Management of surgical pocket scars in patients with cardiac implantable electronic devices: An esthetic medicine review focused on infection risk and electromagnetic interference

Cardiac implantable electronic devices (CIEDs), including pacemakers, implantable cardioverter-defibrillators, and cardiac resynchronization systems, are increasingly used in contemporary clinical practice. As implant rates rise, attention is expanding beyond survival and arrhythmic outcomes to include quality of life, body image, and the esthetic consequences of device implantation. In selected patients, the surgical pocket scar and device prominence may become a relevant source of discomfort, self-consciousness, and dissatisfaction despite the clinical benefit of the implant. This narrative review was developed from targeted PubMed/MEDLINE searches and manual screening of key consensus documents, official manufacturer guidance, and reference lists. Scar management in the CIED pocket region differs substantially from routine post-operative scar treatment because any intervention must be evaluated against two major safety concerns: pocket infection and electromagnetic interference (EMI). The review examines conservative and procedural approaches to scar treatment in patients with CIEDs, including intralesional corticosteroids and 5-fluorouracil, botulinum toxin type A, fractional lasers, pulsed dye laser, mechanical microneedling, cryotherapy, chemical peels, fillers, lipofilling, and high-intensity focused ultrasound. Each modality is considered in light of tissue trauma, infectious risk, potential device interference, and practical applicability to the chest pocket region. A pragmatic management framework is proposed based on time from implantation, scar phenotype, overall infectious risk, patient-reported outcome measures, and device-related EMI risk. In this setting, the most appropriate principle is not maximal correction, but the minimum effective intervention capable of improving the scar without compromising pocket stability, skin integrity, or device safety.