“Patients who have scars where others can see them may experience low self-esteem or be self-conscious of what others might be thinking,” says Teri McGillis, M.D., Cleveland Clinic dermatologic surgeon.
But scars, although they mar the skin, are the body’s way of repairing itself. Injuries, disease or surgical procedures may damage the dermis (the deep, thick layer of skin). Through a natural healing process, the body forms new collagen fibers to repair the skin, resulting in a scar. Rarely, scars may hurt or itch and restrict movement.
“How a wound heals — and what type of scar it leaves behind — depends on many factors,” explains Dr. McGillis, such as the location of the wound; type, depth and size; what caused it; the length of time it took to heal; as well as the patient’s age, heredity, sex and ethnicity.
“Fortunately, we have treatments that can help change or modify the look of a scar to make it less noticeable,” she says.
The Appearance of Scars
In most cases, scar tissue is of inferior quality to the tissue it replaces, and it leaves a noticeable mark in the affected area. Usually, the new tissue will have a different texture than the surrounding tissue.
“Scar tissue will always look different than normal skin,” Dr. McGillis says. That’s because scars are less resistant to ultraviolet radiation, and hair follicles and sweat glands do not grow in the scar tissue.
Most scars are flat and pale, but some can be raised, sunken or have a pitted appearance. Scars also can appear as stretched skin. Depending on the type of scar, it can be pink, red, brown or silvery in color.
Rarer types of scars include hypertrophic scars, which are raised red to purple scars, and keloids, which are more common in darker-skinned patients and extend beyond the original area of injury.
Improving the Look
Treatment for scars has come a long way, with dermatologists using advanced methods. “Although scars can never completely be erased, we can minimize the appearance,” Dr. McGillis explains. At Cleveland Clinic, scar treatments include:
Dermabrasion — Special equipment removes the surface of the skin. It works best on scars left after surgery and saucer-shaped acne scars. Microdermabrasion may be useful for very superficial scars.
Laser resurfacing — Similar to dermabrasion, it removes the surface layers of the skin using different types of lasers. Newer types of lasers may achieve more subtle results in the treatment of depressed scars by stimulating the collagen in the dermis without removing the upper layers of skin. This results in little to no down time. Best used for mild scarring, the patient may need several sessions.
Injections (collagen, hyaluronic acid, fat) — These treatments can be used to raise sunken scars to the level of surrounding skin. The effects of these injections are usually only temporary, however, so the procedures may need to be repeated to maintain improvement.
Surgical scar revision — Although it will not remove a scar, surgery can be used to alter a scar’s shape or make it less noticeable. It is best-suited for wide or long scars, those in prominent places, or scars that have healed in a particular pattern or shape.
Medications — Medications may be injectable (steroid or cortisone) or topical (corticosteroids or antihistamine creams). These products may reduce raised scars that are caused from surgical incisions or wounds and may alleviate symptoms of itching or pain.
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. Light peels require no healing time while deeper peels can require up to two weeks to heal. Many treatments are outpatient procedures and require no anesthesia. Pain for most is minimal.
Managing Expectations
Dr. McGillis notes that a combination of the above methods may be necessary, as well as multiple sessions. Although the best results are seen when treatment is sought sooner rather than later, it may be difficult to decide when action is appropriate.
“Many actively healing scars seem unacceptable at three months, but with time, they may improve nicely,” Dr. McGillis explains. “Talk to your dermatologist to determine when a scar should be treated and what the results may be.
“But no scar is out of the question — no matter how old.”
© Copyright 1995-2008 The Cleveland Clinic Foundation. All rights reserved
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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 1/1/2007
