Raised scars

Raised scars are pathological forms of skin healing in which there is an excessive production of fibrous connective tissue, mainly type III collagen and subsequently type I. As a result, lesions elevated above the skin surface are formed, with a firm, often dense structure. This group primarily includes hypertrophic scars and keloids, which differ in their growth dynamics and ability to extend beyond the boundaries of the original injury. Raised scars can cause not only an aesthetic defect but also functional complaints, such as itching, pain, or limited tissue mobility.

Raised scars – causes

The formation of raised scars is the result of an imbalance between the processes of collagen synthesis and degradation during wound healing. A key role is played by the excessive activity of fibroblasts – cells responsible for the production of the extracellular matrix.

The most important etiological factors include:

1. Local factors:

deep skin damage (burns, surgical wounds, injuries)
chronic inflammation within the wound
infection or delayed healing
excessive skin tension at the site of injury (e.g., chest, shoulders)

2. Individual predispositions:

genetic predisposition (more frequent occurrence in individuals with phototype IV–VI)
young age (greater fibroblast activity)
hormonal disorders

3. Molecular disorders:

overexpression of growth factors, such as TGF-β (transforming growth factor beta)
decreased activity of metalloproteinases (enzymes that break down collagen)
excessive angiogenesis (formation of new blood vessels)

In the case of hypertrophic scars, the lesion remains limited to the area of the original skin injury and often undergoes partial regression over time. In contrast, keloids tend to invade surrounding tissues and do not regress spontaneously, making them more therapeutically challenging.

Raised scars – how to remove

Treatment of raised scars is a complex process and requires an individual approach based on the type of scar, its age, location, and clinical symptoms. In clinical practice, combination therapies are used, as monotherapy rarely brings satisfactory results.

Most important therapeutic methods:

1. Topical and preventive therapies:

silicone gels and sheets – reduce transepidermal water loss and modulate collagen remodeling
pressure garments – used especially after burns

2. Injectable treatments:

corticosteroids (e.g., triamcinolone) – inhibit fibroblast proliferation and collagen synthesis
5-fluorouracil (5-FU) – has an antiproliferative effect on scar cells
platelet-rich plasma (PRP) – supports tissue remodeling

3. Laser therapy:

fractional CO₂ or Er:YAG laser – causes controlled micro-damage and collagen remodeling
pulsed dye laser (PDL) – reduces erythema and scar vascularization

4. Technologies stimulating skin remodeling:

microneedling (microneedle mesotherapy) – induces regenerative processes
microneedle radiofrequency – combines micro-injuries with thermal energy, intensifying remodeling

5. Surgical and physical methods:

surgical scar excision – mainly used in the case of keloids (always in combination with adjuvant therapy)
cryotherapy – causes destruction of scar tissue through freezing

In the conditions of aesthetic medicine clinics, such as Ambasada Urody Clinic & Spa, therapies stimulating skin remodeling are primarily used, including fractional laser therapy, microneedle radiofrequency, and microneedle mesotherapy, which lead to flattening of the scar, improvement of its elasticity, and evening out of the skin tone.

It should be emphasized that complete removal of a raised scar is usually impossible – the goal of the therapy is its maximum flattening, softening, and reduction of accompanying symptoms.