Raised scars can be flattened and softened through a range of treatments, from simple silicone sheets you apply at home to steroid injections and laser therapy performed in a clinic. The right approach depends on the type of raised scar you have, how old it is, and how it has responded to earlier treatment. Most people see meaningful improvement, though complete elimination isn’t always realistic, especially with larger or older scars.
Know Which Type of Raised Scar You Have
Raised scars fall into two main categories, and the distinction matters because they behave differently and respond to different treatments.
Hypertrophic scars stay within the boundaries of the original wound. They typically become visible within weeks of an injury, grow for three to six months, plateau, and then slowly start to flatten on their own. They can be linear (like a surgical scar) or spread across a wider area (like a burn scar). Because they have a natural tendency to regress, less aggressive treatments often work well.
Keloids grow beyond the edges of the original wound and invade healthy surrounding skin. They can take on nodular, butterfly, or cauliflower-like shapes and tend to form in areas where skin is frequently stretched, such as the chest, shoulders, and earlobes. Keloids rarely appear on the scalp, lower legs, or upper eyelids. Unlike hypertrophic scars, keloids don’t regress on their own and are more likely to recur after treatment.
Silicone Sheets and Gels
Silicone products are the most accessible starting point for treating raised scars at home. They work by hydrating the scar tissue and creating a protective barrier that helps regulate collagen production. International clinical guidelines recognize silicone as effective for both preventing and managing hypertrophic scars, and studies show silicone gel performs as well as or better than silicone gel sheeting.
Silicone sheets should be worn as close to 23 hours a day as practical, removed only for cleaning. Most clinical trials assess results over 12 to 20 weeks, but many dermatologists recommend continuing for at least three to six months to see the full benefit. The sheets are reusable (typically replaced weekly) and available over the counter. Silicone gel is a good alternative for scars in areas where sheets won’t stay put, like the face or joints.
Scar Massage
Regular massage helps break up the dense collagen fibers that make a scar feel hard and raised. The technique is simple: apply gentle, sustained pressure with your fingertips, working in circular and cross-fiber motions over the scar. For best results, aim for at least 10 minutes, twice a day, for six months. You can combine massage with silicone gel application. Massage is most effective on scars that have fully closed and are no longer red or scabbed, typically starting a few weeks after the wound heals.
Pressure Therapy
Pressure garments have been a standard treatment for hypertrophic burn scars for decades. They work by compressing the scar tissue, which limits blood flow to the area and slows collagen overproduction. Higher-pressure garments are more effective than lower-pressure ones, and people with moderate to severe scarring tend to see the greatest benefit. Pressure therapy requires wearing the garment consistently, often for many months, which can be uncomfortable but is one of the more reliable non-invasive options for widespread burn scars.
Paper Tape for New Scars
One of the simplest preventive measures is applying adhesive microporous hypoallergenic paper tape over a healing surgical incision. Studies show this significantly reduces the chance of a hypertrophic scar forming compared to leaving the wound uncovered. If you’ve recently had surgery and are concerned about raised scarring, taping the incision for several weeks while it heals is a low-cost, low-risk strategy worth discussing with your surgeon.
Steroid Injections
When topical treatments aren’t enough, steroid injections are the preferred first-line treatment for keloids and a strong second-line option for hypertrophic scars. A corticosteroid is injected directly into the scar tissue every four to six weeks, which softens the scar and reduces its volume by breaking down excess collagen.
Response rates range from 50% to 100%, meaning most people see noticeable flattening. The tradeoff is that recurrence rates for fully resolved scars range from 9% to 50%, so some scars grow back after treatment stops. Potential side effects include thinning of the surrounding skin, visible small blood vessels, and lightening of the skin at the injection site, though using lower doses helps minimize these.
Laser Treatment
Pulsed dye lasers target the blood vessels feeding a raised scar, which reduces redness and triggers the body to remodel the disorganized collagen. In clinical studies, patients reported symptom improvement (less itching and tightness) after just one session. After an average of 2.5 treatments, scars showed decreased redness along with improved texture and pliability. International guidelines cite an estimated 72% efficacy rate for pulsed dye laser on both hypertrophic scars and keloids.
A different type of laser, called an ablative fractional laser, creates microscopic channels in the scar tissue. When combined with steroid injections delivered through those channels, this approach can be effective for stubborn scars that haven’t responded to other treatments. Laser sessions are typically spaced several weeks apart, and most people need two to six sessions depending on the scar’s size and severity.
Cryotherapy
Cryotherapy uses extreme cold to destroy excess scar tissue. Traditional surface cryotherapy (freezing the outside of the scar) works but commonly causes lightening of the surrounding skin, which can be cosmetically problematic, especially on darker skin tones.
A newer approach, intralesional cryotherapy, inserts a probe directly into the scar to freeze it from the inside out. This method reduces scar volume by 51% to 63% in a single treatment, with recurrence rates between 0% and 24%. Because the freezing targets the interior of the scar rather than the surface, skin lightening is much less common and recovery is faster. Combining traditional cryotherapy with steroid injections can also improve results for smaller keloids.
Injections for Resistant Scars
For scars that don’t respond adequately to steroids alone, a chemotherapy-derived medication can be injected into the scar tissue. This drug works by blocking the rapid multiplication of the fibroblast cells responsible for excess collagen production. It has a 50% to 70% response rate on its own, but combining it with steroid injections improves outcomes beyond what either treatment achieves alone. The combination has also been shown to reduce recurrence rates after surgical removal of ear keloids. Side effects can include pain at the injection site and temporary skin darkening.
Surgical Removal
Surgery is generally reserved for large or functionally limiting scars that haven’t responded to less invasive treatments, and it’s almost never used alone. Cutting out a keloid without any follow-up treatment leads to recurrence rates of 45% to 100%, which is why surgery is nearly always paired with another therapy.
A technique called intralesional excision, where the keloid is removed from within while leaving the outer shell of scar tissue intact, has shown significantly better results. A meta-analysis of over 600 keloids found a pooled recurrence rate of just 13% with this approach. Radiation therapy delivered shortly after surgical excision is another common combination that decreases keloid recurrence, though it’s typically reserved for adults with severe or repeatedly recurring keloids.
Choosing the Right Approach
For new or mild hypertrophic scars, start with silicone products, massage, and pressure therapy. These are low-risk, inexpensive, and often effective enough on their own, especially since many hypertrophic scars naturally improve over 12 to 18 months.
For established hypertrophic scars that haven’t flattened, or for any keloid, steroid injections or laser therapy are reasonable next steps. Many clinicians combine these with silicone to improve results. For keloids that keep coming back or scars that resist multiple rounds of injections and laser, cryotherapy, combination injectable therapy, or surgical excision with adjuvant treatment become the practical options. Treatment often involves layering multiple approaches rather than relying on a single one, and patience matters: most protocols take several months before the full effect is visible.