Understanding Scars
When a person sustains a minor injury, such as a scrape after a fall, a scab typically forms. When the scab falls off, the skin may be pink or reddish in color, but over time this will fade and the skin will return to normal. Wounds such as these only cause a partial thickness skin injury and are likely to heal without significant scarring because there is sufficient remaining skin to regenerate the surface layers.
Conversely, when a full thickness injury through the skin occurs from an accident or following surgery, the skin does not regenerate, but rather it heals with scar tissue. Scar tissue consists of collagen, whereas skin consists of the dermis and epidermal cells. Although scar tissue is similar to skin, it is not identical and that is why a scar can always be differentiated from regular skin.
Scars are permanent!
Skin is elastic. When lacerated, the edges of the wound pull apart. When an open wound is closed with stitches, the skin along each side of the wound is pulled together with stitches. The skin, being elastic, tries to return to its original position. Because the healing scar tissue is only 80% as strong as natural skin, the scar will stretch and may result in a wide scar.
In an attempt to prevent the scar pulling apart, the healing scar may thicken and bulge above the level of the surrounding skin.
Scars typically thicken for the first few months after injury occurs and then will soften and flatten over a period of a year or two. The red color of the scar will also fade over a period of a year or two. A mature scar will usually be lighter than the surrounding skin.
The surgeon has a partial role to play in the healing of the scar. The surgeon is able to control the neatness of his or her stitching of the scar and the tension in the closure of the wound. After the wound has been stitched, the healing that occurs thereafter depends on many factors. Some of these factors include the following:
Patient Factors
o The patient’s genetic makeup
o Overall health
o Diet
o Smoking
o Diabetes
o Tension of the scar
o Stretching/pulling of the wound (may contribute to a wide or thick scar)
Complications
o Separation of the wound edges
o Development of wound infection
Scar Treatments
In general, there numerous options to improve the appearance of scars:
1) Over-the-counter or prescription creams, gels, oils, ointments, and tapes
2) Dermatological interventions such as chemical peels, microdermabrasion, dermaplaning,
lasers, fat grafting.
3) Surgical revision.
4) Steroid or collagen injections – These injections help soften scars and may shrink them.
5) Indented scars may respond to dermal filler injections.
Scar Care Products
While the wound is open, follow the treatment recommendation of your health care provider.
There are many products available on the market to improve the appearance of scars. Wait until the wound is completely closed before beginning scar treatments.
Silicone-Based Products:
Silicone based products have been shown to improve the appearance of scars. A study by Puri and Talwar (2009) found
that silicone produces an 86% reduction in scar texture, 84% in color improvement, and 68% reduction in scar height. These products are available as gels and tapes.
Some advantages of using a silicone based product are the following:
Increased skin hydration thereby facilitating the regulation of fibroblast production
rather than collagen production. This results in a softer, flatter scar.
Reduces itching and discomfort associated with scars.
Silicone Gels – A thin layer of a silicone based gel will dry within 4-5 minutes of application and work for 24 hours.
Silicone Based Tapes - These products come packaged as squares that can be cut into appropriate sizes to cover the scar.
Generally, patients should wear the scar strips over the scars for a number of weeks for optimal results.
Mederma:
Mederma products claim to improve the overall appearance, color, and texture of scars. The active ingredient in this products is the common onion, or allium cepa.
Onion extract apparently reduces inflammation, inhibits bacterial growth, and regulates excessive collagen growth. While these properties seem as though they would be effective, clinical research shows mixed results on scar products using the onion as the active ingredient.
Bio Oil:
Bio Oil is a moisturizing oil that claims to improve the appearance of scars, stretch marks, uneven skin tones, aging, and dehydrated skin. Bio Oil contains plant extracts and vitamins which are mixed into an oil base. It contains both Vitamin A and E, but the breakthrough ingredient, PurCellin Oil, is what Bio Oil claims makes the formula light and non-greasy, allowing for better absorption of the vitamins and plant extracts.
Vitamin E:
Many believe that putting vitamin E on scars will improve their appearance; however, there is a paucity of scientific evidence that supports this notion. Vitamin E does influence the formation and arrangement of collagen fibers.
Dos and Don’ts of Scar Care
To lower the chances of developing a more noticeable scar, we recommend the following scar tips:
- Protect the scar from the sun for several months to avoid permanent darkening of the scar.
- Do not apply any scar care products until the wound is completely closed.
- Gently massage the scar twice daily to assist your body in the remodeling process.
Vanessa Lelli, CNP
Bryan J Michelow, MD
