Most scars fade significantly on their own over 6 to 12 months as your body remodels the collagen underneath. But the type of scar you have, how old it is, and what you do during healing all determine how visible it remains long-term. Some scars respond well to drugstore silicone products, others need professional treatments like lasers or chemical peels, and a few (especially keloids) require a combination approach. Here’s what actually works and what doesn’t.
Why Scars Form and How Long They Take to Mature
When your skin is injured, your body rushes to close the gap with new collagen fibers. Early on, a scar is typically red, raised, hard, and sometimes painful. This is normal. Over weeks and months, the scar enters a remodeling phase where the collagen reorganizes and softens. This process starts around week three and can continue for up to 12 months.
The key takeaway: don’t judge a scar’s final appearance for at least a year. Many people seek aggressive treatment for scars that would have improved substantially on their own. That said, what you do during those early months matters a lot, and older scars that haven’t faded can still be treated.
The Type of Scar Determines the Treatment
Not all scars behave the same way, and the right approach depends on what kind you’re dealing with.
Flat or slightly discolored scars are the most common result of cuts, burns, or surgery. They stay within the original wound boundary and generally respond well to topical treatments and sun protection.
Atrophic scars are indented or pitted, sitting below the surface of surrounding skin. Acne scars are the most familiar example. These form when the body doesn’t produce enough collagen during healing, leaving a depression. They typically need treatments that stimulate new collagen growth from below, like microneedling or chemical peels.
Hypertrophic scars are raised and thick but stay within the borders of the original wound. They result from prolonged inflammation that causes excess collagen buildup. Silicone products, lasers, and steroid injections can all help flatten them.
Keloids are the most stubborn type. They grow beyond the boundaries of the original wound and can expand in distinctive patterns, sometimes forming crab-claw or butterfly shapes on the chest or dumbbell shapes on the upper arm. Keloids develop because inflammation continues far longer than it should, driven partly by ongoing mechanical tension on the skin. They almost always require professional treatment and have higher recurrence rates than other scar types.
What to Do While a Wound Is Still Healing
The single most effective thing you can do for scar prevention is keep the wound moist. Research in animal models shows that wounds treated with moist dressings heal twice as fast as those left to dry out. Moist healing also produces less inflammation, a shorter recovery period, and a significantly smaller scar surface area compared to dry healing. In practical terms, this means covering a healing wound with an occlusive bandage or petroleum jelly rather than letting a scab form in open air.
Sun protection is the other non-negotiable step. New scar tissue is highly susceptible to UV damage, which can darken the scar permanently. Keep healing skin covered or apply sunscreen with SPF 30 or higher for at least the first year.
Silicone Products: The Best-Supported OTC Option
Silicone gel and silicone sheets are the most studied and most recommended over-the-counter scar treatments. In clinical studies, silicone gel produced an 86% improvement in scar texture, 84% improvement in color, and 68% reduction in scar height. After a full course of treatment, 60% of hypertrophic scars returned to a normal appearance.
Silicone works by forming an ultra-thin breathable layer over the scar that increases hydration in the outer skin layer. This sends signals to the underlying cells to slow down collagen production, which is what makes raised scars thick and firm. Over time, the balance between collagen production and collagen breakdown resets, and the scar softens and flattens. Silicone also reduces the itching and discomfort that often accompany healing scars.
For silicone gel, apply a thin film twice a day and rub it in for two to three minutes. It dries within four to five minutes and works continuously. A standard tube lasts about 90 days for a 3- to 4-inch scar. Silicone sheets work on the same principle but are worn directly over the scar for extended periods. Both are available at most pharmacies without a prescription, and results typically become visible after 8 to 12 weeks of consistent use.
Onion Extract Gels: Limited Evidence
Products containing onion extract (you’ll see it on the label as Allium cepa) are widely marketed for scar reduction. There is some clinical data showing benefit: in one study, about 56% of patients had lower scar height on the treated side after 12 weeks, and 81% reported fewer scar symptoms like itching and tightness. But these studies tend to be small, with short follow-up periods, and the improvements are modest compared to silicone. If you’re choosing between the two, silicone has stronger evidence behind it.
Skip the Vitamin E
Despite its reputation, vitamin E applied to scars does not hold up under clinical testing. Studies have found no meaningful benefit for scar appearance, and roughly a third of patients in one trial developed contact dermatitis from the cream. In some cases, researchers found that topical vitamin E actually worsened the cosmetic appearance of scars. The evidence is clear enough that dermatologists generally discourage its use on healing wounds.
Professional Treatments for Stubborn Scars
Microneedling
Microneedling uses a device with fine needles to create controlled micro-injuries in scar tissue, triggering your body to produce fresh collagen that fills in and remodels the scar. It’s particularly effective for atrophic (indented) acne scars. Depth matters: a clinical trial comparing 2.5 mm needle depth to 1.5 mm found that the deeper treatment produced significantly better results after six sessions. Sessions are typically spaced four to six weeks apart, and you can expect redness and mild swelling for a few days after each one.
Laser Treatments
Two main types of lasers are used for scars. Pulsed dye lasers target the blood vessels that give scars their red or purple color. Fractional CO2 lasers create tiny columns of controlled damage in the scar, prompting the skin to rebuild with smoother, more organized tissue. A head-to-head clinical trial found both types equally effective for hypertrophic scars after four monthly sessions. Your dermatologist will recommend one or the other (or sometimes both) based on whether your scar’s main issue is color, texture, or thickness.
Chemical Peels
Chemical peels use acid solutions to remove damaged skin layers and stimulate regeneration. The depth of the peel determines what it can treat. Superficial peels using lower concentrations of acid address mild discoloration and very shallow scars. Medium-depth peels penetrate into the upper layers of the dermis and work well for moderate acne scars and uneven texture. Deep peels reach further into the skin and can improve severe acne scarring, but they carry more downtime and risk of complications. Your provider will select the appropriate depth based on your skin type and scar severity.
Steroid Injections for Raised Scars
For hypertrophic scars and keloids, corticosteroid injections directly into the scar tissue can reduce inflammation and flatten the scar over a series of treatments. This is often the first-line approach for keloids, sometimes combined with surgical excision for larger ones. Keloids in particular have a tendency to come back after treatment, so many dermatologists use a combination strategy: surgery to remove the bulk of the scar followed by injections, pressure therapy, or even targeted radiation to prevent regrowth.
What Works Best for Each Scar Type
- Fresh surgical or injury scars: Moist wound care during healing, then silicone gel or sheets for at least 8 to 12 weeks. Sun protection for the first year.
- Indented acne scars: Microneedling (6 sessions at deeper needle depths), chemical peels, or fractional laser. These can be combined for better results.
- Raised hypertrophic scars: Silicone products as a first step. If they don’t respond, laser therapy (4 monthly sessions) or steroid injections.
- Keloids: Professional treatment is almost always needed. Steroid injections for smaller keloids, surgical removal with follow-up therapy for larger ones. Ongoing monitoring is important because keloids frequently recur.
Older scars are harder to treat than newer ones, but they still respond. If your scar is more than a year old and hasn’t improved to your satisfaction with topical products, a dermatologist can evaluate it and recommend the right combination of professional treatments for your specific situation.