New scar reduction technology: fractional laser and silicone gel

Scars have long been a persistent source of distress for many people, from the marks left by teenage acne to surgical scars, burn scars, or scars caused by accidents. In the past few years, alongside the wave of skincare and aesthetic treatment in Vietnam, the two methods most often mentioned in scar management are fractional laser and silicone gel. On social media, plenty of advertisements promise to "erase scars after a single course of treatment" or "flatten keloids at the root." So how do these two technologies actually work, what benefits do they offer, and where are the limits that patients need to view with a clear head?

Why is scar treatment drawing more and more attention?

Scars form when the skin's wound-healing process becomes disordered in the number and arrangement of collagen fibers. Depending on how collagen proliferates, a scar may be depressed (atrophic acne scars), flat but discolored, hypertrophic, or keloid. Each type of scar calls for a different approach, and there is no "universal method" that applies to all of them.

Demand for treatment has risen not only for cosmetic reasons. Many people develop contracture scars that restrict movement, or keloids that itch, hurt, and feel tight, affecting quality of life. As new-generation laser devices and scar-care products become more widely available, patients have more options, but at the same time they can easily get lost in a maze of unverified advertising claims.

How does fractional laser work?

Unlike traditional lasers that act on the entire skin surface, fractional laser splits the beam into thousands of tiny columns of micro-injury, interspersed with healthy skin. This approach stimulates the body to regenerate collagen and remodel scar tissue, while the surrounding healthy skin helps speed up recovery.

• Ablative fractional laser (for example CO2, Erbium): acts more aggressively and is often used for deep atrophic scars, with clearer results but a longer downtime and a higher risk of hyperpigmentation in darker skin.
• Non-ablative fractional laser: gentler and less invasive with faster recovery, but usually requires multiple sessions before changes become visible.

Reviews of the medical literature show that fractional laser has relatively good evidence for atrophic acne scars and some hypertrophic scars. However, the result is usually improvement rather than complete erasure. A realistic course of treatment typically involves several sessions, spaced a few weeks apart, and depends heavily on the type of scar, how old the scar is, and each individual's constitution.

Silicone gel: a foundational option, especially for keloids and hypertrophic scars

Silicone gel (and silicone sheets) is one of the few topical scar treatments that many international guidelines classify as a first-line option for preventing and managing hypertrophic scars and keloids. The mechanism is thought to help retain moisture in the stratum corneum, stabilize collagen formation, and soothe the scar area.

• Easy to use at home, minimally invasive, and safe for most users, including on sensitive skin.
• Suitable for early use once a wound has closed, to help guide the scar-healing process.
• Effectiveness depends heavily on perseverance: it usually needs to be applied or worn consistently for many hours each day, over weeks to months.

It should be stated clearly: the evidence supports silicone best in a supportive and preventive role, not as a "miracle cure" that dissolves keloids that have been present for many years. For hard, large keloids, silicone alone is often not enough.

Why is the current trend toward combination treatment?

The notable shift over the past few years lies not in any "miracle machine," but in a mindset of multimodal combination. Rather than expecting a single method to solve everything, doctors often combine multiple tools so they complement one another:

• Fractional laser to remodel the surface and soften scar tissue.
• Silicone gel or sheets to maintain and stabilize results and help prevent the scar from thickening.
• For keloids, corticosteroid injections, cryotherapy, pressure dressings, or other measures may also be needed, depending on clinical assessment.

A combination approach helps offset the limitations of each method used on its own. Even so, combining treatments does not mean "the more the better"; every protocol needs to be individualized, based on a direct examination rather than a fixed, off-the-shelf package.

A keloid-prone constitution: a group that needs special caution

This is the part patients are most likely to overlook. People with a keloid-prone constitution are a group that must be extremely careful with invasive procedures. Laser itself, if indicated or set with unsuitable parameters, can in theory still trigger keloid recurrence or worsening in someone with this predisposition. For that reason:

• Be clear about any history of keloids, hypertrophic scars, or poor scarring after surgery, piercing, or vaccination.
• People with darker skin should be carefully counseled about the risk of pigmentation disorders after laser.
• Pregnant women, people taking certain medications, and people with an active skin condition need a separate assessment.

The general principle is that results depend on individual constitution, and no one can predict exactly how much improvement to expect before treatment. Be wary of exaggerated advertising along the lines of "guaranteed scar removal," "instant results," or applying technology that lacks sufficient evidence to every type of scar. Treatment at a properly accredited facility, performed by a specialist physician, remains the single most important safety factor.

Realistic expectations: improvement, not complete "whitening"

A course of scar treatment is usually measured by the degree of improvement over time, and rarely returns the scar to completely intact skin. Many cases achieve good results in terms of flatness, color, and sensation, but still require time, multiple sessions, and persistent home care. Understanding this correctly helps patients avoid disappointment and avoid falling for treatment packages that promise too much.

The perspective of Dr. Vo Thanh Sang

According to Dr. Vo Thanh Sang, MD (Level I Specialist, World Wide Hospital, Ho Chi Minh City), fractional laser and silicone gel are both useful tools, but their real value lies in indicating them for the right person, the right type of scar, at the right time. "There is no single technology that is best for everyone. With scars, what matters is a direct examination to classify the scar and assess the patient's constitution, especially a keloid-prone constitution, and only then build a suitable combination protocol. Patients should set their expectations on durable, safe improvement, rather than on promises of instant scar removal," the doctor shares.

If you are concerned about a specific scar, especially if you have a history of keloids or long-standing scars, do not self-treat based on online advertising. Visit a properly accredited medical facility to be examined and given individualized advice by a specialist physician. For information support, you can contact the hotline 079 7479 222.

This article is for informational purposes and does not replace a direct medical examination and physician's indication. Treatment results vary depending on each person's individual constitution.