What are scars?
Scars result from the skin changing as it heals from a wound or surgical incision. They often stand out due to differences in texture and colour compared to the surrounding skin and can be noticeable depending on their shape, size, and location.
A well-tended wound, that is kept clean and closed, reduces the chances of a pronounced scar forming. However, scarring may become even more severe if the healing process is disrupted by straining or widening the cut.
Even with proper healing, scars may still be visible but tend to diminish with time.
The appearance of a scar is different from normal skin due to its unique composition. Normal skin contains collagen and elastin fibres, contributing to its strength and flexibility respectively. However, during the healing process, only collagen is produced by the body.
This lack of elastin produces scars that are rougher, thicker, and a different colour compared to normal skin. Doctors recommended having scars examined by a dermatologist before undergoing any scar treatment, as occasionally skin cancer can mimic the appearance of a scar.
The type and severity of scarring are influenced by various factors, including genetics, age, and skin colour. Older individuals tend to heal with less scarring and dark skin is more susceptible to raised scars known as keloids. Lastly, a wound's type, size, and location also play a role.
Scars fall into five categories:
- Normotrophic scars, also known as colour and surface irregularities, are faint scars that fade to white and smooth out with time. These scars typically do not affect movement or cause discomfort and include those caused by small surgical incisions and minor injuries.
- Atrophic scars are superficial indentations in the skin that arise when the healing occurs beneath the skin's surface. These scars are generally caused by severe acne, particularly cystic acne, as well as chickenpox. There are three distinct types of atrophic scars, distinguished by their depth, shape, and appearance. These include icepick scars, boxcar scars, and rolling scars.
- Hypertrophic scars are characterised by raised clusters of thick scar tissue that develop at the location of a wound. These scars can be uncomfortable and may get bigger or even change colour over time, becoming either hyperpigmented (darker) or hypopigmented (lighter).
- Keloid scars are a type of scarring that extends beyond the boundaries of the original wound. They are larger than hypertrophic scars and can be itchy, painful, and often protruding. Keloids are difficult to remove and can appear anywhere on the body, although they are more common in areas with less fatty tissue. While keloid scarring rarely happens on the face, it is still possible.
- Contracture scars form when the skin and its underlying tissue are pulled and tightened together during the healing process. The absence of elastin in the new skin leads to limited flexibility, restricting movement. Contracture scars typically develop when there is significant tissue loss, such as during a burn, or when the skin heals around a joint.
How to get rid of scars
Scars tend to fade with time, but some may require assistance to become less visible. Fortunately, there are several treatment options available to help reduce their appearance.
It is essential to protect scars from sun exposure while undergoing treatment. Sunlight can darken scars permanently, and negate the effects of treatments. To avoid this, make sure to wear clothing that covers the scar and apply sunscreen to the area throughout the year, not just during the summer.
According to doctors and patients, these treatments offer the best results in reducing scars.
Silicone Scar Sheets
Silicone Scar Sheets are a DIY home treatment that uses a silicone adhesive bandage to help prevent and minimise scarring while a wound heals. The dressing is applied to the incision and works by reducing tension and trapping moisture, both crucial for optimal wound care.
Scar sheets are a low-maintenance and convenient treatment option, with each bandage lasting for more than 10 days.
There have been reports of patients experiencing blistering from the sheets, and some doctors have noted similar reactions. If this occurs, stop using the treatment until the irritation subsides
Silicone Scar Gel
Silicone scar gel with SPF can be applied at home to reduce the visibility of scars. It forms a breathable and flexible coating on the skin to retain moisture, curb excessive collagen production, and guard against movements that may stretch or irritate the wound. This gel is highly effective in preventing hypertrophic scars and smoothing out already-formed ones.
This gel is frequently used after plastic or reconstructive surgery. It is most effective on new scars and is best applied once the wound has re-epithelialized (when the scab falls off and reveals a fresh pink colour). For optimal results, it is recommended to use the gel twice daily for a minimum of 2 to 3 months.
Laser resurfacing uses targeted lasers to heat and stimulate the deep layers of the skin, this prompts the body to naturally produce new and restorative collagen.
The effectiveness of laser has been demonstrated in several clinical studies, particularly using pulsed dye lasers to reduce redness and fractionated lasers for resurfacing. Both surgical and traumatic scars have shown improvement with laser resurfacing.
The success of laser therapy is greatly influenced by timing. Research has shown that starting the treatment sooner rather than later can result in more favourable outcomes. In practice, doctors have anecdotally found this to be true, often using a combination of pulsed dye and fractionated lasers to improve the colour and texture of scars.
When it comes to laser resurfacing treatments, there are two main options to choose from. The first type, known as ablative lasers, work by removing the top layers of skin, providing large improvements but with a longer recovery time. On the other hand, non-ablative lasers are quicker to recover from but may require multiple treatments to achieve the same results. For scar treatment, it is not uncommon to utilise both types of lasers.
Microneedling is a skin treatment that activates the body's natural healing mechanism through the creation of microscopic injuries from fine needles. This process has a compounding effect on the skin. “First, it releases cytokines and growth factors in the epidermis and dermis (the top and bottom layers of your skin),” as per Brisbane, dermatologist Dr Davin Lim. “This, in turn, remodels scars and the dermal layer of the skin. Additionally, needles can break up scars themselves leading to new collagen formation.” This approach is particularly effective in improving the appearance of acne scars, skin discolouration or surface irregularities.
The procedure is quick, budget-friendly and suitable for all different skin types and tones. A series of treatments may be needed to achieve the best results. After treatment, your skin will resemble a sunburn, and you may need up to 3 days to fully recover.
It is worth noting that some patients have experienced new scarring or tiny punctures on the skin after micro-needling.
Subcision is a surgical intervention used to treat sunken scars, primarily those caused by acne e.g. rolling scars or boxcar scars.
This minimally invasive procedure uses a small needle to sever the fibres that hold a scar in place underneath the skin. To reduce pain, swelling, and other side effects, a blunt cannula can also be used instead of a needle.
1 to 5 sessions may be required, to break up all the tissue, says Dr Lim. “Think of a scar like tree branches. To break all the bonds in one session, is difficult in complex scars, hence multiple treatments from all angles.”
Other scar treatment solutions
Scar Removal Surgery
Scar removal surgery can significantly reduce the visibility of a scar, though it may not eliminate it entirely. The surgical process involves excising (cutting out) the scar and then suturing the edges together, effectively replacing the old scar with a new tidier incision.
This method is particularly effective for those with elevated scars, such as keloids, contractures and deep tethered scars. In cases where deep tissue removal is necessary to access a scar, a skin graft or tissue expansion may be needed to close the wound.
This procedure is possible on any part of the body and at any age. However, it is recommended to wait a year after the initial wound has healed before undergoing surgery as scars may change over time. It is important to note that there is a risk of poor scarring a second time.
Intralesional steroid injections, such as Kenalog or Triamcinolone, are used to treat raised scars like keloids and hypertrophic scars by reducing inflammation and smoothing them out. These injections are available in two different strengths and are directly injected into the keloid or hypertrophic scar. Kenalog is more commonly used and has been shown to enhance the thickness and overall appearance of scars.
Steroid injections can cause some discomfort, but the use of numbing creams can alleviate this pain. There are also several potential risks involved with this treatment, such as bleeding, bruising, infection, skin thinning, and skin discolouration.
Botox has more use cases than just smoothing out wrinkles. Research has indicated that it can help improve the appearance of fresh facial scars. This is done by inhibiting movement and relieving the tension on a scar, reducing the likelihood of it widening. Unfortunately, botox is not effective for and cannot reshape scars that have already been set.
Z-plasty is a cosmetic surgery technique that aims to improve the appearance and function of scars caused by contractures. This procedure can extend the length of a contracted scar, realign it in a more favourable position along natural skin tension lines, and separate a scar to blend in with the surrounding skin.
The operation involves rearranging two triangular flaps to produce the desired outcome. With z-plasty, there is a small chance of complications such as necrosis of the flap, hematoma formation, or infection.
Are scars permanent?
It is not possible to completely erase scars, but specific treatments can help improve the different aspects of scarring.
For example, treatments can help lighten pigmented scars, correct redness, raise indented scars, flatten scars, and improve scar texture. It often takes a combination of treatments to address all the different factors of a scar, and despite improvements, scars may not completely disappear.
Scar treatment should only occur after the wound has completely healed and there are no open areas or scabs left. For invasive operations such as scar revision surgery, it may be necessary to wait a year for the scar to stabilize beforehand. On a positive note, some scars naturally become less noticeable with time.
If your scar is causing physical discomfort, your private health insurance or Medicare may cover the cost of treatment. However, if the procedure is purely for cosmetic reasons, you will likely have to pay out of pocket.
Can topical skin care products treat scars?
If you are looking to fade your scar, off-the-shelf creams can be a practical option. Some people find success with natural ingredients like cocoa butter and aloe vera, though the benefits are often limited to hydration. If you want a more active approach, consider using scientifically-backed products such as topical silicone gel or silicone sheets, as numerous studies have shown them to be the most effective.
One natural product is an exception to the rule, an over-the-counter scar cream called Mederma, which utilises an active ingredient found in onions. In a comprehensive review of various scar treatments, 16 studies demonstrated the efficacy of Mederma.
When it comes to topical treatments, silicone is often your best bet. Proven techniques using silicone technology can minimise the redness and elevation of scars. Another option involves the combination of silicone with growth factors, which have also been shown to diminish redness and discolouration.
It is crucial to protect scars from sunlight, to avoid darkening. Make sure to always apply sunscreen with an SPF of 30 or higher when you are outside. Sun protection is one of the best topical ointments for scars and your skin's overall health.
Studies & Sources
Harithy, R & Pon, K 2012, ‘Scar Treatment with Lasers: A Review and Update’, Current Dermatology Reports, vol. 1, no. 2, pp. 69–75, viewed 10 February 2023, <https://link.springer.com/article/10.1007/s13671-012-0009-7>.
Hu, L, Zou, Y, Chang, S-J, Qiu, Y, Chen, H, Gang, M, Jin, Y & Lin, X 2018, ‘Effects of Botulinum Toxin on Improving Facial Surgical Scars’, Plastic and Reconstructive Surgery, vol. 141, no. 3, pp. 646–650, viewed 10 February 2023, <https://journals.lww.com/plasreconsurg/Fulltext/2018/03000/Effects_of_Botulinum_Toxin_on_Improving_Facial.14.aspx>.
Preissig, J, Hamilton, K & Markus, R 2012, ‘Current Laser Resurfacing Technologies: A Review that Delves Beneath the Surface’, Seminars in Plastic Surgery, vol. 26, no. 03, pp. 109–116, viewed 10 February 2023, <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3580982/>.
Sidgwick, GP, McGeorge, D & Bayat, A 2015, ‘A comprehensive evidence-based review on the role of topicals and dressings in the management of skin scarring’, Archives of Dermatological Research, vol. 307, no. 6, pp. 461–477, viewed 10 February 2023, <https://link.springer.com/article/10.1007/s00403-015-1572-0>.