Scar, Keloid and Stretch Mark Treatment: Which Method for Which Scar?

Every wound heals with a scar, but some scars become thicker, redder or itchier than expected, or keep growing. Stretch marks (striae) are not wounds at all: they are scars formed from within when the skin is stretched quickly and its connective tissue tears. The right treatment depends on the type and age of the scar, so the first step is always to identify which kind of scar we are dealing with.

Types of scar

• Hypertrophic scar: thick, red and raised but staying within the wound's borders; may fade on its own over time.

• Keloid: a firm, itchy and sometimes painful scar that grows beyond the wound into healthy skin. Common on the earlobe, shoulder, front of the chest and around the jaw; darker skin and a family history increase the risk. Keloids do not regress on their own.

• Atrophic scar: depressed scars, most often after acne (ice-pick, boxcar and rolling types). See acne and acne scar treatment.

• Surgical, traumatic and burn scars: scars that widen, sink or leave a colour difference.

• Stretch marks (striae): red-purple at first (striae rubra), later white-silvery (striae alba); linked to pregnancy, rapid weight change, adolescent growth, corticosteroid use and genetic predisposition.

Treatment options

• Silicone gel and sheets, pressure: the first step for fresh scars; helps prevent thickening.

• Intralesional corticosteroid injection: the standard treatment for hypertrophic scars and keloids; several sessions 4–6 weeks apart, combined with antimitotic agents (5-fluorouracil) when needed.

• Cryotherapy: for small keloids, usually together with injections.

• Fractional CO₂ laser: tissue remodelling for atrophic scars, surgical and burn scars and mature stretch marks. See fractional CO₂ laser.

• Radiofrequency microneedling: deep collagen stimulation for acne scars and stretch marks. See RF microneedling.

• Vascular laser / BBL: targets the blood vessels in red, fresh scars and red stretch marks. See BBL.

• Subcision and filler: releasing tethered, depressed scars.

• Surgical excision: in keloids, only combined with injections or radiotherapy because of the high recurrence rate after surgery alone.

Keloids: the most common mistakes

Having a keloid cut out "for cosmetic reasons" is the most frequent mistake; after surgery alone it is likely to return larger. Ear piercings, cartilage piercings and unnecessary skin procedures can trigger new keloids in predisposed people. Anyone with a history of keloids should tell the physician before any skin procedure.

Realistic expectations for stretch marks

Stretch marks cannot be erased completely. The goal is to reduce their visibility by improving colour, width and texture. Red-stage stretch marks respond far better; for whitened marks, laser and RF microneedling aim for tissue improvement over 3–5 sessions. Creams alone have limited effect.

Frequently asked questions

Are keloid injections painful? A brief burning sensation is felt during the injection; the procedure takes a few minutes.

Can an old surgical scar be improved? Even years-old scars can be made less visible with laser and radiofrequency; the result depends on the scar's type and depth.

When should stretch mark treatment start? After pregnancy and breastfeeding are over, and ideally while the marks are still red-purple.

Scar and stretch-mark treatment in Kırklareli

Our practice is in central Kırklareli, in Turkish Thrace — about an hour from Edirne, with the Kapıkule (Bulgaria) and İpsala (Greece) border crossings within easy reach. We are open Monday to Saturday, 10:00–18:15, and see patients from Bulgaria and Greece under our international health tourism authorisation. The scar type and the right method are decided at the examination; session intervals are planned around travel. To book, use our contact page.

This article is for general information; treatment is decided after an examination.