Scar Treatment in Ankara, Turkey

Scar treatment is a medical approach aimed at reducing or improving the appearance of permanent tissue changes that occur after wound healing. The treatment method is determined according to the type of scar, its depth, and the patient’s skin type. The goal is both to improve the aesthetic appearance and to reduce functional limitations.

Laser scar treatment is an effective method especially for scars that develop after acne or surgical wounds. Fractional laser systems create controlled damage in the skin and increase collagen production. In this way, the skin texture renews itself and the appearance of scars is significantly softened.

Surgical scar revision is a preferred treatment option for deep and thick scars. With plastic surgery techniques, the scar tissue is removed and the suture line is rearranged. This procedure provides functional improvement especially in contracture-type scars that cause restriction of movement.

Topical creams and silicone-based products are supportive treatments for preventing scar formation or softening the appearance of existing scars. These products support new tissue formation by preserving the skin’s moisture balance. Regular use increases the success of the treatment process and shortens the scar maturation period.

What Is a Scar and Why Does It Form?

When our skin encounters an injury, the body’s repair process begins immediately. A scar is the natural result of this repair process. Ideally, the tissue would renew itself exactly as before (regeneration), but this miraculous ability is mostly limited to the time in the womb. Adult skin replaces lost tissue not with a new identical structure, but with a tougher and denser “patch” tissue called scar tissue.

How a scar will look in the future is largely determined during the earliest “inflammation” phase of healing. The balance of chemical signals during this stage determines whether the scar will be normal or problematic (raised or depressed).

Are All Scar Types the Same and How Are They Classified?

The most important step in treatment is correctly identifying the “identity” of the scar, because each scar requires a different treatment. First, we look at the maturity of the scars.

• Fresh (Immature) Scars
• Settled (Mature) Scars

“Immature” scars are fresh, red, itchy scars that are still in the process of changing. “Mature” scars are those that have completed healing and taken their final form.

Settled, or mature, scars are also divided into three categories according to their appearance.

• Normal Scars (Flat and pale, at the same level as the skin)
• Atrophic Scars (Indented scars)
• Hypertrophic Scars (Raised scars above the skin)

Raised Scars: What Is the Difference Between a Hypertrophic Scar and a Keloid?

Although all raised scars are commonly called “keloids,” medically these two are very different, and their treatment plans are completely different.

Hypertrophic Scars: These scars are raised, but their key characteristic is that they remain only within the original wound borders. In other words, if the suture line is this long, the raised area is also limited to that same line. It does not spread into surrounding skin; it only rises upward.

Keloids: Keloids behave much more aggressively. They are raised scars that extend beyond the wound borders and actively spread into healthy skin. Genetic predisposition plays a role, and their treatment is much more stubborn, complex, and prone to recurrence.

Why Do Depressed (Atrophic) Scars Form?

Atrophic scars are the exact opposite of raised ones; they appear flat or sunken below the level of the skin. They usually form due to loss of underlying tissue. The most common examples we see are scars left after severe acne or chickenpox. In these conditions, the intense inflammatory process damages the collagen and supporting tissue beneath the skin, and the skin surface “collapses” into this void.

What Are the Different Types of Acne Scars?

Acne scar treatment is perhaps the area that requires the most individualized planning. Successful treatment depends on recognizing the different anatomical structures of these scars, because each type requires a different approach.

There are three main types of acne scars:

• Ice Pick Scars
• Boxcar Scars
• Rolling Scars

These scars differ in appearance. “Ice pick” scars are narrow and deep, “boxcar” scars are sharply edged depressions, and “rolling” scars create a wavy appearance caused by tethering bands that pull the skin downward. The treatment plan should aim to elevate the base in “ice pick” scars and release those bands in “rolling” scars.

How Is It Evaluated Whether a Scar Needs Treatment?

To understand whether a treatment is truly effective, we use objective measurement tools. This is because scars can also change on their own over time to some extent. One of the most preferred and comprehensive methods today is the system called POSAS (Patient and Observer Scar Assessment Scale).

This system has two components:

• Observer Scale (the physical characteristics the doctor sees)
• Patient Scale (the subjective symptoms the person feels)

This two-way approach is very important. Because a successful treatment should not only reduce the height or redness of the scar, but should also relieve the following symptoms that negatively affect the patient’s quality of life:

• Pain
• Itching

How Is Treatment for Raised Scars and Keloids Approached?

The management of raised scars follows a stepwise approach. We begin first with more conservative and simple methods. If these are insufficient or if the scar is already mature and stubborn, more aggressive combination treatments are used.

Which Treatments Are Used to Prevent Raised Scars?

For newly formed raised scars or scars likely to become raised, there are preventive methods we use as first-line treatment:

• Silicone Therapy (Gold Standard): It is started immediately after the wound closes or after stitches are removed (usually 2 weeks after surgery). Silicone-based gels or sheets cover the scar (occlusion) and help keep the area at the ideal moisture level (hydration). This helps regulate collagen and prevents excessive elevation. For the best results, it is recommended to use it for at least 8–12 weeks, close to 24 hours a day.
• Pressure (Compression) Therapy: These are special pressure garments used especially in extensive burn scars. They need to be worn 23 hours a day (almost continuously), and the treatment continues for a long period such as 12 to 18 months. They reduce the height and redness of the scar. More importantly, in scars around joints, they prevent functional losses that could lead to restricted movement (contracture).
• Dynamic Scar Management: In recent years, this has increasingly been used preventively after surgical incisions, especially in very mobile areas such as the face, shoulders, or joints. By reducing the mechanical tension caused by muscle movements over the healing wound line, it helps prevent the scar from widening and becoming raised.

Which Injection Treatments Are Applied for Established Raised Scars and Keloids?

If scars are already mature and raised, the main treatment option is “intralesional” injections, meaning injections directly into the scar itself.

Corticosteroid (TAC) Injection: This is the first-line pharmacological treatment for established keloids and hypertrophic scars according to international guidelines. The corticosteroid injected into the scar reduces the volume of the raised scar. It does this by decreasing the proliferation of collagen-producing cells, suppressing collagen synthesis, and calming inflammation. Depending on the response, injections are usually repeated every 3 to 4 weeks.

Combination Therapy (TAC + 5-FU): Especially in stubborn and large keloids, combining corticosteroid with an agent called 5-FU (which slows cell proliferation) is definitely more effective than corticosteroid treatment alone. Clinical data show that this combination provides a much more marked reduction in scar volume. The success of this treatment depends on applying the medication homogeneously and at high concentration into the scar. To improve patient comfort, a local anesthetic may be added to the mixture. This high-concentration protocol is generally repeated monthly.

How Is Redness in a Scar Treated with Laser?

Redness (erythema) is one of the most prominent features of immature scars and is caused by excessive vascularity in the area. In treatment, vascular lasers that target these blood vessels are used.

Two main laser types stand out:

• Pulsed Dye Laser (PDL – 595 nm)
• KTP Laser (532 nm)

These lasers target the vascular component in the scar and reduce redness. Newly formed, red scars respond much faster to this treatment compared to older, established scars.

It should not be forgotten that laser treatment in raised scars is generally not used alone. For the best results, laser treatment is always combined afterward with silicone/compression therapy and often with intralesional corticosteroid injection to enhance the anti-inflammatory effect.

What Is the Next Step for Keloids Resistant to Treatment?

If raised scars, especially keloids, do not improve despite 12 months of meticulous conservative and injection treatments, surgical intervention may be considered.

However, surgical removal (excision) of keloids carries a very high risk of recurrence. Surgery alone is almost never a solution.

For this reason, the surgical excision must always be immediately combined with an appropriate adjuvant treatment. One of the following treatments is started immediately after surgery:

• Intralesional TAC (corticosteroid) injections started immediately after surgery
• Localized radiotherapy (low-dose, targeted radiation therapy)
• Intralesional cryotherapy (freezing treatment inside the scar)

Both hypertrophic scars and keloids may have a chronic tendency. Therefore, close and continuous follow-up for at least 18 to 24 months is mandatory until the scar is confirmed to be completely flat and soft. This close monitoring allows immediate intervention (for example, steroid tapes or small injections) at the slightest sign of recurrence.

How Is the Treatment of Depressed Acne Scars Planned?

The treatment of depressed scars is basically directed according to the morphology (type) of the scar. Different scars require different anatomical interventions in order to elevate the depression, release the bands pulling the skin downward, or stimulate collagen accumulation.

For example, a general resurfacing technique alone cannot safely treat the deep structure of an “ice pick” scar or the bands pulling down a “rolling” scar. Treatment begins by recognizing these different types.

What Is the TCA CROSS Method for “Ice Pick” Type Acne Scars?

The TCA CROSS technique is highly effective for “ice pick” scars, which are very difficult to treat with general resurfacing procedures.

In this method, Trichloroacetic Acid (TCA) at very high concentrations such as 70% to 100% is applied precisely only to the base of the depressed scar with a specially sharpened wooden applicator. At the moment of application, an immediate whitening called “frosting” is seen in that spot.

This creates a controlled chemical injury in the area and triggers a strong inflammatory response followed by new collagen production (collagenization). The body’s healing response in this area allows the depression to fill from the base upward with new collagen and become elevated. Usually, a protocol of four sessions performed at 2–4 week intervals is applied.

How Does Microneedling (Dermapen) Help Acne Scars?

Percutaneous Collagen Induction (PCI), better known as Microneedling, triggers the release of growth factors by creating thousands of controlled micro-holes in the skin. This activates the body’s natural repair mechanism and stimulates the production of new collagen and elastin.

The success of the treatment depends on correctly adjusting the needle depth. The needle penetration depth should be individualized according to the depth of the scar and the thickness of the skin. Superficial scars may respond to depths between 0.5 mm and 1.0 mm, whereas deep or tethered scars require deeper needling between 1.5 mm and 2.5 mm to reach the deeper layers of the dermis (reticular dermis) and mechanically break the stubborn fibrous bands.

Why Is Gold Needle (Radiofrequency Microneedling) Effective in Scar Treatment?

Fractional Radiofrequency (RF) Microneedling, also known as Gold Needle, enhances results by combining mechanical microneedling with heat delivered into the deeper layers of the skin through radiofrequency energy.

While the needles are inside the skin, RF energy is delivered through their tips. This adds a strong heating effect in the deeper layers of the skin on top of the mechanical stimulation created by needling. This synergistic effect increases collagen remodeling and skin tightening much more than regular microneedling.

It is especially effective in “Boxcar” type scars. One of its biggest advantages is that it is safe for all skin types, including darker skin tones. In comparative studies, it has also been observed to have a much lower recurrence rate in old acne scars compared to traditional laser methods, meaning that it creates a more permanent collagen foundation.

How Does Laser Resurfacing Work for Acne Scars?

Laser resurfacing provides general texture improvement and is a versatile tool in scar management. There are two main laser types:

Ablative Fractional Lasers: Ablative systems such as CO2 10600 nm or Erbium:YAG lasers controlledly vaporize the outer layer of the skin (epidermis) and heat the dermis underneath. This deeply stimulates new collagen formation. “Fractional” technology treats the skin in small columns rather than all at once, shortening the healing period. They are considered the “gold standard” in the treatment of deep or depressed scars and offer the most dramatic results. However, patients should be prepared for a few days of recovery time.

Non-Ablative Lasers: These lasers are less invasive. Without damaging the epidermis, they create controlled heating zones within the dermis. This heat encourages collagen production without peeling the skin surface. They offer very few side effects and negligible (or zero) downtime. They are suitable for patients with mild to moderate scars or for those who prefer multiple treatment sessions instead of a long recovery period.

Which Deep Acne Scars Require Surgical Techniques?

Subcision: This is the definitive treatment for deep, wavy “Rolling” scars caused by fibrosis (firm bands). A special needle is inserted under the skin and moved back and forth in a fan-like pattern beneath the scar. The goal is to mechanically cut the firm fibrous bands that pull the dermis downward and cause the depression. Once the bands are released, the sunken area rises.

Punch Techniques: These are used for focal correction of deep “Boxcar” and “Ice Pick” scars.

Punch Excision: The scar tissue is completely removed with a small round surgical instrument (punch), and the resulting small defect is closed with sutures. The goal here is to replace a wide, depressed scar with a smaller, linear surgical scar.

Punch Elevation: The base of the scar is cut, but the tissue is not removed. After breaking the adhesions pulling the skin downward, the depressed scar tissue is simply elevated to the level of the surrounding skin and fixed there.

Why Are Multiple Scar Treatments Combined for the Best Results?

Optimal scar revision protocols frequently use combination treatments. This is because several pathological factors are usually present together in one patient (volume loss, tethering bands, vascularity, surface texture irregularity).

It has been clinically proven that combined methods provide superior results compared to a single treatment (monotherapy).

For example, combining microneedling with a medium-depth chemical peel allows the micro-channels created by microneedling to help the chemical peeling agent penetrate more evenly and effectively.

Similarly, combining ablative fractional laser (CO2) with PRP (Platelet-Rich Plasma) increases efficacy. PRP obtained from the patient’s own blood provides an intense concentration of growth factors. This accelerates wound-healing processes after laser treatment, allows faster and better scar healing, reduces side effects, and shortens recovery time.

How Is the Risk of Pigmentation Managed During Scar Treatment?

Managing pigmentation risk is very important, especially for patients with higher Fitzpatrick skin phenotypes (darker skin tones). This is because ablative lasers or deep peels carry a risk of “Post-Inflammatory Hyperpigmentation” (PIH), in other words, pigmentation that develops after the procedure.

To minimize this risk, a preparation phase should be applied before starting laser or chemical peel treatments, using topical agents such as retinoic acid, hydroquinone (skin lightener), and glycolic acid.

Some scars, on the other hand, are non-pigmented and white (achromic scars). In these scars, repigmentation may be encouraged by applying topical medications such as 8-MOP together with microneedling, followed by controlled sun exposure (phototherapy).

Is the Process Considered Complete After Scar Treatment Is Finished?

Expert scar management requires both comprehensive patient education and meticulous long-term care. The treatment process does not end when the sessions are completed.

Patients should be aware of the risk factors, especially for keloids and hypertrophic scars, and should understand the potential side effects associated with treatments (indentation and telangiectasia after steroids, color changes after lasers).

Considering the chronic nature of raised scars, continuous follow-up for a minimum of 18 to 24 months is mandatory to ensure lasting therapeutic results and to intervene early in the event of recurrence.

In addition, the deep psychological distress caused by scars should also be addressed holistically. Including camouflage therapies and medical makeup in the long-term management plan usually significantly improves patients’ quality of life and cosmetic appearance.