Treating (and Minimizing) Scars
How Does a Scar Form?
The scar that you see on the surface of the skin is the result of a complex process the skin goes through as it recovers from damage. There are many factors that affect how a wound heals, and the way the wound heals affects how the scar will end up looking in the long run. How skin heals and scars varies from person to person, but it also depends on how you care for the wound before the scar is done forming.
The skin goes through three stages of repair before you see a scar. In the first stage, there's swelling, redness, and some tenderness or pain as a scab begins to form. During the next stage, new skin tissue forms underneath the scab. The final stage involves rebuilding and reforming the outer and inner layers of skin.
What you do during the first days after getting a wound, what you do after the scab has formed, and what you do when the scab eventually falls off all affect the appearance of the final scar.
Wound Care to Minimize Scars
There's an easy-to-follow plan to minimize scarring. Although there's a lot of anecdotal information about specific ingredients (such as aloe and vitamin E) to reduce scars, most of it is not supported by research and it may be just a waste of time, time during which you could have used more effective remedies instead. Here's how to care for a wound to minimize scar formation:
- Allow the wound to "breathe" as much as possible. Do not gunk up the area with creams, oils, or vitamin E from capsules because these substances have occlusive textures that can impede healing during the first stages of healing when the skin is trying to repair itself. The fluid that is produced naturally around a wound (known as exudate) is fine by itself for the first few days.
- Don't soak the wounded area in water or get it wet for extended periods; doing so breaks down the scab and impairs the formation of new skin below.
- Keep the damaged skin clean using a gentle cleanser, but don't overclean or scrub it.
- After cleansing, cover the wound with a thin, light bandage that allows air to circulate.
- You may want to consider a specialty adhesive dressing such as Nexcare Tegaderm Transparent Dressing or Convatec Duoderm Extra Thin Dressing. These cost more than standard bandages, but are excellent at keeping the wound moist without letting it get wet.
- If you suspect there is a risk of infection, consider using an over-the-counter antibacterial liquid such as Bactine Original First Aid Liquid or Band-Aid Antispectic Wash, Hurt-Free. If the redness increases or if the wound changes color, throbs, or swells, consult a doctor.
- After a day or two, apply a thin layer of a lightweight gel moisturizer or serum loaded with antioxidants (which are brilliant for helping skin heal) and other skin-repairing ingredients.
- If possible, rather than applying sunscreen to the injured area, keep it out of direct sunlight altogether, which means seek shade or cover it up. Sun exposure makes scarring worse, so protecting the injured area from the sun (as you should be doing for your skin everyday even if you don't have a wound) is important.
- At night, change the bandage; if the wound is dry or itchy, apply a very thin layer of a lightweight moisturizer or serum, as mentioned above. Keeping wounds moist (but not wet) encourages healing. Tip: A lightweight moisturizer also makes the scab less itchy as it forms, and still allows the skin to breathe!
- Once a scab forms, don't pick at it or even touch it—ever! Any manipulation or removal is a serious impediment to the healing that is taking place underneath the scab, and can cause scarring that otherwise would not have occurred.
- Do not irritate the skin! The skin's primary, natural reaction to a wound is inflammation, so anything you do to irritate skin further makes matters worse.
- Avoid soaps (they're too drying), highly fragrant products (whether natural or synthetic, fragrance is a skin irritant), and alcohol, peppermint, menthol, citrus, eucalyptus, clove, camphor, or any type of mint, all of which increase irritation and make matters worse.
Types of Scars
Depending on your genetic makeup and the depth and type of tear in your skin, scarring can range from a slightly reddish discoloration to a thick, raised red or dark scar. There are three main types of scars, generally described as flat, indented, or raised.
Flat scars are the most common, and usually occur from everyday injuries or minor burns. Depending on your skin color, flat scars may be pink to red (and eventually fade to very light pink or white) or tan to deep brown or black (eventually becoming lighter).
Note: The flat, pink-to-red or tan-to-brown marks left from a breakout are technically not scars. These marks are known as post-inflammatory hyperpigmentation. Read about how to treat these marks here.
Indented (atrophic) scars often result from cystic acne or a bout with the chickenpox virus. If you've ever had a deep, painful breakout or chickenpox, chances are you have at least one of these scars. Other names for indented scars are pockmarks, ice pick scars, and depressed scars. These scars result from destruction of the skin's underlying support structure, which is why they don't heal as well as flat or raised scars.
Raised (hypertrophic) scars result from overproduction of collagen in response to injured skin. This type of scarring can result from a slight tear in the skin or from a deep wound, and everything in between. Sometimes referred to as keloid scars, these are more common in persons with dark skin. Raised scars flatten over time, but can take years to resolve. We explain how you can help this process along in the next section: Scar Treatments. Stubborn or large/long raised scars may require medical or surgical treatment.
Even when you take the proper steps to minimize scarring, once the wound has healed, you'll likely want to keep treating the scar to make it even less noticeable. You'll be happy to know there are products and medical procedures that can help—a lot!
Even if you choose to do nothing, a scar continues to heal and change (for the better) for up to two years after the fact. With ongoing gentle skin care, sun protection, and patience (that's the hardest part), most scars get better, becoming less apparent over time. If you don't want to wait it out, here are some things you can do to treat the scars you have now:
- Apply a silicone-based scar treatment gel or serum loaded with skin-healing ingredients and antioxidants such as quercertin. Eight weeks of once- or twice-daily application can make the scar less noticeable, especially if it's a fresh scar. This type of product shows the best results on flat scars, but also can be helpful on raised and indented scars. Always treat the skin gently and protect the scar with a sunscreen rated SPF 25 or greater!
- Raised scars can be flattened to some extent with daily application of a silicone-based scar treatment gel and/or a silicone gel sheet, such as ScarAway Silicone Scar Sheets or Rejuveness Pure Silicone Sheeting (which is reusable). The sheet is worn for 12 to 24 hours at a time for at least three months.
- Indented scars respond best to a series of in-office laser treatments (including Fraxel), dermal fillers, fat grafting, or a combination of these. In extreme cases, surgery may be necessary; there are various methods your dermatologist can discuss with you. How much an indented scar improves depends on its depth and on how well your skin responds to treatments. Although it's not realistic to expect 100% improvement, 50% improvement is possible.
What about Mederma for scars? Research on Mederma is conflicting; some research shows that it does work and some shows that it does not work, so the results are mixed. Yes, that's confusing, but it's what the science says. You can check out our assessment of Mederma Advanced Scar Gel here. In short, Mederma is a product for which you must weigh the pros and cons yourself.
Watch out for scar gels that are little more than silicone, and there are a lot of them out there. Although pure silicone can help heal and reduce scars, silicone alone isn't all that the skin needs to improve scars. A range of anti-inflammatory, skin-healing, and skin-repairing ingredients will get you much better results because they work with the skin's natural repair process.
Sources: Journal of Drugs in Dermatology, January 2013, pages E7–E13 and 86–90; Lasers in Surgery and Medicine, August 2012, pages 447–452; The Journal of Craniofacial Surgery, May 2010, pages 706–710; International Journal of Molecular Medicine, March 2010, pages 347–352; Burns, December 2009, pages 1097–1103; Journal of Drugs and Dermatology, July 2008, pages S2–S6; Cancer Research, December 2007, pages 11906–11913; Dermatologic Surgery, February 2006, pages 193–197, and April 1999, pages 311–315; The Journal of Trauma, November 2004, pages 1032–1037; Plastic and Reconstructive Surgery, July 2002, pages 177–183; and Total Skin, Leffell, David J., M.D., Hyperion Press, 2000, pages 189–199.