Columbine survivor Craig Scott observed: "From every wound, there is a scar, and every scar tells a story. A story that says, 'I survived.'" A scar shows that we triumphed over harm, and that's not a bad thing. Still, prominent scars can affect your confidence, making you self-conscious about your appearance. Your scar may show strength but you'd probably rather that the scar itself didn't show at all. Today we have a host of options for every kind of scar to diminish their size and appearance and help restore your self-confidence.
What is a Scar?
A scar is a natural product of the body's healing process that replaces our normal skin following trauma. All but the most minor injuries will leave scarring to some extent. Scars can also form on tissues in the body besides the skin, one example is that a heart attack causes scar tissue to form in the heart muscle. Scars usually begin as firm purple or red fibrous tissue that gradually lightens and flattens out over time. Older scars tend to turn a silvery white.
Scar Tissue vs. Skin Tissue
Scar tissue is fibrous tissue made of collagen, a structural protein that forms connective tissue. In other words, scars are made out of the same material as our ordinary skin. If that's the case, though, why does scar tissue look and feel so different? The answer lies in the fiber composition of the collagen in scar tissue.
In the case of normal skin tissue, the collagen fibers follow a woven formation like that of a basket. With scar tissue, the collagen fibers cross-link and align in the same direction. This peculiar alignment is what gives scar tissue different properties from skin tissue; specifically, scar tissue doesn't have sweat glands, hair follicles, or protective sebaceous glands. As a result, scar tissue is very smooth and tends to itch more than skin tissue. Scar tissue is also more vulnerable to UV rays.
What Causes Scarring
Anyone who has lived through childhood knows what sorts of events cause scars — burns, cuts, surgeries, acne, bites, and other injuries to the skin can all leave permanent marks. But what is the process of scar formation? Here is what's happening beneath the surface when you suffer an injury:
- A trauma harms the skin and hemostasis begins. Blood platelets start aggregating immediately and release hormones, cytokines, and chemokines. The chemokines summon inflammatory cells to the area to begin the next step.
- The inflammatory phase begins. The cells and factors needed for the healing process migrate to the wound site. Cytokines begin stimulating the proliferation of fibroblasts, which are the specialized cells of which collage is made. Lymphocytes also start secreting lymphokines, including fibroblast growth factor.
- Scabbing takes place. A clot forms over the exposed area of the wound and dries. Once the scab forms, the fibroblasts that have accumulated in the area under the surface of the skin will start leaking into the clot beneath the scab.
- Fibroblasts secrete collagen. As soon as the clot is sufficiently saturated with fibroblasts, they begin secreting collagen and a growth factor. The growth factor is what enables the fibroblasts to express their contractile proteins.
- Fibroblasts pull the wound together. At this point, fibroblasts are no longer migratory cells and can begin contracting to pull the wound together tightly to heal.
Types of Scars
Although all scars consist of the same material, they differ in their amounts of collage over-expression. This affects their appearances, which is the primary criterion by which they are classified. The two most common types of scars are keloid and hypertrophic, both of which produce stiff collagen that overextends the tissue.
Atrophic scarring, most commonly seen in acne sufferers, has a sunken appearance because its collagen bundles don't overextend the tissue. Higher levels of melanin, as well as Asian and African ancestry, tend to make scarring more prominent. We've summarized the various scar classifications for you below:
- Hypertrophic. Excessive deposits of collagen lead to a red, raised scar. Hypertrophic scars are different from keloid scars in that they don't extend beyond the original boundaries of the wound. They are usually caused by burns or trauma.
- Keloid. These scars are the product of overly aggressive wound repair. They can extend beyond the boundary of the wound, possibly restricting movement. Keloid scars most commonly affect dark skin.
- Atrophic. These scars form recesses in the skin that can resemble waves or deep pits. Atrophic scares are caused by the loss of structures underneath the skin that support it, such as muscle or fat. Accidents, acne, and chickenpox commonly cause atrophic scarring.
- Contracture. This type of scar occurs when the skin is burned. Contracture scars tighten the skin to the point that they may hamper movement, potentially also affecting muscles and nerves.
- Stretch marks. Considered a scar by most, stretch marks occur when the skin stretches quickly. Stretch marks most often occur during pregnancy, rapid and substantial weight gain, or growth spurts.
Never having an accident or suffering an injury that creates a scar is obviously an impossible goal. However, properly caring for a wound after it happens can help minimize a scar's appearance. Here are some scar-prevention tips from the American Academy of Dermatology:
- Clean it out. Wash the area gently with cool water and mild soap to kill germs and remove any debris. Make sure you clean the area around the wound as well. If you suspect your wound might need stitches, go to the emergency room as soon as possible. The wound will begin healing on its own if you wait 24 hours or more, which prevents successful suturing. Stitches, when needed, can help the wound heal properly and minimize scarring.
- Apply petroleum jelly. While it may seem counterintuitive, you don't want your wound to dry out and scab. Scabs impede healing. Keeping your wound moist and scab-free will prevent the scar from getting too big, itchy, or deep. Apply petroleum jelly to the area with a clean cotton swab.
- Cover it. Applying a bandage to the wound speeds healing by keeping germs and irritants out and locking moisture in. For larger wounds and burns, you might want to use silicone gel sheets or hydrogel.
- Change your bandage and wash the wound every day. As long as you wash the area daily, you don't need to use an antibiotic ointment.
- Don't pick at it. If a scab does form, don't touch it. Disturbing the scab will make your scar worse. If you have stitches, follow your doctor's instructions on how to care for them and when to remove them.
- Stay out of the sun. Remember that scar tissue is more susceptible to damage from UV rays than normal skin tissue. Exposing the scar to the sun will cause it to darken and make it more noticeable. If you have to go outside, apply at least SPF 30 sunscreen to the scar.
- Massage the scar every day with vitamin E. Studies suggest that massaging the scar, once the wound has healed, with vitamin E will help the scar fade.
Acne Scar Prevention
If you have atrophic scars from acne, you have plenty of treatment options available to you. But, of course, prevention is a critical part of remaining scar-free. You may be at risk for acne scarring if:
- You have inflammatory acne. This refers to red, painful cystic acne. Inflammatory acne tends to affect deeper layers of the skin, thus causing more damage.
- You wait to treat or don't treat acne. The longer you go with acne, especially if it's inflammatory, the more likely it is that you'll scar.
- Acne scars run in the family. Heredity not only plays a role in the presence and severity of acne but also in a person's propensity to scar.
- You pick, pop, and/or squeeze pimples. The more you touch and irritate acne, the more inflamed and likely to scar it becomes.
If any of those apply to you, here are some things you can do to prevent your acne from leaving scars:
- Treat your acne early. Don't wait until your acne is really bad to treat it. By that time, you will already likely have some scarring.
- Don't stop your treatments once your face clears. Continue treating your acne until your doctor tells you otherwise, even if your acne disappears.
- Don't pick or pop. Picking and popping can turn a mild breakout into a permanent scar.
- Be gentle in washing your skin. Scrubbing your skin harder when you have acne inflames it and makes it worse, not better. Wash your face gently and not too frequently.
At-Home Scar Treatments
If you'd like to try natural, home remedies before taking more drastic measures, you'll quickly find that the market is saturated with creams, gels, and other products that claim to lighten scars. In choosing a natural scar treatment, make sure you look closely at the ingredients. While you don't want to load your skin up with chemicals, you also want something that will actually work.
Researchers have found that a number of natural ingredients are effective in minimizing the appearance of scars. For example, in some advanced repair scar gels, you'll find a potent, naturally occurring protein called Epidermal Growth Factor that expedites the healing process. You can also look for gotu kola as an ingredient, which helps restore healthy skin, and green tea, fucoxanthin, astaxanthin, and sea kelp to strengthen damaged skin with antioxidants.
Medical Scar Treatments
Some scars may require medical treatment to reduce their appearance. Treatment options might include:
- Surgery. With some keloid scars especially, surgery may be necessary to remove the scar. Surgery can also involve a skin graft, which takes skin from another area of the body and applies it to the scar site. Burn victims often have this form of scar surgery.
- Cryotherapy. This option, which involves freezing the scar off the skin with liquid nitrogen, is usually reserved for small keloids.
- Steroid injections. Injections at the scar site may reduce its size in the case of raised scars.
- Gel pads with silicone sheets. Silicone sheets can help prevent the formation of keloid scars and can reduce inflammation and flatten the scar.
Cosmetic Scar Treatments
For scars that don't respond to over-the-counter treatments but don't necessarily warrant medical intervention, cosmetic treatments are another option. While only doctors can perform many of these treatments in certain states, you may also be able to have aestheticians perform certain procedures. Cosmetic treatments include:
- Resurfacing. You can resurface your skin with several different methods, including laser therapy, microdermabrasion, dermabrasion, and chemical peels. All of these work well on atrophic scars, such as depressed acne scars.
- Filler. For atrophic scars, dermatologists can fill them with a substance, such as collagen or fat, to diminish their appearance.
- Laser therapy. Lasers and similar light treatments can help minimize the appearance of some scars. For example, pulsed dye laser (PDL) treatment can make a raised scar less itchy and painful and lighter. Those with lighter skin may also be good candidates for intense pulsed light (IPL).
- Skin bleaching agents. In the case of darker scars, you may be able to apply topical bleaching agents to the area to diminish its color.
No one wants to look at an unsightly scar, especially a visible one, for the rest of their lives. Thankfully, you can make most minor scars almost invisible with simple, all-natural products.