Scar Types and Treatment Approaches
흉터 수정 (hyungter sujeong — scar revision) in Korea uses a broader range of modalities than most markets — Korean dermatology clinics combine surgical, laser, injection, and energy-based approaches in individualised protocols. The starting point is accurate scar classification, since different scar types respond to fundamentally different treatments.
| Scar type | Clinical features | Primary treatment in Korea | Sessions / timeline |
|---|---|---|---|
| Hypertrophic scar | Raised, stays within wound boundary; may be red or pink | Corticosteroid injection + silicone + CO2 laser | 3–6 sessions over 6–12 months |
| Keloid | Raised, grows beyond wound boundary; recurs after excision | Excision + corticosteroid injection (± radiation) | 6–12 injection sessions post-excision |
| Atrophic scar (acne — rolling) | Broad shallow depression; tethered appearance | Subcision + fractional CO2 laser | 4–6 laser sessions |
| Atrophic scar (acne — boxcar) | Sharp-edged rectangular depression | Fractional CO2 + punch excision for deepest | 3–5 laser sessions |
| Atrophic scar (acne — ice pick) | Deep narrow punctate | Punch excision or punch elevation | Per scar; followed by resurfacing |
| Surgical scar (mature, linear) | Flat or slightly raised; pale at 18+ months | Laser resurfacing or surgical re-excision | 1–3 laser sessions; or single excision |
| Contracture scar | Scar tightening limiting movement | Z-plasty or W-plasty surgical release | Single surgical procedure |
| Post-inflammatory hyperpigmentation | Flat dark discolouration — not a raised scar | Pico laser + topical agents | 3–6 laser sessions |
Cost by Treatment Approach
| Treatment | Korea (KRW) | Korea (USD) | USA (USD equivalent) |
|---|---|---|---|
| Corticosteroid injection (per session) | ₩30,000–₩100,000 | $22–$72 | $100–$300 |
| Fractional CO2 laser (per session, full face) | ₩300,000–₩800,000 | $217–$580 | $1,000–$3,000 |
| Pico laser (per session) | ₩100,000–₩300,000 | $72–$217 | $300–$700 |
| Subcision (per session) | ₩200,000–₩500,000 | $145–$362 | $400–$1,000 |
| Punch excision (per scar) | ₩50,000–₩200,000 | $36–$145 | $200–$500 |
| Surgical scar re-excision (linear, per scar) | ₩500,000–₩2,000,000 | $362–$1,449 | $800–$3,000 |
| Keloid excision + injection course | ₩1,000,000–₩3,000,000 total | $725–$2,174 | $2,000–$6,000 |
Candidacy
Often a good candidate
- Patients with hypertrophic or keloid scars that have been stable for 6+ months
- Patients with significant atrophic acne scarring seeking structured multi-session treatment
- Patients with post-surgical scars that have not faded satisfactorily at 18–24 months
- Patients who understand that scar revision improves but does not eliminate scars
- Patients who can schedule multiple sessions (for laser-based approaches requiring 3–6 sessions)
Should reconsider or wait
- Patients with scars less than 12 months old — further natural maturation should be allowed first
- Patients with keloid history being treated with excision alone — recurrence risk requires combined protocol
- Active acne — acne scar revision in the presence of active breakouts risks creating new scars
Not a suitable candidate
- Patients currently on isotretinoin (Accutane) — laser scar revision must wait 6–12 months after cessation
- Patients with unrealistic expectations of complete scar elimination — no treatment achieves this
When is the right time to seek scar revision?
The minimum wait after any wound or surgery before assessing for revision is 12 months. Most surgeons prefer 18–24 months for scars from surgical procedures, as the collagen remodelling process continues for up to 2 years. Scars that are actively improving — becoming flatter, paler, and softer — should be monitored rather than treated. Revision is most appropriate when: a scar has been stable for 6+ months without improvement, significant hypertrophy or pigmentation remains after 12 months, or functional issues (scar contracture limiting movement) are present.
Does laser scar revision work on keloids?
Laser alone does not effectively treat keloids and may stimulate further keloid growth in some patients. Keloids require a multi-modal approach. At Korean clinics, the standard keloid protocol typically combines: surgical excision of the keloid body; immediate post-excision corticosteroid injection; weekly or bi-weekly corticosteroid injections for 3–6 months; silicone sheeting. For high-risk or large keloids, low-dose radiation therapy may be added. Korean dermatologists and plastic surgeons have high keloid case volumes given the prevalence in Asian skin types.
How many laser sessions are needed for acne scar revision?
Acne scar type determines the treatment approach and session count. Rolling scars (broad, shallow depressions): typically 3–6 fractional CO2 or pico laser sessions at 4–6 week intervals. Boxcar scars (sharp-edged depressions): fractional CO2 2–4 sessions, sometimes with manual subcision. Ice pick scars (deep, narrow): punch excision or punch elevation for individual severe ice picks, followed by laser for residual pigmentation. Korean dermatologists often recommend a combination approach: subcision + CO2 laser for structural scars, pico laser for residual hyperpigmentation. Total treatment courses of 4–8 sessions are common for moderate-to-severe acne scarring.