Scar. It’s a four letter dreaded word that cannot possibly mean anything good. Scars in cosmetically sensitive areas such as the face, hands, breasts, and belly can certainly make one self conscious and seek out scar revision surgery. But scars can sometimes be managed well without surgery. This article will discuss why we scar and how to improve them.
Scars are a normal reaction from the body to injury. When the surface of skin is injured, the body will immediately to to wall off the surface from the environment for obvious reasons. Time is of the essence. Cells rush to the injured site and throw everything including the kitchen sink into the wound to get it closed as quickly as possible. There is no time for decorating the wall. If we evolved as humans to “take our time” to heal with the primary goal of beauty, we’d all still be cosmic dust.
Now that you know why we have scars, why do some scars look better than others? Here is a list of things that determine how scars look after healing, in no particular order.
- Area of the body: More vascular areas like the face heal better (and form nicer scars) than the back, leg, or arm.
- Orientation of the scar: Scars that form in favorable orientations relating to underlying muscles will heal better. In addition, areas that are static will heal better than areas that have a lot of motion. Lastly, scars that are oriented along with natural contours of the body heal and look better than those that do not.
- Technical closure: It is debatable how important this factor is in the healing of wounds. Certainly there are better ways than others to close a wound, but the real question is how much does this matter in areas that heal very, very well or areas that regardless of closure, heal poorly?
- Timely stitch removal and types of stitches: Stitches themselves can ironically cause scars if they are left in too long or are of the dissolvable type. An entire chapter can be written on stitch (suture) selection and does play into #3, technical closure.
- Tension: Wounds with greater tension will often result in wider scars. The tighter it is, the wider it gets, is a rule in plastic surgery.
- Genetics and skin type: This may be the most important variable. Darker skin persons tend to develop darker (or lighter) and often wider and elevated scars. Red heads with blue eyes almost always heal with the smallest scars with the least changes in pigmentation.
- After care: Silicone sheeting and sunscreen as well as massaging of scars do help improve the final appearance of scars.
If you have a scar you don’t like, it is possible it can be improved with surgery or other methods. Below is a list of methods to improve a bad scar:
- CO2 laser resurfacing (limited efficacy in dark skinned persons)
- Surgical scar revision: The scar can be excised and closed with better stitches, technique, and aftercare.
- Proper after care: (see above)
- Kenalog injections: To shrink elevated scars
- Medical tattooing: To darken light scars
- Nano-fat (micronized fat): To deliver stem cells into the scar to aid in remodeling
- PRP (Platelet rich plasma): To deliver cytokines and growth factors into the scar to aid in remodeling.
- Sunscreen with SPF 30 or greater: To reduce the sun’s UV radiation exposure that can darken scars.
- Microneedling: To improve blood flow and aid in tissue remodeling.
- Timing: Wait at least 6 months before any surgical revision to ensure the best possible result. But act on scars as quickly as possible with other non-surgical methods.
While there may be more factors, those are the big players. So, if you have a scar that bothers you, it may be worthwhile to get it evaluated because early intervention can make the outcome better.
To contact Dr. Neavin to discuss a scar that bothers you, click here.
Dr. Tim Neavin is a board-certified plastic surgeon located in Beverly Hills, California.