The best scar treatment depends on the type of scar. Surgical revision suits scars that are wide, badly positioned, tethered or contracted; injections, usually steroids, suit raised hypertrophic scars and keloids; and laser or other resurfacing treatments mainly improve redness, texture and uneven surfaces. Many scars respond best to a combination, often starting with the least invasive option. Silicone and sun protection support every approach.
Start with the scar, not the treatment
Before comparing treatments, it helps to be clear about what is wrong with the scar. Is it too wide, too raised, sunken, red, dark, stuck down or pulling on something? Is it still maturing? A scar that is only a few months old may improve considerably on its own. Understanding the type of scar you have is the foundation of choosing the right option.
Side-by-side comparison
- Surgical revision: best for wide, stretched, puckered, tethered, badly angled or contracted scars. Replaces the scar with a finer one; usually local anaesthetic; stitches for one to two weeks; the new scar takes 12 to 18 months to mature.
- Steroid injections: best for raised, itchy hypertrophic scars and keloids. Softens and flattens over a course of several injections a few weeks apart; minimal downtime; possible skin thinning or lightening.
- Laser and resurfacing: best for redness, surface irregularity and some acne scarring. Several sessions usually needed; downtime varies from days to a week or two; risk of pigment change, particularly in darker skin. Provided by dermatology and laser clinics.
- Fillers and fat grafting: best for sunken or depressed scars. Filler is temporary; fat grafting can be longer lasting but some fat is reabsorbed.
- Silicone and pressure: best as a foundation for maturing or raised scars. Non-invasive, used daily for months.
When surgery makes sense
Surgery is the only option that can physically change a scar’s width, length or direction, or release tethering. Techniques include excision with layered closure, Z-plasty to reorient a scar, W-plasty to break up a straight line and, for contractures, release with local tissue rearrangement. Surgery is usually timed after the scar has matured and is often followed by silicone and, if needed, injections. It creates a new scar, so it is chosen when the expected improvement clearly outweighs this. Learn more on our scar revision page.
When injections make sense
Steroid injections work by reducing the overactive collagen production and inflammation within a raised scar. They are a first-line treatment for keloids and for hypertrophic scars that have not responded to silicone. They can also be combined with surgery to reduce the chance of a keloid returning. The effect builds gradually over several sessions. Side effects include thinning of the skin, visible small blood vessels and lighter patches, which is why doses are kept as low as possible.
Where laser fits in
Laser treatments can reduce persistent redness in a young scar and improve surface texture, and fractional resurfacing is widely used for acne scars. They do not reduce the width of a scar or release tethering. Mr Nassab does not provide laser resurfacing, but where laser is likely to add benefit alongside other treatment, he can advise on seeing an appropriate dermatology or laser specialist.
Which option is right for you?
As a general guide: a raised, itchy scar usually starts with silicone and injections; a keloid needs injections, sometimes with excision; a wide, stretched or puckered scar is best improved surgically; a sunken scar may respond to filler or fat grafting; and a red or textured scar may benefit from laser. Combining approaches in stages often gives the most balanced result. Your skin type, keloid history, the scar’s location and how much downtime you can manage all shape the recommendation.
Costs and consultation
Surgical scar revision is from £950; other scar treatments are quoted at consultation, as the plan depends on the scar and may involve several stages. The £150 consultation is charged separately. Treatment is for adults aged 18 and over. Mr Nassab will set out the options clearly, including when doing nothing, or waiting longer, is the sensible choice.
Frequently Asked Questions
Is laser better than surgery for scars?
They do different jobs. Laser improves redness and texture; surgery changes a scar’s width, shape or direction and releases tethering.
Do steroid injections work on old scars?
They are most effective on active, raised scars but can still soften older hypertrophic scars and keloids.
Can treatments be combined?
Yes. Many scars are treated with surgery followed by silicone and injections, or with injections alongside other therapies.
Which treatment has the least downtime?
Silicone and injections have minimal downtime. Surgery and some laser treatments need more recovery time.
Can any treatment remove a scar completely?
No. All treatments aim to make a scar less noticeable or more comfortable rather than remove it entirely.
