Scars
A scar is fibrous tissue that replaces normal skin after a wound heals, and it can be raised, flat, sunken or discolored. At Desert Bloom in Scottsdale, Dr. Natalya Borakowski, NMD first identifies the scar type, then treats it with microneedling, RF microneedling, laser resurfacing or Bellafill.
A Scar That Stopped Fading, and What to Do Next
Most scars improve on their own for about a year, then stop. That is when many patients come in, with a surgical scar that is still thick, a healed injury that looks different from the surrounding skin, or a burn mark that never quite settled. Scar treatment finishes the healing the body could not complete on its own.
At Desert Bloom, Dr. Natalya Borakowski, NMD starts by classifying the scar, because the scar type, the scar’s age, and the patient’s skin tone together determine which treatment belongs in the plan. A single approach does not cover all scars. She routes surgical, trauma, burn, hypertrophic, and pigmented presentations differently.
If your scars are specifically from acne (ice pick, boxcar, rolling), the Acne Scars page covers that pathway in detail. For color-only concerns that are not scar-related, see our Hyperpigmentation hub.
Not sure which treatment fits? Book a consultation and get a plan for your skin
At a Glance
Scope. Atrophic (depressed), hypertrophic (raised), keloid, pigmented, surgical, trauma, burn, and stretch-mark scars. Five treatment options at Desert Bloom cover most presentations: RF Microneedling (all skin tones), CO2 (lighter skin, deeper scars) or Erbium laser resurfacing (hypertrophic or keloid scar in all skin types), Microneedling with PRP (newer or mild scars), and PRX-T33, the Unicorn Facial (pigment-only concerns). Active keloids might need medical management with steroid injections first.
Provider & candidacy. Dr. Natalya Borakowski, NMD oversees all scar treatment planning. RF Microneedling is appropriate across Fitzpatrick I–VI. Ablative laser such as CO2 is reserved for Fitzpatrick I–III, because surface ablation carries risk of skin pigment changes. Silicone gel sheeting is a great home adjunct therapy for scars that are under a six month old.
Downtime & how to start. PRX-T33 and microneedling: minimal to no downtime. RF Microneedling: 24–48 hours redness. Erbium resurfacing: 3–7 days. CO2 laser: 7-10 days. A consultation with Dr. Natalya maps scar type, skin tone, and scar age before any plan is built. There is no universal protocol.
The Four Clinical Scar Types
A scar is what the skin leaves behind when the dermis (the collagen-rich middle layer) is damaged and the body’s repair process does not produce a perfect match to the original tissue. Instead of the woven collagen of healthy skin, scar tissue lays down collagen in parallel bundles, which is why scars often feel tight, look slightly raised or sunken, and behave differently than the surrounding skin. The type of scar depends on how the body handled that repair, and scar type is the first thing that determines which treatment belongs in the plan.
Atrophic (Depressed) Scars
Too little collagen replaces the wound, which leaves a pitted or sunken scar. Common after acne, chickenpox, trauma, and surgical sites. Sub-types: ice pick (narrow, deep), boxcar (broad, defined edges), rolling (wide undulation). Treatment must stimulate new collagen from underneath.
Route to: RF Microneedling (all skin tones) with Erbium laser followed by Bellafill or HA filler injections to fill in the scar.Hypertrophic Scars
Too much collagen forms, but the scar stays within the original wound boundary. Raised, red or pink, firm to touch; common after burns, surgical incisions, and traumatic injury. Many soften over 12–24 months without any treatment. Erbium laser scar revision can speed up scar remodeling, along with silicone gel sheeting at home.
Route to: Silicone sheets + Erbium laserKeloid Scars
A keloid looks like a hypertrophic scar at first but keeps growing, extending past the original wound boundary, sometimes enlarging years after the initial injury. Keloids are most common in darker skin tones and often follow ear piercings, surgical incisions, burns, and even minor skin conditions. The scar’s size does not correlate with the original wound; a small scratch can produce a large keloid in susceptible individuals.
Active keloids are not treated with aesthetic laser alone. Ablative energy can trigger the same over-healing response that caused the keloid to form. First step is always intralesional corticosteroid injection, often combined with silicone, pressure, or cryotherapy. Aesthetic resurfacing is only considered after the keloid has been stable under medical management for at least six to twelve months.
Route to: Intralesional corticosteroid first, NOT aesthetic laser as primaryPigmented (Color-Only) Scars
The scar has healed flat and smooth but left a red or brown mark. These are color problems. Post-inflammatory hyperpigmentation (brown, more common in darker skin tones) and post-inflammatory erythema (red, more common in lighter skin) are the two main types. The skin architecture underneath is intact; only the pigment signal is dysregulated.
Pigment problems need a surface treatment, not a resurfacing laser. For Fitzpatrick IV–VI patients, IPL and ablative laser are not appropriate. The safe non-laser route at Desert Bloom is PRX-T33 (the Unicorn Facial), chemical peels and the Desert Reset treatments with a gentle peel, plus home skincare.
Route to: PRX-T33 (all tones), then the Desert Reset treatments and home skincareScar age matters alongside scar type. Scars younger than about six months are still remodeling, which means the body is still producing and breaking down collagen. Treating these scars early can often improve appearance of scars before they fully mature. Mature scars (over twelve months) are stable and often will need more treatments to achieve desired results. Silicone gel sheeting, which is often recommended two to four weeks post-surgery or post-injury to help prevent hypertrophic scar formation before it starts.
Surgical scars are the most common non-acne reason patients come in for a scar consultation. C-section scars, appendectomy scars, rhinoplasty or facelift scars that did not settle well, dermatology-excision scars, and cosmetic surgery scars that are still thick or raised many months later all follow this routing logic. Trauma scars from lacerations, accidents, or burns follow similar treatment reasoning. The body’s healing process after surgery or traumatic injury produces the same parallel-bundle collagen architecture as any other scar, so the type classification above still applies.
Skin Tone, Fitzpatrick Type, and Treatment Safety
Fitzpatrick skin type matters more for scar treatment than for almost any other aesthetic decision. Ablative lasers such as CO2 disrupt the skin surface. In Fitzpatrick IV–VI this can trigger post-inflammatory hyperpigmentation, turning a textural scar into a color problem. For this reason, darker skin tones are routed to RF Microneedling with or without Erbium laser; PRX-T33 and Microneedling with PRP are the adjuncts.
Patients with darker skin who have been told “laser is not for your skin type” often misunderstand the distinction: it is the type of laser that matters, not laser treatment in general. RF Microneedling delivers energy through microneedles directly into the dermis without ablating the surface. It is safe and effective across Fitzpatrick I–VI, including skin tones where ablative CO2 would carry real risk.
Treatment Options for Scars
Most scar plans at Desert Bloom start with Erbium laser or RF Microneedling and layer in PRP-enhanced microneedling and use of acids such as kojic or azelaic, depending on scar depth, skin tone, and how the scar responds over time. The five options below are the ones Dr. Borakowski routes scar patients to most often. Each has a distinct role and a clear decision trigger that separates it from the others.
Texture or Depth vs Color: Which Route Is Yours?
Most scar presentations fall into one of two primary concerns, and identifying which one applies to your scar tells you roughly which category of treatment should lead. The grid below maps the two paths.
Texture or Depth Problem
The scar is pitted, sunken, raised, or has a surface irregularity you can feel with your fingertip. This is a structural concern, and the collagen architecture underneath needs remodeling.
Color or Pigment Problem
The scar is flat and the surface is smooth, but the tone is off, with a red or brown mark where the wound healed. This is a pigment concern rather than a structural one. Treatment targets the epidermis, not the dermis.
When scars are beyond what resurfacing can address, such as contractures limiting movement, wide surgical scars under tension, or specific keloid cases, Dr. Borakowski will explain your options honestly at your consultation.
Compare All Scar Treatment Options
| Feature | RF Microneedling | CO2 Laser | Erbium Laser | MN + PRP | PRX-T33 |
|---|---|---|---|---|---|
| Best for | Atrophic, hypertrophic, surgical and trauma scars in all skin tones | Deep atrophic scars, lighter skin | Moderate atrophic scars, medium skin | Newer scars, mild texture, bridging | Flat pigmented / color-only scars |
| Mechanism | RF energy through microneedles for dermal collagen remodeling, no surface ablation | Ablative CO2 vaporizes surface + deep collagen stimulation | Erbium:YAG ablates a thin, precise layer with less thermal spread than CO2 | Microchannel collagen induction + platelet-rich plasma healing boost | TCA biorevitalization, outer skin layer left intact |
| Fitzpatrick range | I–VI (safe all tones) | I–III only (PIH risk Fitz IV–VI) | I–III (some III caution) | I–VI | I–VI (all skin tones) |
| Sessions typical | 3–4 sessions, 4–6 weeks apart | 1–2 sessions (high impact) | 3-4 sessions | 3–4 sessions | Series of 4 |
| Downtime | 24–48 hrs redness | 10–14 days | 3–7 days | Minimal 24 hrs | None to minimal |
Safety, Skin Type, and Contraindications
Scar treatment carries real contraindications that are easy to miss if the consult focuses only on what the patient wants rather than what the scar needs. The most important safety variables are skin tone (Fitzpatrick type), scar type, scar age, and any active skin conditions at the scar site. Four situations require a different path before aesthetic treatment begins.
Active or growing keloid. An active keloid requires intralesional corticosteroid management first, because aesthetic laser alone can worsen keloid formation. Wait at least 6–12 months of documented stability under medical management before considering aesthetic resurfacing. Keloid history does not automatically exclude treatment, but it changes the plan significantly.
Fitzpatrick IV–VI skin + pigmented scar. Ablative CO2 laser is not appropriate for post-inflammatory hyperpigmentation in darker skin tones. The non-laser route at Desert Bloom, PRX-T33 and the Desert Reset treatments with a gentle peel plus topical brightening, is both safer and more effective for this presentation. Nd:YAG 1064nm can be appropriate for vascular red scars in darker skin but should be discussed in person.
Scar under 6 months old. Scars still in active remodeling are not ready for aggressive treatment. The exception is silicone gel sheeting, which can be started 2–4 weeks post-surgery as a preventive measure. We can also start gentle Erbium laser 6-8 weeks after surgery if the scar is fully healed. If in doubt, schedule a consultation to assess readiness before committing to a treatment series.
Active acne flare or open skin condition at the scar site. Clear the active condition before any energy device or chemical treatment. Treating over active inflammation extends healing time and can worsen surface irregularities.
Home care is part of most scar plans. Three things work well: silicone gel sheeting (apply daily, minimum 12 hours, for several months), daily sunscreen (broad-spectrum SPF 30+ is the most effective OTC scar product, since UV darkens scars and reverses in-office progress), and topical retinoids (retinoic acid softens scar texture when paired with in-office treatment). What does not work as advertised: vitamin E oil (mixed evidence, contact dermatitis risk), onion extract gels (modest effect at best), and most OTC creams without active ingredients.
If your scars are specifically from acne (ice pick, boxcar, rolling), the routing logic and treatment priorities on this page overlap with the acne-scar pathway but are not identical to it. The Acne Scars page covers acne-specific scarring in more depth, including the post-inflammatory hyperpigmentation that often accompanies acne-derived scarring and the specific sub-type considerations that change which treatments lead. Everything else (surgical, trauma, burn, general keloid or hypertrophic, and scars of unknown cause) belongs on this page. If you are unsure which category your scars fall into, bring photos to the consultation and Dr. Natalya will help you route from there.
Questions
Frequently asked questions
Can scars be completely removed?
Usually not. Most scars can be made significantly less noticeable, often with a 50–80% improvement over a treatment series, but full erasure to match the surrounding skin is rare. Very superficial or very new scars sometimes come close. Deep atrophic scars, old keloids, and large surgical scars have realistic improvement ceilings. The goal is a meaningful softening of the scar’s appearance, not disappearance.
What is the best treatment for raised or keloid scars?
For hypertrophic scars contained within the original wound, RF Microneedling combined with silicone gel sheeting is the starting point; stubborn cases need intralesional corticosteroid injections. Active keloids require medical management first, because aesthetic laser alone can worsen keloid formation and should not be the primary treatment for an active or growing keloid. Once a keloid is stable under medical management for 6–12 months, aesthetic resurfacing may be added to a broader plan.
Is laser or microneedling better for scars?
It depends on scar depth and skin tone. For darker skin (Fitzpatrick IV–VI) or moderate-depth scars, RF Microneedling is usually the safer, more appropriate starting point. For deep, mature atrophic scars on lighter skin (Fitzpatrick I–III), fractional CO2 or Erbium laser resurfacing is more powerful. Many treatment plans use both in sequence: RF Microneedling first, then ablative laser later if the scar warrants escalation and the skin tone is appropriate.
How long does it take to see results from scar treatment?
Collagen remodeling is slow. Some improvement is noticeable a few weeks after each session, but the full result of a scar treatment series typically takes three to six months after the final session. Collagen maturation takes that long. Patients who expect to see optimal results immediately after treatment underestimate how much of the improvement happens in the weeks and months that follow.
Can scars on darker skin (Fitzpatrick IV–VI) be treated?
Yes, but the treatment plan is different. Darker skin is more prone to post-inflammatory hyperpigmentation from aggressive ablative laser, so treatment prioritizes RF Microneedling and PRP-enhanced microneedling, with PRX-T33 as an adjunct. Ablative laser (CO2, Erbium) is used sparingly on Fitzpatrick IV–VI and only for specific indications where the benefit is clear and conservative settings apply. For pigmented flat scars in darker skin, the non-laser route at Desert Bloom is PRX-T33 and the Desert Reset treatments with a gentle peel, plus home skincare, not IPL or ablative resurfacing.
How soon after surgery can I treat a scar?
Most scars need to mature before aesthetic treatment, usually for at least six months and often twelve. Treating during the active remodeling window can worsen the scar’s appearance. The exception is silicone gel sheeting, which can be started two to four weeks post-surgery to prevent hypertrophic scar formation before it becomes established. For cosmetic surgery scars, Dr. Borakowski checks the scar’s maturity at your consultation before scheduling any aesthetic scar treatment.
Will insurance cover scar treatment?
Usually no. Aesthetic scar treatment is generally considered cosmetic. Exceptions may apply for functional scars (contractures limiting range of movement, scars causing medical complications, or severe burn scar reconstruction), which may have insurance coverage. Call your insurer for specifics. Desert Bloom does not bill insurance.
What is the difference between this page and the Acne Scars page?
This page covers surgical scars, trauma scars, burn scars, hypertrophic scars, keloids, pigmented scars, and scars of unknown origin. The Acne Scars page covers scarring specifically from acne (ice pick, boxcar, and rolling scars), along with the post-inflammatory hyperpigmentation that commonly accompanies acne-derived scarring. The treatment modalities overlap, but the consultation flow and selection priorities differ. If your scars are from acne breakouts, start at the Acne Scars page. If they are from surgery, injury, or you are not sure, start here.
Ready to talk it through? Book a consultation and we will look at your goals, explain your options and give you a clear plan and price.