What is a Scar

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Scars result when the skin repairs wounds caused by accident, diseases, or surgery. They are a natural part of the healing process. The more the skin is damaged and the longer it takes to heal, the greater the chance of a noticeable scar.

Typically, a scar may appear red and thick at first, and then gradually fade. Many actively healing scars that seem unsightly at three months may heal nicely if given more time.

The way a scar forms is affected by an individual's age and the location on the body or face. Younger skin makes strong repairs and tends to over heal resulting in larger, thicker scars. Skin over a jawbone is tighter than skin on the cheek and will make a scar easier to see. If a scar is indented or raised, irregular shadows will be seen, giving the skin an uneven appearance. A scar that crosses natural expression lines or is wider than a wrinkle, will be more apparent because it will not follow a natural pattern, nor look like a naturally occurring line.

Any one, or a combination of these factors, may result in a scar that, although healthy, may be improved by treatment. Some scars may improve on their own over 6 to 18 months.

What Can and Cannot Be Done for Scars?

Several techniques can minimize a scar. Most of these are done routinely in the dermatologist's office. Only severe scars, such as burns over a large part of the body may require general anesthesia or a hospital stay.

Surgical scar revision can improve the way scars look by changing the size, depth, or color. However, no scar can ever be completely erased, and no technique will return the scar to its normal uninjured appearance. Surgical scar revision typically results in a less obvious mark. Because each scar is different, each will require a different approach.

The most important step in the treatment of scars is careful consultation between the patient and the dermatologist, finding out what bothers a patient most about a scar, and deciding upon the best treatment.

Before and after treatment of acne scarring

Scar Treatment

Surgical Scar Revision

Based on the ability of the skin to stretch with time, surgical scar revision is a method of removing a scar and rejoining the normal skin in a less obvious fashion. The surgical removal of scars is best suited for wide or long scars, those in prominent places, or scars that have healed in a particular pattern or shape. Wide scars can often be cut out and closed, resulting in a thinner scar, and long scars can be made shorter. A technique of irregular or staggered incision lines, rather than straight-line incisions, forming a broken-line scar which is much more difficult to recognize, may be used. Sometimes, a scar's direction can be changed so that all or part of the scar that crosses a natural wrinkle or line falls into the wrinkle, making it less noticeable. This method can also be used to move scars into more favorable locations, such as into a hairline or a natural junction (for instance, where the nose meets the cheek). Best results are obtained when the scar is removed and wound edges are brought together without tension or movement (pull) on the skin.

Dermabrasion

Dermabrasion is a method of treating acne scars, pockmarks, some surgical scars, or minor irregularities of the skin's surface. An electrical machine is used by a dermatologist to remove the top layers of skin to give a more even contour to the surface of the skin. While it can offer improvement for certain scars, it cannot get rid of the scar entirely. Patients can usually return to work within a week. If defects are minor, only one dermabrasion will be needed. Several sessions may be required if defects are deep and extensive, as in deep acne scars.

Results of early dermabrasion scar treatment

Laser Resurfacing and Pulsed Dye Laser

Scar Revision

Another method of improving surgical, acne, chicken pox, and other scars is laser scar revision. High-energy light is used to remove or remodel unwanted, damaged skin. Patients can usually return to work or regular activity within one week, but skin may stay pink for several weeks or months, particularly after skin resurfacing with a carbon dioxide laser. Several different lasers are available depending on the skin defect requiring improvement. A pulsed dye laser, for example, uses yellow light to remove scar redness and to flatten raised scars (hypertrophic scars or keloids). This laser can also improve itching and burning sensations in the scar. Acne scars or other indented (atrophic) scars can be improved with laser skin resurfacing. Hypertrophic (thick, raised) scars or keloids typically need two or more pulsed dye laser treatments every two months.

Soft Tissue Fillers (collagen, hyaluronic acid, or fat injections)

Various injectable substances are available to elevate indented soft scars. The amount of material injected will vary with the size and firmness of the scar. Bovine or human collagen may be used. Improvement is immediate but is not permanent and collagen injections often need to be repeated. Hyaluronic acid injections typically last a little longer. The patient's own fat or injectable donated fascia can be used in full-thickened deep depressed scars. The dermatologist will discuss the available "fillers" and help you decide which is best for your scar. Research is continuing to develop more long-standing substances to inject into scars.

Results of a combination of surgical
elevation of chicken pox scars and dermabrasion

Punch Grafts and Punch Excisions

Punch grafts are small pieces of normal skin used to replace scarred skin. A tiny circular "cookie cutter" is used to cut a hole in the skin and remove the scar. The area is then filled in with a matching piece of unscarred skin, usually taken from the skin behind the ear. The "plugs" are taped into place for five to seven days as they heal. Punch excisions, on the other hand, involve the use of stitches to close the holes produced by the tiny skin punch. The stitches are removed in five to seven days. Even though the punch grafts and excisions form scars of their own, they provide a smoother skin surface which is less visible than depressed scars. Deep or "pitted" acne scars are best treated by punch grafts or excisions.

Chemical Peels

This procedure involves the use of a chemical to remove the top layer of the skin in order to smooth depressed scars and give the skin a more even color. It is most helpful for shallow superficial scars.

The chemical is applied to the skin with an ordinary cotton-tipped applicator or gauze beginning on the forehead and moving over the cheeks to the chin. Different chemicals can be used for different depth peels. Light peels require no healing time while deeper peels can require up to two weeks to heal. The amount of scarring and color change determines the type of peel selected.

Other Scar Treatment Methods

Pressure bandages and massages

can flatten some scars if used on a regular basis for several months.

Silicone-containing gels, creams, and bandages

have also been helpful in reducing scar thickness and pain. They must also be used regularly and results are variable. Silicone impregnated gels can be used by the patient at home to remodel elevated scars in addition to injections of scar tissue.

Cryosurgery

involves freezing of the upper skin layers which causes blistering of the skin to remove the excess tissue at the scar.

Cortisone (steroid) injections or tape

are effective in softening very firm scars (or keloids) causing them to shrink and flatten. This treatment is popular (along with pulsed dye laser) for hypertrophic scars and keloids.

Interferon

is a chemical that is injected into the scar and may help improve the hardness and cosmetic appearance of the scar.

Cosmetics

applied correctly can be very good at covering up scars. Physicians encourage patients to wear make-up after scar treatments. Make-up will improve the appearance while nature completes the healing process.

 

For more information about scars, call toll free (888) 462-DERM (3376) to find a dermatologist in your area.

 

AAD Web site: www.aad.org
Toll-free: (888) 462-DERM (3376)
Images used with permission of the American Academy of Dermatology
National Library of Dermatologic Teaching Slides
© 2005 American Academy of Dermatology
Revised 1991, 2001, 2004
American Academy of Dermatology
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P.O. Box 4014
Schaumburg, IL 60168-4014

 

PAM35 - 05/04

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