Sir We read with interest the letter by Zhong and He on the use of pressure therapy for hypertrophic scars using a round rod, and we would like to make certain comments on it. Keloids and hypertrophic scars are two discrete pathological, histological, and clinical entities. Scars within these categories will vary both in their clinical course and in their response to treatment.1 The selection of the appropriate treatment, in each case, is based on the type, size, and location of the scar. Pressure application is an unquestionable weapon in the hand of a doctor, whether dermatologist or plastic surgeon, who deals with wound healing. Pressure application is not an accidental affair as far as the amount of force used, the amount of time pressure is applied, and the orientation of the pressure. Pressure therapy is a specific entity and has been established as an effective option that is known to reduce the volume of scar tissue. This is considered to occur as a result of localized hypoxia, resulting in fibroblast degeneration and cell detriment. Besides this, it is claimed that mechanical pressure changes glycosaminoglican levels and capillary permeability during the early phase of wound healing, causing shortening in the scar formation time. The pressure exerted should be at least 24 mmHg to exceed the inherent capillary pressure, but it must be below 30 mmHg; otherwise, it critically reduces peripheral blood circulation.2 Successful treatment can result after consideration of the following parameters: (a) the applied pressure should always be measured to achieve local hypoxia, without critically reducing local blood circulation; (b) the pressure should be applied 24 hours a day and for a period of 20 to 25 weeks3; (c) the use of custom-made pressure garments is preferable, because they apply isomorphic or controlled pressure to the entire surface of the scar only; and (d) the material that will come in contact with the skin should be hypoallergic and atraumatic. Finally, the patient should be evaluated to determine whether he or she is collaborative enough to follow the treatment. Thus, knowing the way that pressure application affects the hypertrophic scar or keloid, we also understand the requirements this treatment has in terms of time, technique, and mainly patience from the patient. If “you get what you pay for” is a rule of the market in the domestic economy, in perfection of pressure therapy, the gnome that applies is “the more precise you are in terms of measurement and orientation, the more you approach the cure.” Chrisostomos Chrisostomidis, M.D. Petros Konofaos, M.D. Grigorios Chrisostomidis, M.D., Ph.D. Anastasia Vasilopoulou, M.D. Othon Papadopoulos, M.D., Ph.D. Department of Plastic and Reconstructive Surgery, A. Sygros Hospital, University of Athens, Second Propedeutic Surgical Department, Laikon Hospital, Athens, Greece