What causes scars ?
Scars can develop in many situations :
• Severe acne : a common cause of depressed scars.
• Surgery or medical procedures : incisions can leave visible marks.
• Accidents or injuries : cuts, burns or trauma.
• Stretch marks : resulting from extreme skin tension (pregnancy, weight changes).
• Skin diseases : such as chickenpox or skin infections.
Because every scar is different, treatment must be personalised.
The 4 phases of healing
A scar develops through tissue repair following a skin injury. Once the dermis is affected (by a burn, wound or spots), the skin activates physiological healing. Beginning immediately after trauma, this process aims to repair skin tissues deeply and proceeds through several stages. Depending on the extent of the injury, total healing time may be between 1 year and 1,5 years.
The healing phases are :
• Coagulation : a blood clot forms after bleeding and develops into a scab.
• Inflammation or cleansing : leucocytes become active to clean the lesion and destroy any foreign bodies in the tissue. This phase involves inflammation that may cause redness, swelling (oedema) and increased temperature in the affected area.
• Proliferation : the dermis and epidermis start rebuilding. These new tissues are initially very imperfect.
• Remodelling : the scar's structure, strength and appearance improve. It gradually becomes more supple.
Healing quality varies according to lesion size, skin quality and general health. Skin regeneration depends on several factors (age, vascular disease, nutritional deficiencies, smoking).
When abnormalities affect healing, visible, permanent scars form in the area. Several aesthetic medical techniques can reduce a scar.
Which factors affect healing ?
Healing is a complex process influenced by many internal and external factors.
• Age : younger patients generally heal faster because of greater collagen production, while more mature skin may heal more slowly.
• Genetics : some people are predisposed to hypertrophic or keloid scars.
• Skin type : darker skin is more prone to pigmented scars, while fair skin may be more sensitive to prolonged redness.
• Injury location : heavily used areas or those under tension (knees, elbows) tend to heal less well.
• General health : chronic diseases (diabetes, vascular insufficiency) or deficiencies (zinc, vitamins A and C) can slow healing.
• Infections : local infection can worsen a scar by disrupting skin regeneration.
• Aftercare : appropriate care (cleaning, hydration and protection) is needed for optimal healing.
• Sun exposure : UV rays can cause hyperpigmentation in recent scars, making them more pronounced.
• Smoking : smoking reduces tissue oxygenation, delaying healing.
• Stress : chronic stress can disrupt the immune system and slow skin repair.
What are the different types of scars ?
Scars are classified according to their nature.
Atrophic scars
These are the most common scars. Because of reduced dermal thickness at the lesion site, they appear as depressions in the skin surface. These scars do not regress naturally.
Three types of atrophic scars are distinguished by shape, edges and depth : ice-pick or V-Shaped scars, depressed scars with less pronounced edges called Boxcar or U-Shaped, and depressed scars with pronounced edges called Rolling or M-shaped.
Hypertrophic scars
These lesions are raised (less than keloid scars) and red. Simple hypertrophic scars disappear naturally after 12 to 18 months.
Keloid scars
A keloid scar does not disappear spontaneously and is often associated with pain and/or itching. It appears as a raised lesion, slightly coloured between white, red, brown and pink. Its specific shape results from abnormal skin tissue proliferation.
Erythematous or pigmented macules
These marks represent a form of healing after superficial inflammatory lesions. Erythematous macules often disappear spontaneously within weeks without a trace, while pigmented macules regress more slowly and variably.
Techniques to reduce or remove a scar
Several innovative aesthetic medical techniques can reduce or eliminate a scar. These targeted treatments are adapted to each scar and skin type.
Among the most effective solutions, a medium-depth peel exfoliates skin layers, stimulating cell renewal.
Ablative lasers, whether continuous or fractional, are powerful tools that deeply regenerate skin tissues, visibly improving deep, old scars.
For depressed scars, hyaluronic acid injections fill skin depressions for an immediate but temporary effect. Treatment is personalised, with each technique selected according to skin type, scar characteristics and patient expectations.
Fractional CO2 and erbium lasers for scars
Fractional ablative laser reduces scars by stimulating collagen production. It heats skin tissues and creates tiny ablation zones, supporting regeneration of a denser, thicker dermis.
Between four and six sessions are needed.
The advantage is relatively mild after-effects (five days of downtime should be planned) , but improvement is less marked than with a medium-depth or deep peel.
Pigmented scars also fade.
Laser peels to remove scars
Continuous ablative laser, ideal for old, deep scars, is used to perform a laser peel. The aim is to remove damaged skin layers to stimulate collagen production. Particularly effective for deep scars, this treatment produces dramatic improvement reaching 80 %-95%.
After-effects include redness and scabs for 10 to 14 days.
Medium-depth or deep peels to remove scars
A medium-depth peel exfoliates the superficial and middle skin layers using specific solutions.
A medium-depth peel uses TCA (trichloroacetic acid) at 20-25 or 30 % concentration. Modified phenol is used for a deep peel.
By stimulating cell regeneration, this treatment improves superficial and moderately deep scars, with up to 80 % reduction depending on skin and scar type.
This technique is ideal for acne or pigmented scars.
After-effects are identical to a laser peel.
Hyaluronic acid injections to smooth scars
Hyaluronic acid has two main indications :
• Correcting an isolated depressed scar : when the scar is not too fibrous, it can be filled using hyaluronic acid's volumising properties. Dr Romano uses moderately cross-linked hyaluronic acid in this case.
• Increasing dermal density (improving overall skin quality) : to thicken, firm and soften the skin, Dr Romano uses SkinBooster hyaluronic acid. Denser skin makes scars less visible.
Scar treatment : what happens during a session ?
During an initial information consultation, Dr Romano listens to the patient's expectations, assesses their needs, analyses their skin and scar type and advises on possible procedures : laser or a peel for scars.
What happens during a laser session for scars
A session takes around 20 minutes, with the eyes protected by ocular shields. The protocol involves 4 sessions one month apart.
For a history of cold sores, preventive antiviral treatment must start the day before the session. Applying the prescribed anaesthetic cream to the treatment area one hour beforehand is strongly recommended. This makes the procedure painless.
After the session, scar cream must be applied 2 times daily for at least 10 days.
What happens during a peel session for scars
Before the peel, local anaesthesia makes the procedure completely painless. The area is disinfected. Depending on skin type and treatment goals, the number of passes and application time vary. Immediately after application, the peel causes intense redness and skin whitening (frosting). This is entirely normal.
Skin preparation must start 3 weeks before the peel, and Dr Romano will recommend the cream most suited to your skin. For one month before treatment, do not use self-tanner, essential oils, scrubs or masks.
On the day of the peel, make-up and even applying cream are prohibited.
After the session, scar cream is applied to the treated area.
Contraindications and side effects
After a peel, redness and slight swelling last around 48 hours, then the skin gradually darkens before peeling around day 7. Some complications can occur : swelling, persistent redness, peeling, exfoliation, bacterial or viral infection, an acne flare-up.
Peels have several contraindications :
• Diabetes or severe organ failure, such as kidney or heart failure.
• Pregnancy.
• A pacemaker or cardiac defibrillator.
• Isotretinoin stopped less than a year ago or ongoing acne treatment.
• Skin infection in the treatment area.
• Recent aesthetic procedure (surgery, laser, dermabrasion).
• Dark phototypes.
• Contact skin allergies.
Results : before/after scar treatment
Initial results are visible around one month after treatment and are optimal between three and six months. This depends greatly on the treatment performed.
During the preliminary consultation, Dr Romano explains that treatment improves the scar rather than eliminating it completely, and the extent of improvement depends on scar type and patient skin.
An estimated improvement rate is also provided during this consultation.
Why consider scar treatment ?
Scar treatments are intended for people who want to :
• Reduce scar visibility.
• Improve skin quality and smooth contour irregularities.
• Reduce pigmented marks or persistent redness.
• Regain more even skin and confidence.
What are the benefits ?
• Significant improvement in skin appearance.
• Non-invasive or minimally invasive techniques.
• Natural stimulation of collagen synthesis for lasting results.
• Protocols tailored to each patient.
How much does scar removal cost ?
Scar treatment costs vary according to the technique, scar characteristics and affected areas. Dr Romano welcomes you to her Geneva practice for diagnosis and a personalised quotation.
Several approaches, such as lasers, peels or injections, are offered : laser and injection scar treatments follow a personalised approach adapted to lesion type and location. A laser peel starts at CHF 700 per session, with one session performed. Fractional ablative laser starts at CHF 500 per session. A medium-depth or deep peel, according to indication, starts at CHF 700, with only one session needed. For certain indications, hyaluronic acid injections may be appropriate, at CHF 600 per syringe.
International recommendations developed by 26 specialists clarify the role of lasers in treating traumatic scars, particularly when they contract and pull on the skin. Depending on the scar’s characteristics, vascular or fractional lasers can reduce redness or thickness, improve pliability or even out the surface. Laser selection therefore depends on scar type and the patient’s skin phototype.
Recommendations by Gold and colleagues present treatments for hypertrophic scars and keloids. Several techniques can be combined when they complement one another. Treatment selection takes account of the age, location and characteristics of the scar. Regular follow-up allows results to be assessed and management to be adapted.
Recommendations by Monstrey and colleagues propose adapting scar treatment as the scar evolves. They clarify, in particular, the roles of silicone, hydration and sun protection, and the situations in which medical treatment may be considered. The aim is to improve the scar’s appearance and reduce the discomfort it causes, taking account of its stage of maturation.
Frequently asked questions about scar treatment in Geneva
What is an abnormal scar ?
A scar is considered abnormal when it has an irregular shape, abnormal size or is painful. This includes hypertrophic scars (thick and red), keloid scars (extending beyond wound edges) and atrophic scars (depressed). These scars may result from poor healing or a genetic predisposition.
Which product erases scars ?
Although no product completely erases a scar, certain options support healing : silicone-based scar creams ; hyaluronic acid gels to improve skin quality ; retinoid creams to promote cell renewal ; plant oils (rosehip, vitamin E) to nourish and soften the skin.
How can scars fade faster ?
To speed scar fading : moisturise daily with suitable creams ; use silicone dressings to support healing ; protect the scar from the sun to avoid pigmentation ; use gentle massage to soften scar tissue ; consult a doctor for targeted treatments such as laser.
What is the best cream for scars ?
Various creams support skin repair, smooth scars, soothe skin or reduce hypertrophic and keloid scars. Some contain repairing ingredients, others silicones or soothing agents that support skin regeneration and softening. Product choice depends on scar type, age and healing stage.
Who should you consult to remove a scar ?
A dermatologist and an aesthetic doctor are the specialists to consult to assess a scar and propose suitable treatments. In some cases, an aesthetic surgeon may be consulted for more complex corrections.
How can a scar be removed naturally ?
Natural methods are not effective but remain useful : regularly apply rosehip oil or aloe vera to nourish and soften the skin ; use gentle scrubs to stimulate cell renewal ; massage with honey, which has healing properties.
