Understanding Scars: How They Form, and What Actually Helps

Over 20 million people in the UK are negatively impacted - either physically or emotionally - by scarring that serves as a constant reminder of pain, illness, or trauma. Yet there is still a profound lack of public awareness around the toll scars take, and a shortage of clear guidance on what genuinely helps.

The process of scarring

Scarring is the body's natural repair mechanism after trauma or injury. The process has three stages:

• Inflammation: Lasts a few days and initiates the repair process.
• Proliferation: New cells form scar tissue for around 28 days.
• Remodeling: Scar tissue softens from raised and red into flatter, paler tissue over months or years (keloid scars can persist longer, since they don't follow this pattern the same way).

As we age, scarring becomes more pronounced due to reduced collagen and elastin production, slower fibroblast activity, impaired circulation, and insufficient oxygen supply.

Acne scars: atrophic, hypertrophic & keloid

Acne scars fall into two main categories: atrophic (depressions) and hypertrophic (raised). Atrophic scars include:

• Ice Pick: Narrow, deep scars that resemble puncture marks.
• Boxcar: Broad, sharp-edged scars often on cheeks and temples.
• Rolling: Wide depressions with wavy edges caused by deeper tissue damage.

Raised acne scars include:

• Hypertrophic: Firm, raised scars that remain within wound boundaries.
• Keloid: Raised, thickened scars that spread beyond the original wound, often seen on the chest, back, and shoulders.

Laser options available in clinic

Laser and light-based treatments for scarring generally fall into three categories:

• Ablative lasers cause superficial wounding to much of the skin's surface, some removing the entire outer layer of skin.
• Non-ablative lasers deliver thermal energy by heating the water content in cells, triggering a repair response and collagen production without wounding the surface.
• Fractionated lasers treat extremely small, pixelated areas of skin at a time.

Devices commonly found in dermatology clinics include:

• PicoSure
• Halo
• Clear + Brilliant
• Nd:YAG (Q-switched)

Each comes with its own trade-offs in downtime, precision, and cost, and the right choice depends heavily on scar type, skin tone, and how the scar has responded to previous treatment - which is why a dermatologist consultation is the right starting point rather than choosing a device first.

Treatment strategies for scars

1. Sun Protection: The simplest daily habit with the biggest payoff - consistent broad-spectrum SPF shields healing skin, keeps a scar from darkening as it fades, and quietly does more for your long-term skin tone than most treatments on this list.

1. Laser Treatments: As shown above, some in-clinic lasers and laser surgery resurface skin and remodel collagen, though they can be costly and invasive, and results vary by scar type.
2. Consult a Dermatologist: Essential for severe or complex scarring, and the right first step for anything beyond minor marks.

1. Topical Treatments: Retinoids remain the best-studied topical option for mild atrophic scarring, working by speeding up cell turnover and encouraging collagen production. Gentler alternatives like bakuchiol are sometimes used by those who find retinoids irritating, though the evidence for scars specifically is thinner. AHAs (glycolic and lactic acid) help exfoliate and fade the discoloration that often sits alongside a scar. A vitamin-C-rich diet - citrus fruit, kiwi, colourful berries - supports the body's own collagen production generally, though diet alone won't resolve a scar. As with clinic options, visible change from topicals takes months, not weeks.

1. Chemical Peels: Gentle exfoliation for superficial scarring and discoloration.

1. Microneedling: Stimulates collagen with micro-injuries. Best suited to shallow rolling or boxcar scars, and for anyone comfortable committing to a series of in-clinic sessions over several months. It's a deeper, more invasive approach than most on this list, generally not recommended for darker skin tones due to a higher risk of post-inflammatory hyperpigmentation, and requires strict sun avoidance while skin heals between sessions.

1. Dermal Fillers: Best suited to depressed scars - rolling or boxcar types - where the goal isn't to remove the scar but to physically lift it level with the surrounding skin. A hyaluronic acid or collagen-stimulating filler is injected just beneath the scar tissue, plumping the indentation from below so it reads as smoother at skin level. Results are visible immediately, which is the main appeal - there's no downtime and no waiting for a mechanism like collagen remodelling to kick in the way there is with lasers or microneedling. The trade-off is that it's temporary: most fillers last 6-18 months depending on the type used, so it's a maintenance treatment rather than a fix - a way to look better in the meantime while pursuing something longer-lasting, or a good option for anyone who just wants a quick improvement ahead of an event.

1. Steroid Injections: Flatten raised scars like keloids by targeting the cause rather than just the shape. The steroid - usually triamcinolone acetonide - is injected directly into the scar tissue, where it reduces inflammation and suppresses the overactive fibroblast activity driving the excess collagen production that makes keloids keep growing past the original wound. Injections are typically repeated every 4-6 weeks, with the scar gradually flattening over several months as production slows and some of the existing tissue breaks down. Common side effects include thinning or lightening of the skin at the injection site, and sometimes visible small blood vessels where the steroid has been injected repeatedly. It's often combined with cryotherapy or silicone sheeting, since steroids alone have a fairly high recurrence rate on larger or older keloids.

1. Surgical Options: Two distinct procedures, each suited to a different scar shape. Punch excision is used on narrow, deep scars - ice pick scars are the classic case - where a dermatologist cuts out the scar tissue with a small circular tool down to the fat layer, then stitches the edges closed or grafts in a small piece of skin; what's left is a thin surgical line, far less noticeable than the original pitted scar, and multiple scars usually mean multiple sessions spaced a few weeks apart. Subcision targets rolling scars specifically, caused by fibrous bands under the skin tethering it down to deeper tissue - a needle is used to break those bands, releasing the skin so it can sit level again, often paired with a filler afterward since the release creates space that benefits from being filled while new collagen forms. Both are more invasive than the options above, generally reserved for scars that haven't responded to gentler approaches, and need a qualified dermatologist or dermatologic surgeon rather than an aesthetician.

1. Laser and Light-Based Options (LLLT & Pulsed Dye Laser): Two energy-based approaches with growing evidence, particularly for scars caught early. A 2024 systematic review and network meta-analysis of 18 randomised trials found that low-level laser therapy and pulsed dye laser were both effective for minimising scar formation after surgical wounds were closed, with comparable outcomes between the two. Scars treated with either approach scored significantly better on the Vancouver Scar Scale than untreated scars, though the review notes the data isn't yet sufficient to say definitively which of the two performs better. Pulsed dye laser works by targeting blood vessels within the scar to reduce redness and thickness, while low-level laser therapy uses lower-intensity light to support the skin's own repair process without heat damage. Both are generally used early, often starting once stitches come out, rather than on scars that are already old and established.
2. Consistency: Scar treatment takes time regardless of approach - visible change is measured in months, not days.

Complete scar removal isn't always possible, and outcomes vary a lot by scar type, skin type, and how long the scar has been there - which is exactly why a dermatologist consultation is worth doing before committing to any treatment path.

Elsewhere in your skin routine: radiance and fine lines

Separately from scar-specific treatment, general skin radiance and fine lines are a different concern with a different set of tools. The LYMA Laser PRO is a cold, near-infrared low-level laser device designed for that broader remit - supporting collagen production and skin radiance, with results on wrinkles and skin tightening.

It's a different mechanism and a different use case from the scar-specific approaches covered above, and worth exploring on its own terms if fine lines and overall radiance - rather than scarring - are what you're looking to address.

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• Peer-reviewed study on near-infrared laser.