Seongdong-gu Dermatology: Is Shaving-Off Treatment the Only Answer for Papular Scars and Hypertrophic Scars? [Chief Director Skin Column]

Papular scars, should they be shaved first?

Hello, this is Raon Dermatology in Seongdong-gu!

Raised scars on the skin surface rarely subside over time and can be a major source of stress for many people. In particular, protruding lesions clustered around the nose or chin are not easily concealed even with makeup, which can deepen aesthetic concerns! When facing these symptoms, many people tend to think only of aggressively shaving them off, but in reality, a delicate approach that takes the characteristics of skin tissue into account is more important than anything else. Today, I’ll take a detailed look at the treatment direction and management know-how for hypertrophic scars, also called papular scars.

Papular scars, should they be shaved first?

Features of papular scars

Papular scars are raised scars that appear when collagen tissue abnormally proliferates at the site where acne or a wound has healed. They typically form as small hill-like bumps around the tip of the nose or the jawline, where sebaceous gland activity is active, and at first glance they can look like tiny acne, which is why people sometimes try to squeeze them forcefully and end up making the condition worse~ If they feel unusually firm compared to the surrounding skin when touched, there is a very high chance that they have already turned into scar tissue.

If it were simply inflammation, it would improve over time, but papular scars are the result of internal tissue already becoming fibrotic and fixed in place. Therefore, it is difficult to return them to a flat state with ordinary cosmetics or home care alone, and medical management must be involved. Because the degree of protrusion and the firmness of the tissue vary from person to person, the first step toward satisfactory results is accurately understanding the current condition of your scar :)

<Causes & features of papular scars>

• Occurs after acne or inflammation as skin tissue proliferates

• Usually protrudes around the nose / chin in the shape of tiny bumps or small hills

• Feels firmer than normal skin when touched / becomes fixed in place

Features of papular scars

Limitations of shaving treatment

When I meet patients in the clinic, I often get asked whether the protruding area should just be shaved off first with a CO2 laser or erbium laser. I fully understand the desire to make it flat quickly, but forcing the skin to be shaved down often ends up doing more harm than good! This is because repeated shaving of the tissue can cause the originally raised lesion to turn into a sunken scar, or it can irritate the surrounding tissue and make it much harder than before.

Physical resurfacing may seem to provide an immediate flattening effect on the surface, but it carries a high risk of causing secondary changes by over-damaging the dermal layer. In fact, when I see people who have undergone repeated resurfacing treatments elsewhere and later visit because their skin texture has worsened, it often leaves me feeling sorry! The key to treating papular scars is to regulate what is inside rather than shaving what is outside. Even without forcibly shaving the skin, improving the internal environment can naturally reduce the volume.

Limitations of shaving treatment

How should it be treated?

Then how can raised scars be improved without shaving? The key lies in softening the abnormally clumped fibrous tissue inside the skin and controlling pressure. By minimizing surface damage through non-ablative treatment and releasing the tight bonds underneath, the force pulling downward or expanding sideways disappears, and the raised area gradually settles down! It is not difficult to find clinical cases where even a single treatment noticeably softens a bump-like lesion.

Because this approach makes use of the skin’s self-healing capacity, recovery after treatment is fast and it has little impact on daily life. Since the tissue itself is encouraged to contract on its own rather than being artificially shaped, the result is much more natural as well! Contrary to the misconception that non-shaving treatment takes too many sessions, when the appropriate energy is used, you can feel that the lesion becomes significantly flatter about two months after just one treatment session :)

How should it be treated?

Factors that determine treatment prognosis

Of course, not every patient improves at the same pace. When predicting the number of treatments or the results, a more important factor than the size of the lesion is the condition of the tissue and the surrounding complex changes~ Even if the protrusion is not severe, if there are sunken scars around it or it feels very hard when touched, you need to be a little more patient with the process. The more severe the hard fibrosis is, the more physical time it takes for the tissue to become flexible!

In cases where sunken scars are mixed in, even if the raised area subsides, the skin texture may still not look smooth, so satisfaction can be slower. In such cases, it is effective to combine regenerative-promoting methods such as subcision or Juvelook to fill the sunken space at the same time! Adjusting the energy level and injection depth while observing each patient’s skin response is part of an experienced specialist’s know-how. Some patients respond quickly and feel a big change after just 1 to 2 sessions, but even difficult cases can definitely improve with consistent care.

<Factors that determine treatment prognosis>

• Tissue hardness / the harder it is, the more treatment sessions are generally needed

• Scar deformity / difficulty increases when sunken scars are present around it

Factors that determine treatment prognosis

Papular scar treatment by a dermatologist

In the end, the goal of papular scar treatment should be the ‘restoration of healthy skin.’ Rather than shaving the skin for an immediate result and creating a deformity that is difficult to reverse, I want to emphasize that taking a little more time to preserve the skin tissue and gently refine it is a much more efficient path! Please remember that if skin that was originally soft has become hard due to an incorrect attempt, the difficulty of treatment increases dramatically.

As summarized today, you can still bring about positive changes through non-shaving treatment, so rather than blindly considering resurfacing, the first priority is to accurately diagnose the pattern of your scar. Since scar treatment plans can vary completely depending on when the scar occurred and its current condition, I recommend having a thorough consultation with a specialist with extensive clinical experience to design the roadmap that is right for you. If you have any other questions, feel free to leave them anytime and I’ll answer :)

<Key points of papular scar treatment>

• Treatment by a specialist with expertise in papular scar care

• Appropriate combination of treatments tailored to each individual scar pattern

• Proceed in a way that minimizes skin damage

Papular scar treatment by a dermatologist

Papular scars, what are the treatment methods?