Ultimate Guide to Scars and How to Treat Them
Scars can result from injury or as a side effect of surgery, leaving behind discolored, raised, or noticeable lines in the skin. Large, distinct scars—especially on the face—can cause constant anxiety and affect self-confidence. Scar treatment and revision can be done to lessen the appearance of a scar, making it barely visible to the human eye.
The human body is equipped with a diverse number of ways to naturally heal and rejuvenate itself. One of the ways it does that is through the process of scarring which occurs during wound healing. Scars manifest themselves in different ways. They might be flat or raised; and might look white, red, or even purple in appearance. They are generally known to fade over time, but once you have a scar, it will never completely go away. Fortunately, there are several avenues available for treating your scars and minimizing their visibility, including laser skin resurfacing, microneedling, carboxytherapy, injectables, dermal fillers, dermabrasion, microdermabrasion, and surgical removal. These, along with DIY remedies and over-the-counter scar products will be discussed throughout this article.
Reasons and Causes
The reasons for scar formation are as diverse as the treatment options available. At the most basic level, a scar is simply a patch of skin that permanently grows over a wound and is your body’s reactive way of healing itself after undergoing some sort of injury. The U.S. National Library of Medicine’s scarring information cited surgeries, infections such as chicken pox, and skin conditions such as acne as the main causes of scarring.
Why Scars Form
Studies done on the formation of scars in the last several years have led to a greater understanding of the wound healing process, a segment of health care treatment that requires approximately 9 billion dollars a year to function adequately. These studies and their correlating infographics have been laid out by the National Institutes of Health. These findings have been explained and categorized into an easy-to-understand process that is commonly known as the wound healing cascade.
The stages of the wound healing cascade are broken down as follows:
- The inflammatory phase – This phase encourages blood clotting and begins the process of bringing healing growth factors to the wound. Inflammation is your body’s natural immune response to the wound itself. It protects the body from further damage by protecting the wound, initiating healing, and allowing repair cells to move with greater efficiency to the wound site. For example, the area is likely to redden during this phase. This is the capillaries filling with additional blood, and greater blood flow to the area is a necessary component of healing.
- The proliferative phase – This phase begins to repair the wound by transmitting collagen to the area for the creation of new tissues. This growth allows new skin to form over the wound opening.
Maturational phase – This phase takes the wound from early tissue development to final scar formation.
The National Institutes of Health combines hemostasis and inflammation into one part of the wound healing cascade, while some sources choose to separate the two into different phases, creating a 4-step cascade rather than a 3-step cascade. A 4-step cascade would include hemostasis, inflammation, proliferation, and maturation with hemostasis referring to the clotting of the blood and the closing of the wound. Since inflammation helps control bleeding, it is directly related to the blood’s ability to clot. Therefore, combining hemostasis and inflammation into one step makes sense, although either way is technically correct.
Types of Scars
There are many different types of scars. The type of scar you have, and the way it looks, is directly related to the reason for the scar’s formation. The size and placement of the wound itself, the amount of time it takes for the wound to heal, your age, your skin composition (whether it is thick, thin, fair, dark, etc.), the way you care for your scar, and your predisposition to scarring all factor into how your scar will evolve and how it will appear over time. It will fall into one of the following categories as defined by the American Academy of Dermatology:
Flat Scar You may hear this type of scar being referred to as a cicatrix scar. This is the most aesthetically pleasing scar to have, and caring for your wound properly may help develop a flat scar. They often resemble your normal skin color, but it is not unusual for flat scars to be either a shade darker or lighter than your skin color. While in the early stages of healing, you might experience a slightly itchy or painful sensation that comes from the skin growing and healing. It will also be red or pink until further along in the healing process.
Raised Scar This type of scar is most often found on the chest, back or shoulders, and is medically termed a hypertrophic scar. Hypertrophic scars may feel itchy or painful initially, but should not inhibit movement long-term. This would be an indication that you need to see a board-certified dermatologist determine why the scar isn’t healing properly. A raised scar will often flatten over several months, or even years, but either way, it will rise above your skin’s surface and will be firm and raised until it begins to flatten, if ever.
Depressed Scar Called an atrophic scar by medical professionals, a depressed scar is most likely to form on the face. Unfortunately, these are most often related to severe acne or infections such as chickenpox. Unfortunately, these scars typically do not improve over time. Instead, they become more and more noticeable as you age. As your skin loses elasticity and begins to droop and sag, depressed scars become much more obvious. Dermatologists have divided depressed scars that formed from acne into three categories – boxcar, ice pick, and rolling acne scars.
Keloid Scar This type of scar is referred to as keloid in both medical and layman terms and differs from raised scars in that they grow significantly larger than the size of the initial wound and do not go away on their own. Keloid scars require treatment and can interfere with your ability to move comfortably, especially when formed over a joint.
Contracture Scar This type of scarring can be a very serious concern because of the way it interferes with your ability to move freely. The American Academy of Dermatology labels “any scar that limits movement” a contracture scar. They are most often caused by serious burns or the formation of large keloid scars.
Stretch Marks These are referred to in the medical world as striae and are one of the most commonly known scar types caused by breaks in the tissue underneath the skin, known as the connective tissue. The most familiar causes of stretch marks are puberty, pregnancy, and quick weight gain or weight loss. They can also be caused by building muscles or “bulking” too quickly as well. Stretch marks start colored red, purple or brown, but often lighten to either a white or silver hue once they have been there for a while.
What to do about Scars: Treatments, Remedies, and Other Options
Dealing with scars can be a tedious concern, but rest assured that you have several options available to help treat your scars. These options do not guarantee that your scars will be permanently eradicated, but they do promise to help alleviate the severity of their appearance.
Laser Skin Resurfacing This is a valuable solution to several problems and is often used to reverse signs of damage on the face, including lessening the appearance of scars. One of the most effective facial resurfacing options available, laser skin resurfacing uses laser technology to remove surface layers of skin to improve and treat skin imperfections. Old, scarred skin is removed either through ablative, non-ablative, factional and non-fractional methods. Ablative lasers are the more aggression option, while non-ablative lasers resurface the skin by gently warming it for a less dramatic effect. Fractional lasers concentrate very precisely onto one targeted area while non-fractional lasers focus on the entire surface area. Each of the laser treatment methods is effective for age-related blemishes, skin damage and concerns such as fine lines and facial wrinkles.
The two most common types of laser resurfacing treatments are carbon dioxide (CO2 lasers), precision lasers that remove thin layers of skin with minimal damage to the surrounding tissues, and erbium, ablative lasers used to remove deep lines and moderate wrinkles. Intense pulsed light treatments (IPL) are not true lasers, but they provide another alternative to treating skin concerns such as acne scars, sun damage, rosacea, and hyperpigmentation. Regardless of the laser skin resurfacing treatment you are leaning towards, they will all offer the benefit of lessening the appearance of your scars due to the way they so effectively resurface the skin.
Microneedling Microneedling is widely known for its ability to address skin concerns including skin laxity, fine lines, wrinkles, scarring, and skin discolorations. You might hear it referred to as “percutaneous collagen induction” or “collagen induction therapy” because of its collagen stimulating effects. Microneedling is a non-invasive cosmetic procedure that increases collagen and elastin production via micro-injuries to give you a more youthful, rejuvenated appearance. These micro-injuries, or tiny punctures in the skin, are made by micro-needles. The microneedling device either rolls across the surface of the skin or uses a pen-like system to create pinprick micro-injuries. Creating micro-injuries stimulates the body’s response to these minute wounds by enacting natural healing properties. These healing properties include the production of new collagen and elastin fibers.
Microneedling is useful in treating scar tissue because the release of growth factors stimulated by the micro-injuries triggers the wound healing cascade and begins the process of breaking down unwanted scar tissue without damaging the outer layer of skin. While there are at-home microneedling kits available, DIY treatments can cause further injury to the area. For example, applying too much pressure can have the reverse effect by further damaging the skin rather than appropriately stimulating the healing process. Microneedling options include:
Microneedling + PRP – Also referred to as a “vampire facial”, this procedure option combines the microneedling process with the application of platelet-rich plasma (PRP). PRP is a formula derived from your blood by spinning it in a centrifuge to isolate the platelets and activate the release of growth factors that will be used to stimulate healing in your tissues.
Microneedling + RF – This treatment combines microneedling and radiofrequency allowing the heat energy to reach below the skin’s surface to the skin’s second layer while the microneedling device is penetrating the surface of the skin to create the micro-injuries.
Microneedling + PRP + Stem Cells – This procedure begins with the microneedling + PRP session described above and enhances those results by applying a stem cell growth factor serum as the last step. This clear serum remains on your skin for the remainder of the day where it has the chance to actively stimulate skin renewal and rejuvenation.
Carboxy Therapy This treatment is particularly helpful for striae scars (stretch marks). A study by the U.S. National Library of Medicine found carboxytherapy to be a highly effective and tolerable method of treating stretch marks. This FDA approved treatment uses infusions of carbon dioxide (CO2), and can also be used to treat cellulite, another common concern among women of all ages. Whereas the previously mentioned procedures focused on resurfacing and triggering the wound healing cascade, carbon dioxide infusions help with scarring because of the way they stimulate circulation, aid in collagen production, and help to break down fat deposits in the targeted areas.
Injectables and Dermal Fillers for Depressed Scars Although these methods are temporary solutions with results lasting a few months to a year, injectables and dermal fillers are FDA approved, safe, and generally well tolerated by most skin types. Their compatibility with depressed scarring is significant because they plump up the skin making your volume loss less obvious. The most common forms of fillers include Juvederm™, Restylane®, and Belotero® – hyaluronic based fillers known for their plumping and skin rejuvenating properties. Dermal fillers are popular for delivering immediate results and having a minimal time commitment.
A study published in the Clinical, Cosmetic and Investigational Dermatology journal referred to this method as “an elegant approach to volume-related scarring,” stating that it is both ideal for volume and accurate in placement. They additionally found that the studies done on dermal fillers and injectables give substantial evidence to support major skin benefits for not only depressed scars, but also in lessening the appearance of other age-related concerns such as fine lines, wrinkles, face sculpting, and volumization concerns.
Dermabrasion and Microdermabrasion Treatment Dermabrasion delivers substantial results in an hour or less. It is known to have great success in treating severe acne scars and chicken pox scars, but it also provides major benefits to fine lines, wrinkles, and uneven pigmentation. It has even been used in the treatment of lesser forms of pre-cancerous growths, skin cancer-related problems, signs of sun damage, and in treating brown spots. Abrasive pressure is applied by a motorized dermabrader that successfully removes the outer layer of skin. Expect to undergo a series of treatments to achieve your desired results. It is common to combine this treatment option with others to greater enhance results. Combining dermabrasion treatments with retinol will give skin a deeper, more noticeable glow, promoting a more youthful overall appearance. Whether you opt for dermabrasion or dermabrasion in conjunction with additional treatment, the abrasive pressure will alleviate scarring by reducing dead skin cells and resurfacing the area itself.
Microdermabrasion is one of the most popular cosmetic procedures available for treating acne, scarring, wrinkles, dark spots, and uneven pigmentation. It is a minimally-invasive procedure that physically exfoliates dead skin through the use of a diamond-tipped or crystal-blowing handpiece. There are also “microdermabrasion creams” that, although not as effective as traditional methods, can also slough away dead skin to reveal fresher, more radiant skin. Microdermabrasion will help alleviate the look of scars, but as an added benefit, it will also smooth, brighten, and rejuvenate tired facial skin as a whole. Although known for its work in treating the facial area, microdermabrasion can also be used in other places on the body. Stretch marks all over the body can benefit greatly from microdermabrasion. This is one of the most effective methods of treating stretch mark scars because microdermabrasion’s exfoliation benefits can dramatically reduce the appearance of those frustrating white or silver lines.
Embrace Scar Therapy Embrace scar therapy is a system used to reduce skin tension and stress on a wound or surgical scar. This form of scar management is meant to be a proactive method of care that helps scars to form less dark, raised, and unsightly than they would if left to heal on their own. The primary function of embrace scar therapy is to reduce tension at the wound site. This helps to control the production of collagen, which helps reduce the likelihood of developing a raised scar. Although new collagen fibers are a necessary part of the healing process, too much collagen can lead to the formation of bumpy keloid scars which are more difficult to address. By reducing tension, the primary cause of scarring, embrace scar therapy is helpful to the overall healing process and to keeping collagen production in check. This combination helps to give you the best possible outcome for your scars.
Scar Revision Surgery Scar revision surgery is the most invasive way of treating scars, but it can be very helpful in improving the appearance of a scar, making them as even and imperceptible as possible. Your surgery will depend on the severity of the scar which will also determine anesthesia type. During surgery, excess scar tissue buildup will be removed, tissue expanders may be placed, or skin grafts used to expand the area of healthy skin and lessen the appearance of scars. Multiple procedures may be necessary to see the desired results. Scar revision surgery may be combined with another method of scar treatment to enhance results.
DIY Home Remedies and OTC Products for Scars
Home remedies are an enticing method of scar treatment due to their relatively low cost and low commitment, but keep in mind that these methods typically have a lower success rate than treatment plans executed by a dermatologist or plastic surgeon. If you decide to try a do-it-yourself or over-the-counter remedy, know that you are doing so at your own risk and may be exposing yourself to unsafe treatments.
Vitamin E Oil One of the most widely-known DIY home remedies is the use of vitamin E oil. It can be taken in capsule form, but you are also able to buy the oil and apply it topically. The idea is that the deep moisturizing properties of vitamin E will assist in the healing of the scar, especially during the stretching that occurs in the early stages of wound healing and scar formation. Coconut oil is said to have a similar effect and maybe another topical remedy worth applying. These oils have been recommended for all scars, but they might be really helpful on stretch marks as they moisturize the entire area and could alleviate some of the skin tightness leading to stretch marks.
Essential Oils Essential oils, such as rosehip, are generally marketed at various health food stores and by homeopathic believers to have skincare benefits that can help reduce scarring. Lavender oil is another homeopathic favorite and is believed to have regenerative properties that would be useful in treating scars. Tea tree oil is also a common ingredient in the cosmetic industry and is often used in products for healing acne-prone skin. This oil is supposed to target and eradicate bacterial activity leading to acne flare-ups. This neutralizing oil might also help treat acne scars or at least lessen their appearance.
Homemade Masks Homemade masks might be another helpful way to treat scars. Many homeopathic healing remedies call for ingredients such as honey, egg whites, and plain Greek yogurt. You can try these ingredients individually or mix them for different variations. You will want to apply masks to clean, dry skin and leave masks on for about 10 minutes before washing them off with warm water. Some suggest including lemon juice in DIY masks because of its lightening properties, but others are wary. Test ingredients before applying them to facial skin and use caution, remembering to remove them promptly.
Chemical Peels Chemical peels can be useful in improving the look of scarring by removing the surface of the skin. This option can sometimes lead to dry skin and peeling associated with skin turnover. While chemical peels are a routinely performed in-office cosmetic treatment, you can also find OTC options. OTC choices will have a lower percentage of the ingredients, but will still contain beneficial elements of glycolic acid and other exfoliating components.
Retinoids Retinoids are touted as one of the best anti-agers in the cosmetic industry. Retinoids are derivatives of vitamin A which is a powerful skin exfoliant. This exfoliation leads to increased cell turnover and collagen production. Although they are mostly used for age-related concerns, using retinoids consistently in your skin care routine will be useful in preventing dead skin and bacterial build-up which will treat your acne concerns as well. Retinoids are sold in both prescription form and OTC form.
Alpha-Hydroxy Acid (AHA) Known for its exfoliating properties, AHA can chemically rid your skin of old skin cells. This simply means that the exfoliation is done chemically as opposed to physically, such as with a facial scrub. Because AHAs are potent exfoliators, they lessen the appearance of scars over time as new skin is continually being revealed.
Vitamin C Already understood to be good for you to consume internally, vitamin C is useful as a topical agent in treating skin concerns. Also known as L-ascorbic acid, or simply ascorbic acid, this antioxidant helps boost collagen and brighten the appearance of your skin. As more collagen is produced, the appearance of scars is lessened. Like other OTC remedies, this method will take time, but it could be an incredibly helpful way of alleviating the intensity of your scars.
Whether you choose to try one of these DIY remedies or seek treatment from a professional, it is always a good idea to schedule an appointment with a dermatologist or a plastic surgeon – as they can most accurately assess the condition of your scar and prescribe the most effective method of treatment. They can also hear your concerns and advise you accordingly. Your scar, like your skin, is unique to you. While there are other scars and skin types similar to yours, your particular needs should be treated on an individual basis. A trained professional will be your best guide to customizing your skin care needs.
List of Sources
- Scars: Signs and Symptoms
- Treatment of a Traumatic Atrophic Depressed Scar with Hyaluronic Acid Fillers: A Case Report
- Complements and the Wound Healing Cascade: An Updated Review
- Scar Revision
- Comparative Study Between: Carboxytherapy, Platelet-Rich Plasma, and Tripolar Radiofrequency, Their Efficacy and Tolerability in Striae Distensae