Scars, once formed, do not disappear and often lead to long-term insecurity. Contrary to expectations that scars will naturally fade over time, they can become harder and darker, placing burdens on daily life and interpersonal relationships. Scars arise from various causes including trauma, surgery, acne, burns and self-harm, and treatment strategies differ depending on the cause, depth, extent and age of the scar.
Kim Young-goo, director of Yonsei Star Dermatology Clinic's Gangnam branch and president of the Korean Society for Laser Medicine and Surgery, is a dermatologist dedicated to scar treatment. As an authority on laser procedures, he treats old and hardened scars using combinations of various lasers. Kim gained recognition in the scar treatment field when he presented the "Pinhole method" at the European Academy of Dermatology and Venereology in 2005. While conventional scar treatment involved broadly shaving the scarred area, the Pinhole method creates pin-sized micro laser holes deep into the skin to intensively stimulate the core of the scar and induce regeneration. This approach has the advantage of promoting tissue recovery while reducing side effects.
"The older a scar becomes, the harder it is to treat, so it's important to keep wounds from drying out when they occur and start treatment early if scarring develops," Kim said.
Kim will appear on Seoul Economic TV's "Now, the Renowned Doctor" program airing at 9 p.m. on the 27th, discussing everything from the fundamental reasons scars form to the latest trends in laser treatment.
Scars Form When Deep Wounds Damage Hair Follicles and Sebaceous Glands
Scars tend to form when wounds are deep. "Deep within the skin are hair follicles and sebaceous glands that play important roles in wound recovery," Kim said. "When a wound damages these structures, normal regeneration pathways become difficult, and the likelihood of scar tissue forming increases."
Another important factor in scar formation is post-wound care. Repeatedly moving the wounded area or leaving it dry can result in thicker scars than would otherwise form.
Common acne can also leave scars. "Inflammatory acne causes strong inflammatory reactions in sebaceous glands, accompanied by tissue damage," Kim said. "Raised, red, swollen acne in particular has a high likelihood of leading to scars, so special care is needed." Squeezing acne by hand or repeatedly irritating it can increase the risk of scarring.
Treating Scars with Laser Combinations
The key to scar treatment is selecting and combining various lasers according to the scar's characteristics. "We take a strategy of combining multiple lasers after comprehensively analyzing the scar's depth, thickness, color, time of occurrence and cause," Kim said.
Carbon dioxide (CO₂) lasers are used for hard, thick scars, while erbium lasers are used for relatively minor scars. Vascular lasers are applied to scars with remaining redness, and pico lasers are used in combination when pigmentation is present.
"If laser intensity is raised indiscriminately, the risk of side effects increases," Kim said. "It's important to appropriately combine multiple lasers to maximize effectiveness while minimizing side effects."
Recently, Kim introduced the Ultra Pulse Alpha laser, a latest-specification device. He explained that this laser's beam is extremely fine at 0.12mm and can penetrate deeply without spreading, making it useful for treating hard, thick scars.
Among scars, severe burn scars have the highest treatment difficulty. "Burn scars often involve very hard and thick tissue," Kim said. "Treatment requires strong laser energy, and accordingly, procedure difficulty and patient management become more demanding." Additionally, older scars often have reduced tissue elasticity, requiring higher treatment intensity.
Self-Harm Scars and Keloids: Deep and Hard, Difficult to Treat
Recently, the number of adolescent patients with self-harm scars (hesitation marks) has been increasing. "Self-harm scars are often deeper and harder than regular scars," Kim said. "Above all, it's important to first convey hope to patients that things can improve."
For those with keloid-prone constitutions, scars form easily. Avoiding excessive movement of the wounded area, maintaining sufficient moisture and managing accompanying conditions such as acne together can reduce the risk of recurrence.
Meanwhile, even old scars can be improved. "While scars rarely disappear completely, mild scars often improve by more than 80 percent," Kim said. "Even severe scars frequently show noticeable changes that patients can perceive." Most patients notice changes after one to two treatments and can expect gradual improvement through repeated treatments.
Lifestyle Guidelines for Scar Prevention
To minimize scarring, early wound management is important. Kim identified three key elements for scar prevention: avoiding excessive movement of the wounded area, maintaining sufficient moisture and seeking early treatment.
"Scars tend to worsen the drier they become," Kim said. "When a wound occurs, it's important to pay attention to moisturizing and protection."
Finally, regarding those worried about scars, Kim said, "Many people come to the hospital thinking 'surely my scar won't improve' and then experience greater changes than expected. Most scars can be sufficiently improved, so rather than worrying alone, seek professional consultation."
