A scar that is not healing as expected can be a source of worry and distress. There are a range of effective treatments and when used consistently, most problematic scars can be significantly improved. The key is matching the right treatment to the right scar type, at the right time.
Taping: The First Line of Defence
Mechanical support remains one of the easiest tools to use in scar management. Micropore or paper tape applied along a healing incision offloads tension on the dermis. By reducing mechanical stress on the remodelling tissue, taping encourages a finer and flatter result. A study on caesarian section scars published in the early 2000’s showed a significantly improved scar at 6 months with using tape compared to those who did not use tape.
Taping is most effective when begun early, typically from two weeks post-operatively once the wound is soundly healed, and continued consistently for two to three months. It is useful over areas prone to tension such as the chest, shoulders, and jawline. Each roll costs around $5 from your local pharmacy. Choose the brown coloured tape as it blends better to skin tone.
Moisturiser and Massage: Softening from the Outside
Regular moisturisation and scar massage play an important role in the remodelling phase of healing. Massage with an oil such as rosehip oil, is effective given its essential fatty acid and antioxidant content. It helps break down the disorganised collagen fibres within a maturing scar, reducing firmness and preventing tethering to underlying tissue.
Firm circular massage applied twice daily for five minutes is a good idea. Silicone-based moisturisers may be helpful as the silicone hydrates the stratum corneum and modulates collagen synthesis, reducing scar thickness, redness, and associated discomfort.
Steroid Injections: Targeting Overactive Healing
When a scar becomes hypertrophic meaning a raised, firm, and persistently inflamed scar then intralesional corticosteroid injections can be helpful. Triamcinolone, injected directly into the scar tissue, suppresses the inflammatory response and inhibits fibroblast activity, reducing excessive collagen deposition.
Treatment is typically administered in a series of sessions four to six weeks apart, with many patients requiring two to four injections. Results include a meaningful reduction in scar height, firmness, and redness, along with relief of itch and discomfort. Side effects — including skin atrophy, hypopigmentation, and telangiectasia are possible with repeated injections and are best managed through careful dosing and technique.
Radiation Therapy: The Keloid-Specific Tool
Radiation therapy occupies a specific and important niche in scar management — primarily in the treatment of keloid recurrence following surgical excision in scars that have not responded to other treatments. Keloids have a high recurrence rate after surgery alone, often reforming larger than the original scar. Post-operative radiotherapy, typically delivered as superficial low-dose fractions beginning within 24 to 48 hours of excision, significantly reduces this risk.
The mechanism involves targeting the rapidly dividing fibroblasts responsible for excessive collagen production. Modern superficial radiotherapy techniques deliver precise, localised treatment with minimal exposure to surrounding structures. When surgery and radiotherapy are combined, keloid recurrence rates drop substantially compared to excision alone which makes this combination the current standard of care for recalcitrant keloids in appropriate patients.
Radiotherapy for scars is not appropriate for all anatomical sites or patient groups.
A Staged, Personalised Approach
No single treatment suits every scar or every patient. The most effective management combines appropriate treatments in a logical sequence, beginning with conservative measures such as taping, massage, and silicone, escalating to steroid injections for hypertrophic or early keloid scars, and reserving surgical revision or radiotherapy for cases where first-line treatments have been insufficient.