A scar is an unavoidable result of incision or injury to the skin. Unsightly as it may be, a scar is a near-miraculous example of the body’s ability to heal itself.
The appearance of a scar is dependent on many factors – the size and depth of the wound as well as the individual’s age, genes, and skin pigmentation.
A scar forms when there has been damage to the deep, thick layer of skin called the dermis. As the skin heals, the new collagen fibers that replace the damaged tissue have a different protein composition than the original tissue, which causes the new skin to have a different texture and appearance than surrounding skin. There are different types of scars: Most are flat and pale. When too much collagen is produced, the scar may be red and raised (hypertrophic) and if the raised scar extends beyond the boundaries of the original wound, it is known as a keloid scar. Contracture scars result from burns; as they tighten, they can restrict movement and may affect underlying muscles and nerves. Cystic acne and chickenpox scars are often pitted or indented (atrophic).
Tips to Minimize Scarring
How you treat a wound can make a big difference in the appearance of the scar.
- Don’t let the wound get soaking wet but keep it moist with a light application of petroleum jelly. Don’t use home remedies or over-the-counter lotions, creams or ointments that purport to prevent scarring. Most, including the popular vitamin E, don’t work and many have ingredients that can be irritating or cause an allergic reaction.
- Keep the area clean with a gentle cleanser. Don’t use soap and don’t scrub. Pat dry.
- Let the wound breathe. Cover it with a thin, light bandage that allows air to circulate; change the bandage daily.
- Avoid sun exposure, which can make scarring worse.
- When a scab forms, don’t touch it! Picking at a scab will impede healing and might cause scarring that would otherwise not have occurred.
Treatments to Improve the Appearance of Scars
- A silicon-based gel or a silicon gel sheet that is pressed on the skin can help flatten a swollen, raised scar. Silicon gel sheeting can also be helpful as the wound is healing, leading to a thinner, softer, less red and less painful scar.
- Injections of corticosteroids are used to soften and flatten keloid and hypertrophic scars. Filler injections can raise sunken scars to the level of surrounding skin.
- Dermabrasion, micro-needling, and laser therapy are different methods that achieve similar results: to remove the surface layers of the skin. They are used on raised scars.
- Surgery can alter a scar’s shape or make it less visible. The scar may be removed completely and the new wound closed carefully (excision) or a series of small incisions can re-orient the scar so it better follows the natural folds of the skin and is less noticeable (Z-plasty). A skin graft may be used when a large area of skin has been lost.