As an aesthetic physician, I have spent years treating scars of all types—stretch marks, hypertrophic scars, atrophic scars, and everything in between. Scars can be a significant cosmetic concern for many patients, and while there are countless treatment options available, finding the most effective approach requires a deep understanding of both the scar type and the patient’s skin.
Over the years, I have experimented with nearly every modality available, from microneedling to chemical peels, lasers, and various injectables. Through experience, trial, and observation, I’ve refined my approach to scar treatment. The conclusion? The best results come from a customized combination of laser therapy and topical exosomes or platelet-rich plasma (PRP).
This tailored approach works because different types of scars require different treatments. The key is selecting the right laser based on skin type, scar characteristics, and patient goals, then combining it with regenerative therapies like exosomes or PRP to optimize healing and collagen remodeling.
In this blog, I’ll break down how I determine the best treatment plan based on scar type, skin type, and the latest advancements in laser and regenerative medicine.
Understanding Different Types of Scars
Before choosing a treatment, it’s essential to classify the scar properly. Here are the most common types of scars and the specific challenges they present:
1. Atrophic Scars (Indented Scars)
Commonly caused by acne, chickenpox, or injuries
Characterized by depressions in the skin due to collagen loss
Includes ice pick, rolling, and boxcar scars
2. Hypertrophic Scars (Raised Scars)
Thick, raised scars that remain within the boundaries of the original wound
Often develop after surgery, burns, or trauma
More common in individuals with darker skin tones
3. Keloid Scars
Similar to hypertrophic scars but extend beyond the wound borders
Can continue to grow and become painful or itchy
More common in darker skin tones and prone areas like the chest, shoulders, and earlobes
4. Stretch Marks (Striae)
A form of dermal scarring caused by rapid stretching of the skin (e.g., pregnancy, weight fluctuations)
Can appear red, purple, or white depending on their age
Difficult to treat because they affect both the epidermis and dermis
My Recommended Approach: The Perfect Combination of Lasers & Regenerative Therapy
The best treatment is not just one laser or one procedure—it’s a combination approach tailored to each patient. While many treatments can help improve scars, the most effective method is using the right laser technology in combination with topical exosomes or PRP.
1. Choosing the Right Laser for Each Scar Type
The choice of laser depends on several factors, including scar depth, skin color, and the patient’s tolerance for downtime. Here’s how I decide:
For Atrophic (Indented) Scars:
Best Lasers:
Fractional CO2 Laser or Erbium YAG (Fotona Laser) – Excellent for resurfacing and stimulating collagen in deeper scars
Microneedling RF (Radiofrequency Microneedling) – Helps rebuild collagen and improve scar texture
Pico Laser (Picosecond Technology) – Great for stubborn acne scars, especially in darker skin tones
Combination Approach:
I often use a combination of fractional laser (Fotona) and RF microneedling for deeper collagen remodeling, then apply exosomes or PRP topically to enhance healing and skin regeneration.
For Hypertrophic & Keloid Scars:
Best Lasers:
Long-Pulsed Nd:YAG (Fotona Laser) – Helps shrink thick scars and reduce redness
Fractional CO2 Laser (For resurfacing hypertrophic scars carefully) – If used cautiously, it can help remodel thicker scars
Pico Laser – Reduces pigmentation and smooths out irregularities
Combination Approach:
For raised scars, I use Nd:YAG laser to shrink the scar and reduce vascularity, followed by fractional CO2 for texture. Injecting PRP or using exosomes helps calm inflammation and improve healing. If needed, I may also use steroid injections to soften the scar further.
For Stretch Marks (Striae):
Best Lasers:
Fractional Erbium YAG (Fotona Laser) – Helps remodel skin texture and stimulate new collagen
Microneedling RF (Radiofrequency Microneedling) – Boosts skin tightening and collagen formation
Pico Laser – Works well for pigmentation in red or purple stretch marks
Combination Approach:
Stretch marks respond best to a multi-layered approach with Fotona laser, RF microneedling, and exosomes. The Fotona laser resurfaces the skin, RF microneedling boosts elasticity, and exosomes accelerate healing and collagen production for smoother, tighter skin.
Why Exosomes & PRP Are Essential in Scar Treatment
Regardless of the laser used, exosomes or PRP should always be included to optimize skin regeneration and healing.
What Are Exosomes?
Exosomes are tiny extracellular vesicles derived from stem cells that carry growth factors, peptides, and mRNA to promote skin healing, collagen production, and overall rejuvenation. Unlike PRP, exosomes contain a much higher concentration of regenerative signals and work more effectively in scar repair.
How PRP (Platelet-Rich Plasma) Helps
PRP is derived from the patient’s own blood and contains growth factors that promote healing, reduce inflammation, and boost collagen production. While it’s not as powerful as exosomes, it’s still an excellent natural option for scar treatment.
Why Combining Lasers with Exosomes or PRP Works Best
Lasers create controlled micro-injuries in the skin, stimulating the body’s natural healing response. Applying exosomes or PRP immediately after laser treatment enhances this healing process, reduces downtime, and improves results. The combination leads to:
Faster healing
Better collagen remodeling
Improved skin texture and elasticity
Reduced inflammation and pigment changes
Tailoring Treatment to Skin Type
One of the most critical aspects of scar treatment is considering the patient’s skin type and color.
For darker skin tones (Fitzpatrick IV-VI): I avoid aggressive ablative lasers like CO2 and use Pico laser, Nd:YAG, or RF microneedling to minimize pigmentation risks.
For lighter skin tones (Fitzpatrick I-III): I can be more aggressive with fractional CO2 or Erbium YAG for deeper resurfacing.
Final Thoughts: A Highly Personalized Approach is Key
By carefully selecting the right laser for the scar type and skin tone and enhancing healing with exosomes or PRP, I’ve seen patients achieve remarkable transformations in their skin. Scar treatment is an art and a science, and when done correctly, it can restore confidence and improve skin quality in a way that no single treatment alone can achieve.
If you’re struggling with scars and want a customized, evidence-based treatment plan, consider seeing an experienced aesthetic physician who can tailor the approach specifically to your needs. With the right combination, scars can be minimized, softened, and even erased over time.
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MEET THE DOCTOR
Dr. Vanden Bosch
Dr. Neda Vanden Bosch ("Dr. V") is an accomplished physician with over 17 years of practice and training in dermal fillers, collagen stimulators, laser and radiofrequency treatments, and skincare. Dr. V holds medical licenses in 7 states and is board-certified by The American Board of Radiology and the American Board of Anti-Aging and Regenerative Medicine. She is recognized nationwide as a top 1% injector of Sculptra Aesthetic and Restylane fillers.
"Advocating the proverbial 'ounce of prevention' approach, I favor doing 'a little bit all along' rather than waiting for substantial changes that make correction more costly."
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