Scars - Keloids

Scars are visible marks left on the skin after an injury as the body’s healing mechanisms are activated to maintain the structural and functional integrity of the damaged tissue.

Scars - Keloids
Dr. Konstantina Mamali Dermatologist – Venereologist

“Incomplete healing after an injury can lead to scarring that creates deformity leaving an ugly aesthetic result. Scars are divided into hypertrophic, atrophic, keloid, post-operative, post-necological and ricrotic scars, while acne scars are a special category,” explains Dr. Konstantina Mamali.

Dermatologist – Venereologist Dr. Konstantina Mamali


Scars are normal signs that exist in every human being. While many scars are due to unknown causes and are naturally present on the body from birth, most scars are created after trauma or even more commonly after acne. They are a fairly significant aesthetic problem, especially in people who are in their teens.

The inflammatory signs of acne are papules and pustules and are formed when a hair follicle pore is filled with sebum, dead skin cells and bacteria. The pore gradually swells and a rupture in its wall is caused. If this rupture occurs close to the epidermis, then healing does not create a significant acne scar. However, if it occurs deeper, then the epidermis fills with inflammatory elements and bacteria destroying healthy skin and leaving behind a lot of tissue destruction leading to acne scarring. The most common areas of acne scarring are the face, back and chest. Less commonly, acne scars also appear on the buttocks. Apart from acne scars, there are several other types of scars that form after varicella, after trauma or burns, and also scars that form after surgery. Even stretch marks, formed after pregnancy or from sudden weight fluctuations due to skin stretching, are a form of scarring.

Acne scars are formed either due to loss of skin tissue or due to increased skin tissue formation during healing. Inflammation is a key factor in the formation of acne scars and the greater the inflammation, the more likely the formation of acne scars. Acne scars are divided into two main categories, atrophic and hypertrophic. Also, in some cases acne can lead to keloids. All three categories have one thing in common: they are created due to the body’s response to inflammation.


  • Atrophic acne scars

    They are the most common category of acne scars and are created due to loss of skin tissue after inflammation. Atrophic acne scars are divided into two categories, “ice pick” which are narrow and deepened acne scars and difficult to treat, and “boxcar” which are wide and deepened. Ice pick scars are less than 2 mm in size, but quite deep, reaching deep dermis or subcutaneous tissue.

    They get their name because of their shape, which is like being hit by a sharp object, such as an ice pick. On the other hand, boxcar-type scars are wide and can be either shallow (0.1-0.5 mm deep) or deeper (more than 0.5 mm deep). They are more rounded and usually have sharply defined vertical sides.

  • Hypertrophic acne scars

    They are created by excessive tissue production during healing and are usually asymptomatic. They are bright red in color, are hyperechoic, confined to the wound margins and appear shortly after injury.

    Usually, they improve over time and gradually become pale in color. Hypertrophic scars can form on the skin of a person of any age and are common in both sexes.

  • Cheloid acne scars

    In rarer cases, acne can lead to keloid scars. These are unshapely hypertrophic scars most commonly located on the back, chest, shoulders.


Causes of Appearance

Under normal conditions, the formation of scars is due to the parallel action of the functions of anabolism and catabolism. To cope with the damage, the epidermis creates new collagen fibres, a fibrous protein that restores skin cohesion. Unfortunately, the deposition of collagen in the acne scar does not occur in an orderly fashion but rather anarchically, disrupting the architecture of the skin. During healing, the body produces a lot of collagen, which creates a scaffold in the skin. This increased collagen production is due to increased anabolism activity.

Cheloid acne scars can be caused in some cases of severe acne in predisposed individuals. These are the excessively hypertrophic acne scars that usually appear on the back, shoulders and chest. Cheloid acne is characterized by unsightly, large scars and treating these unsightly acne scars is usually very difficult.

Keloids often also form after skin injury such as burns, surgery and vaccination or after tattooing (tattooing). They most commonly occur on the back, chest and neck, as well as on the chin and earlobes. They most commonly affect darker skin, and have a particular preference for the female sex and black race. Usually, the causes of keloids are hereditary or due to endocrine factors.


Unlike hypertrophic scars, keloids grow beyond the boundaries of the original lesion and are significantly larger in size. Typically, they are hematogenous, red and are due to abnormal excess collagen and glycosaminoglycan synthesis, resulting in the production of excess extracellular substance and hyperplasia of the skin at the site of injury.

In addition to the aesthetic deformity and negative psychology that keloids can create in patients, very often they can also be symptomatic causing itching and pain. Unlike other forms of scarring, keloids do not recede and become milder over time.

In general, scars do not raise the appearance of other symptoms. Cases have, of course, been recorded in which the patient felt pain in the scar, itching or even inability to move due to skin shrinkage.


The treatment of scars & keloids is a long and demanding process. The effectiveness of each treatment can vary from person to person, and regular repeat sessions are often required to achieve the desired result.

At Cosmetic Derma Medicine, the treatment approach taken is chosen depending on the type of scarring and after a clinical evaluation of each case by a Dermatologist. The methods used to successfully treat scars & keloids are as follows:

CO2 Fractional Laser

Using the CO2 Fractional Laser, a selective scanning of the skin surface that we want to correct is performed and the production of collagen by the fibroblasts in the deeper layers of the skin is stimulated, noticeably improving the texture and color of the scars. Treating acne scars with this method results in skin regeneration without the annoying “peeling” and healing is quick and painless.

Fractional laser helps both acne scars and scars of other etiologies.

The number of sessions required varies depending on the extent of the lesion.

Usually 5-6 sessions are required, with an interval of about 20 days. The duration of each session is approximately 30 minutes.

Autologous Mesotherapy

It is Cosmetic Derma Medicine’s leading method for the treatment of acne scars, but also other causes. In combination with the CO2 Fractional Laser, skin regeneration is enhanced, achieving impressive results (an innovative protocol called Total Plasma Lift).

Chemical Peeling

Exfoliation of the surface layers of the epidermis with the aim of flattening the hypertrophic boundaries of the scar and improving its color. It is particularly effective in the treatment of discoloration and acne scars. Chemical peel treatment is quite widespread, but it lags behind other treatments because it involves skin exfoliation for a few days.


Aims to exfoliate and remove dead cells, smoothing the texture and reducing the depth of acne scars. Acne scars gradually improve after repeated treatments.

Hyaluronic Acid Fillers

They are used to correct atrophic acne scars or other etiologies. They are ideal in boxcar acne scars, as they fill and lift the bottom of the scar making it less visible.


The use of liquid nitrogen at temperatures that induce cellular anoxia leads to the destruction of cells and eventually to the degradation of the hypertrophic tissue of the scar. Cryotherapy has a high success rate in hypertrophic scars and keloids, up to 80%, and is a safe and quick way to treat scars and keloids.

Intravenous injection of steroid solutions & other substances

Injectable steroids are injected into the scar area and reduce the formation of collagen and elastin fibers, as well as limiting the release of inflammatory response. In addition to steroids, antimitotic drugs can also be used. The injections are done once a month and inhibit the proliferation of fibroblasts, reducing the size of the scar. The method is used for hypertrophic scars and acne keloids or keloids of other etiology.

Application of topical steroids in combination with local dressing

Provide relief from symptoms of intense itching and tension in areas of mild hypertrophic scars and small keloids.

Local application of gel or silicone sheets in combination with local dressing

These methods put pressure on hypertrophic scars and keloids, reducing their size

Surgical removal of a keloid

This method is usually avoided, as the new trauma from surgical removal can lead to a new, perhaps even larger-sized keloid. In some cases, however, partial removal is required to reduce the tumor and make it easier to then apply one of the above treatments.


Scars – Keloids

What exactly are scars?

Acne scars or scars are the unwanted result of the healing process of acne skin. The inflammatory elements of acne are papules, pustules and cysts. If rupture of these elements occurs deep below the basement membrane zone of the skin, the healing process leaves a scar. If rupture of these occurs above the basal layer it can lead to discoloration that will then heal without scarring.

The most common areas of scars appearance are the face, back and chest and may also occur on the buttocks.

Is it possible to avoid acne scars?

The best prevention of acne scars is timely and correct Acne Treatment by a specialized dermatologist, depending on the form of acne.

Avoiding pressure on black or whiteheads also helps, as putting pressure on comedones can transfer dead cells, oils and bacteria into deeper parts of the skin, increasing inflammation and leading to the development of large acne scars.

In many cases, however, despite prevention, the appearance of acne scars is inevitable.

What should I look out for after acne scar treatment?

Regardless of the way acne scars are treated, it is quite important to follow the advice of your dermatologist so that the treatment has a maximum effectiveness. Returning to daily activities depends on the chosen method of treatment, as well as the form of the scar. It is imperative in all cases to apply special reconstructive creams, as well as sunscreen to avoid skin discolorations.

Why should I choose Cosmetic Derma Medicine for the treatment of acne scars?

Cosmetic Derma Medicine Medical Group is the largest and most specialized medical group in the field of Dermatology and Plastic Surgery, with 14 clinics in Greece and Cyprus.

The dermatologists and the medical staff of Cosmetic Derma Medicine are specialized in the treatment of such problems and have successfully treated a large number of cases. Many methods for treating scars are used, such as laser regeneration methods, autologous mesotherapy, intravascular injections, application of hyaluronic acid in atrophic and hypertrophic acne scars that can ensure excellent results.

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