Complete Guide to Treatments by Type

This is the most accurate starting point for surgical scar treatment. Although scars cannot be completely erased, it is entirely possible to make them "less noticeable" by bringing their size, color, and texture closer to normal skin. And what determines that result is not expensive equipment, but "when and for which type" you intervene.

Once you start worrying about a scar after surgery, you usually begin by searching the internet. Silicone, lasers, injections, revision surgery... there is a lot of information, but it is hard to know what is right for your scar. The core point is one. The direction of treatment for scars varies completely depending on the type. If you approach a raised scar and a sunken scar with the same method, it is difficult to see results. Therefore, this article begins by first distinguishing "what type of scar is mine."

🔍 What types of surgical scars are there?

The primary criterion for classifying scars is 'whether it is raised or sunken.' This single factor determines half of the treatment strategy.

• Keloid: A hyperplastic scar that continues to grow beyond the boundaries of the original wound. It is accompanied by itching, pain, and redness, and will spread further if left untreated.

• Hypertrophic Scar: A scar that is raised but remains within the boundaries of the wound. The prognosis is better than that of a keloid.

• Atrophic (Depressed) Scar: A form where the surface is sunken due to a lack of collagen. Acne and chickenpox scars are representative examples.

• Contracture Scar: When the skin is pulled, restricting joint movement. If there is a functional issue, it may be covered by health insurance.

• Adhesive Scar: A scar that tangles and pulls on the underlying tissue, like a C-section scar.

The decisive difference between a keloid and a hypertrophic scar is 'whether it crosses the boundary.' If it spreads beyond the wound site, it is considered a keloid; if it stays within, it is considered hypertrophic. This distinction is important because keloids must be handled much more carefully.

📌 Core Summary: Scars are divided into raised types (keloids, hypertrophic) and sunken types (atrophic), and their treatment methods are completely different.

⏰ When is the best time to start treatment?

To state the conclusion first, the earlier, the better. It is much more effective to intervene before the scar matures, that is, while the tissue is still changing.

The 'maturation period' for a scar to settle is usually 12 to 18 months. During this period, the redness fades and the tissue stabilizes, making these first few months practically the golden time. One study reported that the Vancouver Scar Scale score of a patient group that started laser treatment within 3 months of scar occurrence was significantly reduced from 5.16 to 2.49.

Here is a summary by period.

To address one misconception, it is not true that nothing can be done for old scars. The 'current state of the tissue' is a more important criterion for judgment than when the scar occurred. Even for scars that are several years old, a direction can be set by looking at their current activity and shape.

📌 Core Summary: Early management within 3 months after the wound closes is the most effective, but even old scars have room for improvement depending on their current state.

🧴 Silicone, Tape, and UV Protection: Basic Home Care

Surprisingly, the basics of non-surgical management greatly influence the results. This is especially true for self-care in the first few months.

Silicone gels and sheets are the international first-line recommended method for preventing and treating hypertrophic scars and keloids. However, just pretending to apply it is useless. It is only meaningful if used consistently for at least 12 hours a day for more than 2 to 3 months. Rather than a difference in effectiveness, you can choose between gel and sheet based on 'whether it is an area where it can be attached' and 'whether you can use it consistently.'

Medical tapes (such as Micropore) are also easy to underestimate. Reducing the tension on the incision line helps prevent the scar from widening or becoming thick.

Sun protection is not an option; it is a must. If immature scars are exposed to UV rays, permanent hyperpigmentation can remain, so it is recommended to apply SPF 30~50+ sunscreen for at least 6 to 12 months.

Conversely, there are things commonly believed to be effective that actually lack support.

• Vitamin E Oil: The evidence for scar improvement is weak, and it can even cause contact dermatitis.

• Peeling Scabs: Forcing them off worsens the scar. Wait for them to shed naturally. A moist environment is more beneficial for regeneration than a dry scab.

• Smoking: It decreases blood flow, delaying recovery and worsening scars.

📌 Core Summary: Silicone products, scar tape, and sun protection are the basics of early scar management, whereas Vitamin E and peeling scabs actually have the opposite effect.

💉 What treatments are available at clinics?

When self-care has its limits, or when active intervention is required due to the type of scar, clinic treatments are considered. The important thing to note is that there is almost no treatment that ends with a single method.

Raised Scars — A Combination of Injections, Compression, and Lasers

For raised scars (hypertrophic/keloids), the key approach is to flatten the overgrown tissue.

• Intralesional Steroid (Triamcinolone) Injections: A representative injection treatment, usually repeated at intervals of 4 to 6 weeks.

• 5-FU Injections: Sometimes combined for intractable keloids that do not respond well to steroids.

• Compression Therapy: Mainly used for burn scars or ear keloids, and wearing them for more than 20 hours a day is sometimes recommended for effectiveness.

• Vascular Lasers: A method specialized in improving the color of red scars.

Sunken Scars — Filling and Severing

Depressed and adhesive scars are approached in a direction of 'filling the empty spaces and severing the tangled areas.' Methods that alleviate adhesion beneath the dermis while delivering regenerative ingredients, and lasers that refine skin texture and thickness, are used. Keep in mind beforehand that lasers do not end with one session and usually require 3 to 6 or more repetitions.

At Gangnam Onlif Clinic, we do not lump scars together as depressed, adhesive, stretch marks, or white scars; we first diagnose the tissue state and activity, and then design according to the type. We use a needle-free approach that alleviates dermal adhesion using air pressure while delivering regenerative ingredients simultaneously, which has less burden of pain and swelling, allowing for a quick return to daily life. For general scars, we plan 3 to 5 sessions at intervals of 1 to 2 months, and for keloids, 3 to 6 or more sessions at intervals of 3 to 4 weeks depending on activity.

📌 Core Summary: Raised scars are approached with a combination of injections, compression, and lasers, while sunken scars focus on alleviating adhesion and regeneration, with most requiring multiple treatment sessions.

⚠️ Why should keloids be handled with special care?

Keloids are the most difficult lesions to handle among surgical scars. The biggest reason is recurrence.

If a keloid is simply excised alone, the recurrence rate is reported to be 45 to 100% in literature. In other words, removing it through surgery alone carries a risk of making it even larger. Therefore, even if excision is performed, adjuvant treatments such as steroid injections or radiation must be combined, which reportedly lowers the recurrence rate to about 10 to 30%.

Keloids easily develop in areas with high skin tension, such as the chest, shoulders, ears, and jawline, and genetic predisposition plays a major role. Therefore, if you have a family history or a past history of keloids, it is best to inform the medical staff before surgery.

Rather than an excision method through surgery, Onlif prioritizes a non-surgical direction that diagnoses activity first to alleviate adhesion with lasers, and combines intralesional drug injections and compression therapy to suppress overgrowth and manage recurrence. Since keloids have constitutional factors, it is difficult to consider them resolved with a single treatment, and the key is to continuously monitor the progress and perform maintenance care.

📌 Core Summary: Keloids have an extremely high recurrence rate of 45 to 100% when excised alone, so management combined with adjuvant therapy is absolutely necessary.

🩹 How do you decide between scar revision surgery and a non-surgical approach?

There are also revision surgery techniques, such as Z-plasty or W-plasty, that change the direction of the scar or disperse tension. However, if there is no functional issue, it is common to make a judgment after 6 to 12 months, when the scar has sufficiently matured. This is because rushing before maturation makes it difficult to predict the results.

Onlif is a clinic focused on skin procedures and does not handle incisional plastic surgery involving scalpels. We mention revision surgery only as information, and Onlif's direction is to prioritize proposing a non-surgical approach that removes the imbalance called a scar rather than changing the natural skin itself. Under the philosophy that 'one doctor cannot do everything well,' we design scar treatments in a structure where the doctor who is best at each field takes charge of the procedure.

Whichever path you choose, the common principle is the same. Accurate diagnosis comes first, treatment comes next.

📌 Core Summary: Revision surgery is decided after scar maturation if there are no functional issues, and Onlif prioritizes proposing non-surgical skin procedures.

❓ Frequently Asked Questions (FAQ)

Can surgical scars be completely removed?

Unfortunately, complete removal is difficult. The goal of treatment is to make the scar less noticeable by bringing its size, color, and texture as close to normal skin as possible. Setting realistic expectations is the first step to increasing satisfaction.

When is the best time to start scar treatment?

Early management within 3 months after the wound has completely closed is the most effective. It usually takes 12 to 18 months for a scar to mature, so it is recommended to start basic care such as silicone and sun protection during these first few months.

Does cutting away a keloid cure it?

Excising it alone has a very high recurrence rate of 45 to 100%, which can actually make it larger. Adjuvant treatments such as steroid injections or compression therapy must be combined, and because of constitutional factors, continuous observation of progress is required even after treatment.

How many times do I need to get laser treatments?

It depends on the type of scar, but usually 3 to 6 or more repetitions are required. Since it is not a treatment that is completed in one session, it is realistic to set a plan for multiple sessions from the beginning and receive guidance on the individual number of sessions after diagnosis.

Is Vitamin E oil more effective than scar creams?

The effect of Vitamin E on scar improvement lacks scientific evidence, and in some studies, it actually increased the incidence of contact dermatitis. What has more robust evidence are silicone gels and sheets, and it is important to use them consistently for more than 12 hours a day for over 2 to 3 months.

Can old scars be treated as well?

Yes, it is possible. The current state and activity of the tissue are more important criteria for judgment than when the scar occurred. Even for scars or keloids that are several years old, a treatment direction tailored to the type can be established after diagnosis.

The scar area keeps itching and hardening. Is this okay?

If it hardens along with itching, pain, and redness, it could be an active signal of a keloid or hypertrophic scar. Since it can grow if neglected, checking its status is necessary. It is recommended to receive an accurate diagnosis through a consultation.

Surgical Scar Treatment: Good Things to Check Before Choosing a Clinic

Even with the same procedure, the results and recovery process vary depending on where, by whom, and how it is performed. Asking these questions directly during your consultation will help you make a decision.

• Do they perform that procedure often? — Every clinic has different procedures they focus on. Check if it is a place that regularly conducts surgical scar treatments.

• Can you check the products and equipment used? — Ask during the consultation if you can confirm the product names and whether they are genuine (whether they are import-approved products and if there is an unboxing verification process).

• Do they explain the breakdown of the cost? — Rather than just hearing the total amount, you need to hear an explanation of which products are used, how much, and in what area to make an informed decision.

• Do they design while looking at the entire face? — Even for the same procedure, the placement and amount vary depending on face shape, skin condition, and left-right asymmetry.

• Do they explain adverse reactions and the recovery process first? — A place that informs you of potential adverse reactions and how to cope with them, rather than a consultation that only talks about expected changes, is better for making a decision.

• Is there a way to verify after the procedure? — Check if the timing for follow-up, how to contact them if there is an issue, and criteria for revisiting are established.

This is how Onlif Clinic performs surgical scar treatment

• We divide responsibilities — Under the philosophy that a single doctor does not handle every procedure, Onlif divides medical treatment with responsible doctors for each field.

• We verify products and equipment together during the consultation — We guide you through the products used and the unboxing verification process during the consultation.

• Costs are guided along with the breakdown after diagnosis — Since the area, volume, and scope differ for each person, we explain what costs how much together.

• We design by looking at the balance of the entire face — We look at the face through three axes: texture, balance, and signals of youth, and set a plan in a direction of cleaning up areas that obscure the natural impression rather than changing the shape.

• We mention adverse reactions and the recovery process first — Along with the changes that can be expected, we guide you through individual differences, potential adverse reactions, and coping methods before the procedure.

• We review the progress together after the procedure — If verification is needed during the recovery period, we guide you through revisits and contact channels.

If you are considering surgical scar treatment, it is best to first check what is possible and what is difficult in your current state. An accurate diagnosis and procedure plan can only be determined through an in-person medical examination. Please check through a consultation at Gangnam Onlif Clinic.