The skin is an organ that protects our bodies from infection. Throughout our lives, we have experiences that injure our skin, leaving behind a scar. The formation of scars depends on many factors, including:
- How large the wound is.
- The person’s age, sex, and ethnicity (nationality/heritage).
- Genetic (inherited) factors.
There are four main types of scars. Various treatments can help reduce their size and appearance. Before you begin, however, remember this basic truth: scars will never completely disappear.
What are the four main types of scars?
- Hypertrophic scars: These are red scars that rise above the skin. They do not spread beyond the spot where the injury occurred. Possible treatments include steroid injections and laser surgery.
- Keloids: These scars jut out from the skin and spread beyond the spot where the injury occurred. They are caused by the overproduction of certain cells. Over time, keloids may affect mobility (ability to move). Possible treatments include surgery, laser surgery, radiation or steroid injections. Smaller keloids can be removed with cryotherapy (freezing therapy using liquid nitrogen). You can also prevent keloids by using pressure treatment, silicone gel. Keloids are more common in darker skin types, specifically people of African or Asian descent.
- Contracture scars: These scars typically occur after the skin is burned. They cause tightening (contracting) of the skin that can reduce the ability to move. This type of scar can go into muscles and nerves.
- Acne scars: Any type of acne can leave behind scars. There are many types of acne scars, and they can be shallow or quite deep. Treatment depends on the type of scars.
Management and Treatment
What are possible treatments for scars?
Over-the-counter or prescription creams, ointments or gels: These products may reduce scars that are caused by surgical incisions (cuts) or other injuries or wounds. If you are under the care of a dermatologist or plastic surgeon, ask your doctor for recommendations. Treatment options include corticosteroids or antihistamine creams (if your scars are sensitive and cause itching). Your doctor may also recommend intralesional steroid injections, pressure dressings or silicone gel sheeting to prevent acne scars and to help treat existing scars.
Surgery: There are many options under this category, including skin grafts, excision (removal) or laser surgery. When looking into surgery, discuss with your doctor whether you will have local anesthesia with an oral sedative, or general anesthesia. If you’ve recently had plastic, cosmetic or other surgery that has caused your scars, it is best to wait at least one year before making a decision about scar removal treatment. Many scars fade and become less noticeable over time.
If you do opt for scar revision surgery, be sure to keep the area moist so the sutures can come off easily. (If a scab should form, it will delay the healing process and create more scarring.) The more moist the healing environment, the better the scar will look. Use petroleum jelly or any of the silicone scar creams, gels or sheets.
Injections: In the case of protruding scars such as keloids or hypertrophic scars, your doctor may choose to use steroid injections to flatten the scars. Such injections can be used as a stand-alone treatment, or in combination with other treatments.
Laser surgery: Vascular (blood vessel)-specific lasers may be used to lighten flat or raised scars that are pink to purple in color. Vascular laser treatment may also help flatten raised scars. A carbon dioxide ablative laser can also be used to treat different types of scars.
Will insurance cover scar removal treatments?
If your scar is hurting you physically, your insurance plan may cover the cost. You can ask your doctor to write a letter about your particular case. He or she can also take photos to support your case.
If you are having scar removal treatment for cosmetic purposes (for your appearance), you will probably have to pay for it yourself. If your scars resulted from cosmetic surgery, your insurance company may or may not pay for treatment. Some plans will not cover treatments that arise from elective surgery that is not medically necessary. It is best to check with your insurance plan.