Scars are marks left on the skin after a wound or injury has healed. Scars can occur anywhere on the body and are usually the result of the body's natural healing process. The presence of scars however, particularly in aesthetically sensitive areas such as the face, can be undesired, upsetting, and/or emotionally distressing. Get the Skinny on ways to improve the presence of scars.
How do scars form?
When the skin is wounded, damage to collagen, a protein present in skin, occurs. In response to this injury, skin cells make new collagen, depositing this new material into the wound, almost like a patch or putty, to repair the wound. This collagen matures to form a new patch of tissue that is different from the surrounding skin- this new patch of tissue is called a scar. Over an ensuing period of several months to a year, the body breaks down and remakes this scar tissue through a process called remodeling, until the scar has healed fully.
What do scars look like?
Scars may be raised or indented, they may be lighter or darker in color than the surrounding skin, or they may be bright pink or red. Scars are a normal part of the healing process and are generally not a cause for concern. However, some people may be self-conscious about the appearance of their scars and may seek treatment to reduce their visibility.
How may scars be treated to improve their appearance?
There are several treatments that can be used to make scars less noticeable. The best choice for treatment of a scar will depend on the location, size, color, contour (whether a scar is raised, flat, or indented) of that particular scar, as well as the age, skin color, and overall health of the patient. Some common treatments for scars include:
Topical creams and ointments: These products can help to soften and smooth a scar, making it less noticeable with frequent use over time. Examples include silicone gels, vitamin E creams, steroid creams, and other topical products that are specifically formulated to improve the appearance of scars.
Chemical peels: in this treatment, a chemical solution is applied to the skin to remove cells at the top layer of the skin. Chemical peels can be used to improve the appearance of a scar by removing areas of the scar that contain discoloration, or to improve the texture of a raised scar. Some examples include salicylic and tricholoracetic acid peels. These are best done in the office of a dermatologist.
Excision: This is a surgical procedure in which the scar is cut out and the skin is restitched. This can be an effective treatment for scars that have widened over time, deep, uneven scars, or scars that are disfiguring or causing problems with mobility over a joint. Restitching the wound after cutting out the existing scar may allow the scar to heal with a more normal or even contour.
Dermabrasion: This is a procedure in which the top layers of skin are removed physically, using a rotating instrument, similar to “buffing” the skin. Dermabrasion can help to smooth out raised scars and improve their appearance.
Laser treatment: Laser therapy can be used to reduce the appearance of scars in a number of different ways, depending on the type of laser. Vascular lasers improve red and pink scars by burning off broken blood vessel within the scar, leading to a scar that is more similar in appearance to one’s skin color. These lasers work best for red or pink scars on pale skin but may be used in some darker skin tones. Fractional lasers may also be used for scar treatment. They work by emitting a beam of light energy that is absorbed by water and/or collagen in the skin, creating tiny wounds or injuries in the skin, which stimulates the production of new collagen. When used on scars, this laser causes break down of existing scar tissue and stimulation and production of new collagen to smoothen and tighten the skin. Fractional lasers can be ablative or non-ablative. With ablative fractional laser treatments, the top layers of the skin is vaporized, leading to tiny open wounds in the skin that heal over 3-7 days. With non-ablative fractional laser treatments, the top layers of the skin are intact, and the wounds are under the skin, with no open areas of skin. Fractional lasers can be used to improve the appearance of scars in persons of all skin types and tones.
Steroid injections: injection of steroids, which are scar-dissolving medications, directly into a scar may be used to soften and flatten thick scars.
Filler Injections: scars that are indented or depressed may be improved by injection of materials such as hyaluronic acid, a gel-like substance that is naturally found in the skin, into the area of indentation. This treatment is usully repeated in 6 month intervals for best results
Pressure therapy: Wearing a pressure garment or applying pressure to the scar with tape or silicone sheets can help to reduce the size and improve the appearance of raised scars.
Subcision: subcision is a surgical procedure that is used most often for treatment of indented scars. During the procedure, a needle or other sharp instrument is inserted under the scar and used to loosen the scar tissue from the underlying skin. This can help to soften and smooth the scar, making it less noticeable.
Which scar treatment is right for me?
See your local dermatologist for an evaluation of your type of scar, to determine the best scar treatment for your skin. At CCDS, we use many combinations of above described scar treatment options to improve the appearance of scars. Although we treat all types of scars, the most common type of scar treated at CCDS is scarring from acne. It is important to note that no treatment can completely remove a scar, but many of the above treatments can help to significantly improve the appearance of scars and make them less noticeable.
Ekama Carlson, MD
Ekama Carlson, MD is a board-certified San Francisco dermatologist and Mohs surgeon.
https://caldermsurgery.com
