Principles of Treatment
- Types of scars: atrophic (e.g. depressed acne scars), hypertrophic (raised), and keloid (exuberant) scars, pigmented or contractile scars.
- Therapeutic approaches: collagen remodelling (micro-needling, fractional laser), excision or subcision to release adhesions, surface smoothing (chemical peels, dermabrasion), injection of fillers (hyaluronic acid) to raise a depressed scar, and treatment of hypertrophic scars with corticosteroid injections or cryotherapy.
- General principle: stimulating more regular healing and skin remodelling by targeting the cause and morphology of the scar. The choice of technique will depend on the clinical assessment and the patient's aesthetic goals.
Session Process
Prior consultation:
Detailed medical interview (past history, medications, isotretinoin use), dermatological examination, photographs, discussion of expectations, and development of a personalised treatment plan. Alternatives, expected benefits, and risks are explained.
Typical session process:
- Preparation: cleansing and possible application of a topical anaesthetic cream for more uncomfortable procedures.
- Technique based on choice: micro-needling (medical skin needling), fractional laser (non-ablative or ablative as appropriate), chemical peel (TCA), subcision, injections (corticosteroids or filler), or a combination of these procedures.
- Duration: variable depending on the technique and area treated (generally 20–60 minutes).
- Comfort: tingling, warmth, or mild pain modulated by local anaesthesia. Standard precautions (hygiene, anticoagulant discontinuation if necessary after medical advice) are explained.
Care plan:
Often several sessions spaced 4 to 8 weeks apart, and sometimes the combination of several techniques for an optimal result.
Post-treatment Course and Results
- Immediate post-treatment effects: redness, mild swelling, warmth, small crusts for some peels or lasers. These effects are most often temporary.
- Onset of results: improvement develops progressively, over several weeks to months, as collagen remodelling occurs. Several sessions are generally necessary.
- Duration and variability: the response varies with age, scar type, phototype, and post-procedure care. No treatment can guarantee the complete disappearance of a scar; the goal is aesthetic and functional improvement.
Contraindications and Precautions
- Common contraindications: active skin infection in the area, pregnancy and breastfeeding (depending on the technique), recent isotretinoin use (often suspended 6 to 12 months before certain treatments), unhealed dermatological surgery.
- Particular precautions: history of keloids requires rigorous evaluation — some techniques may worsen the keloid and demand caution and careful planning. Higher phototypes (darker skin) require an adapted protocol to limit pigmentation risks.
- Post-procedure advice: avoid sun exposure and use appropriate sun protection, limit heat and friction, follow local prescriptions (antiseptics, repair creams), and inform the practitioner of any abnormal progression.
Risks and Possible Side Effects
- Frequently observed and transient effects: redness, bruising, swelling, flaking, crust formation.
- Less frequent risks: infection, post-inflammatory hyperpigmentation, hypopigmentation, abnormal healing, local allergic reaction, worsening of a keloid. Specific risks vary by technique (e.g. prolonged erythema after ablative laser).
- These risks are explained and contextualised during the individual consultation. Appropriate devices and protocols reduce potential complications.


