the perceived risk of long-term side effects. dressings and topical silicone silicone scar treatments are commonly used in preventing scar formation and improving existing scar appearance. a meta-study by the cochrane collaboration found weak evidence that silicone gel sheeting helps prevent scarring. however, the studies examining it were of poor quality and susceptible to bias. pressure dressings are commonly used in managing burn and hypertrophic scars, although supporting evidence is lacking. care providers commonly report improvements, however, and pressure therapy has been effective in treating ear keloids. the general acceptance of the treatment as effective may prevent it from being further studied in clinical trials. verapamil-containing silicone gel verapamil, a type of calcium channel blocker, is considered a candidate drug for the treatment of hypertrophic scars. a study conducted by the catholic university of korea concluded that verapamil-releasing silicone gel is effective and is a superior alternative to the conventional silicone gel where decreased median sei, fibroblast count, and collagen density in all verapamil-added treatment groups were observed.: 647–656 gross morphologic features suggested that the combination of verapamil and silicone improves the overall quality of hypertrophic scars by reducing scar height and redness. this was verified with quantifiable histomorphometric parameters; however, oral verapamil is not a good choice because of its effect of lowering blood pressure. intralesional injection of verapamil is also suboptimal because of the required frequency for injections. topical silicone gel combined with verapamil does not lead to systemic hypotension, is convenient to apply, and shows enhanced results.: 647–656 steroids a long-term course of corticosteroid injections into the scar may help flatten and soften the appearance of keloid or hypertrophic scars. topical steroids are ineffective. however, clobetasol propionate can be used as an alternative treatment for keloid scars. topical steroid applied immediately after fractionated co2 laser treatment is however very effective (and more efficacious than laser treatment alone) and has shown benefit in numerous clinical studies. surgery scarring caused by acne (left), and photo one day after scar revision surgery: the area around sutures is still swollen from surgery. scar revision is a process of cutting the scar tissue out. after the excision, the new wound is usually closed up to heal by primary intention, instead of secondary intention. deeper cuts need a multilayered closure to heal optimally, otherwise depressed or dented scars can result. surgical excision of hypertrophic or keloid scars is often associated to other methods, such as pressotherapy or silicone gel sheeting. lone excision of keloid scars, however, shows a recurrence rate close to 45%. a clinical study is currently ongoing to assess the benefits of a treatment combining surgery and laser-assisted healing in hypertrophic or keloid scars. subcision is a process used to treat deep rolling scars left behind by acne or other skin diseases. it is also used to lessen the appearance of severe glabella lines, though its effectiveness in this application is debatable. essentially the process involves separating the skin tissue in the affected area from the deeper scar tissue. this allows the blood to pool under the affected area, eventually causing the deep rolling scar to level off with the rest of the skin area. once the skin has leveled, treatments such as laser resurfacing, microdermabrasion or chemical peels can be used to smooth out the scarred tissue. vitamins research shows the use of vitamin e and onion extract (sold as mederma) as treatments for scars is ineffective. vitamin e causes contact dermatitis in up to 33% of users and in some cases it may worsen scar appearance and could cause minor skin irritations, but vitamin c and some of its esters fade the dark pigment associated with some scars. other cosmetics; medical makeup can temporarily conceal scars. this is most commonly used for facial scars. dermabrasion involves the removal of the surface of the skin with special equipment, and usually involves a local anaesthetic. massage has weak evidence of efficacy in scar management. any beneficial effect appears to be greater in wounds created by surgical incision than traumatic wounds or burn wounds. microneedling society and culture intentional scarring the permanence of scarring has led to its intentional use as a form of body art within some cultures and subcultures. these forms of ritual and non-ritual scarring practices can be found in many groups and cultures around the world. etymology first attested in english in the late 14th century, the word scar derives from a conflation of old french escharre, from late latin eschara, which is the latinisation of the greek ἐσχάρα (eskhara), meaning "hearth, fireplace", but in medicine "scab, eschar on a wound caused by burning or otherwise", and middle english skar ("cut, crack, incision"), which is from old norse skarð ("notch, gap"). the conflation helped to form the english meaning. compare scarborough for evolution of skarð to scar. research treatment research, before 2009, focused on scar improvements with research in to molecular mechanisms. molecular mechanisms such as: juvista, ribosomal s6 kinase (rsk), and osteopontin were investigated. in 2011, the scientific literature highlighted stress shielding a fresh wound through the wound healing process, brings significant scar improvement and smaller scars. prevention main article: regeneration in human tissue by 2016, skin had been regenerated in vivo, and in vitro and scar free healing had been operationalized and induced by four main techniques: regeneration by instrument; regeneration by materials; regeneration by drugs; and regeneration by in vitro 3-d printing. in 2018, a silk-derived sericin hydrogel dressing was undergoing research, the material was shown to prevent scar formation.