Effectiveness of different non-surgical scar reduction methods in post-operative scars: a systematic review and meta-analysis

Background: Effective scar management is crucial in improving cosmetic outcomes, restoring physiological function, and supporting psychological well-being in surgical patients. This systematic review and meta-analysis aims to evaluate the effectiveness of post-operative scar reduction techniques in optimising wound healing and minimising scar formation.

Methods: PubMed (Medline), National University of Singapore (NUS) Library, ResearchGate and Springerlink were searched by two independent researchers up to 30th October 2024. Eligible studies compared Vancouver Scar Scale (VSS), Visual Analogue Scale (VAS) and Patient Observer Scar Assessment Scale (POSAS) scores across different studies and their respective scar reduction techniques on post-operative patients. English-language human studies on post-surgical management with scar-related outcomes were included while non-English, non-human, non-surgical, duplicate studies and scars covering burns were excluded. Risk of bias was assessed using the Cochrane risk-of-bias assessment tool. A quantitative synthesis of the results was performed using available outcome data and effect sizes were plotted using forest plots.

Results: A total of 20 studies (1995–2024) including 1,089 post-surgical patients were appraised. Each scar reduction technique was found to have produced significant improvements in different aspects of scar reduction. Fractional CO2 laser produced stable and significant improvements in pliability and texture. Meanwhile, botulinum toxin A (BTX-A) showed moderate-to-strong efficacy, particularly in high-tension areas like the face and chest. Silicone gel demonstrated improvement in pigmentation and pliability in hypertrophic scars, and pulsed dye laser (PDL) was known to significantly reduce scar height and vascularity.

Conclusions: This demonstrates that all four non-invasive interventions—silicone gel, PDL, fractional CO2 laser, and BTX-A—are associated with measurable improvements in scar reduction and appearance. Early intervention and employing a multimodal approach may result in an overall enhanced outcome across multiple dimensions of scar reduction.