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Battling Scars: How to manage different types of scars

They say every scar tells a story, but not every story needs to be retold. Here is everything you need to know about improving that stubborn scar.

The same thing causes all scars: surgery, burn, cut, acne spot, or other injury that triggers a dermal healing response that brings in inflammatory cells. After being hurt, all living things have a natural ability to try to restore function and fix damage to the body. Scar formation is the first step in healing skin, other tissues, or even entire organs. It covers open areas to keep bacteria out and keep tissues from drying out.

It is an amazing thing when you think about what would happen to our bodies without the ability to scar. If our skin did not scar, we would walk around with big wounds, so scarring is necessary. Scars are like some kind of biological glue, but society has decided that they are not attractive. Still, there is no pattern to how the body heals from an injury, so scars can differ. If you do not like the way a scar looks, no matter where it came from, there are things you can do to make it less noticeable.

What Determines the Appearance of a Scar?

No two scars heal the same, even on the same person. Scars heal in different ways depending on how bad the injury was, where it happened, your genes, and how your body reacts to collagen (i.e., how much of the protein, like the building block of skin, is made). When new collagen forms, the bundles fill a hole in the dermis (the second layer of skin). The scar is flat when the body makes the right amount of collagen. When the body makes too much collagen, thick, rope-like scars and keloids form. All scars start out red, then turn pink and white as they heal.

Like a good piece of real estate, the result depends on where the scar is. Some body parts are better equipped to deal with scarring than others. On the face, where there is a lot of blood flow, the area tends to heal more quickly. The further south you go, the less true this is. The blood supply is farther away from the heart as you get closer to the waist and lower. Because of this, it takes a lot longer to heal. Tension is another thing that can cause scars. There is much pulling and tugging in places like the shoulder and back, which can make a scar look bigger because there is always tension.

Types of Scars

Scars are all different, just like snowflakes. At the broadest level, scars can be put into two groups:

Sunken (also called "atrophic"): Sometimes scars are atrophic or indented because there aren't enough fat or other structures under the skin to fill them in.

Hypertrophic (also known as "raised"): In other cases, the body has an overly enthusiastic response that causes too much scar tissue, which shows up as raised or keloid scars, which are usually the hardest to treat. Even if you treat them, they may come back or not respond as well.


Ice Pick Scars: Ice pick scars are deep, narrow, and small. They are almost always caused by nodules or cysts. Ice-pick scars are usually indentations in the skin on the cheeks. They look a bit like puncture wounds.

Boxcar Scars: Boxcar scars are more like craters and are rounder than ice-pick scars. They are wider than ice pick scars but not as wide as rolling scars. They are often caused by acne and are harder to treat the deeper they are.

Rolling Scars: Rolling scars look like pits but do not have precise edges. They give the area a wavy texture and can worsen with age because the skin loses elasticity and collagen.


Even though not all raised scars are keloids, keloids are probably the most well-known type of raised scar. They are also thought to be some of the hardest to treat. Keloids usually form after surgery, a cut or wound, or even a piercing. They are broad, significant, and puffy. Keloids are tumors that grow outside the boundaries of the scar (tumors, by definition, are a growth in the skin and can be noncancerous).

People with darker skin are more likely to get keloids (but any skin tone can develop them). Even though Asians and Africans tend to get keloid scars more often than other skin tones, we do not fully understand why. It has to do with the whole inflammation process and collagen re-growth in the injured area. Some people have a more robust inflammatory response than others, for whatever reason, and especially in those two populations, we see it more often.

At-Home & In-Office Scar Treatments

Scars cannot all be fixed with the same treatment. Each type of scar reacts differently to treatment, so choosing the correct procedure is essential. For the best result, your Certified plastic surgeon will need to look at the scar's size, color, and texture in person. Most scars can get better, even if it means trying different things. No magic pill or one treatment will make scars look perfect. We cannot always get rid of a scar completely, but we can eliminate the redness, change the scar's shape, and make it thinner.

No matter how old or new your scar is, the first rule of scar care is always to protect it from the sun with sunscreen to keep it from getting darker and to make it look better. From there, here are the best treatments for each type of scar:


Scars that are less than six months old respond best to this treatment. If a scar is new, light, and small, you may be able to treat it with a mix of over-the-counter ingredients like vitamin C, retinol, and hydroquinone or with a scar cream that has a mix of effective ingredients.


Best for reducing the look of closed, raised scars from surgery. These specially made self-adhesive sheets (they look a bit like a mega bandage) work well on just about every kind of scar. They not only act as an occlusive dressing, which keeps moisture in by making a barrier, but they also keep the pressure on the scar even. Silicone gel sheets keep the scar and skin surface from getting raised, unsightly, or painful for no apparent reason.


Best for scars that are hard, red, and raised. "Polyurethane dressings" are kind of like a flexible, waterproof pad. They were first used to help wounds heal, but a few smaller studies have shown that they can help the surface of a scar, improve microcirculation, and change the color, firmness, and thickness of a scar for the better. Polyurethane is an alternative to silicon but acts like an occlusive dressing.


Best for scars that are thick, raised, painful, or itchy and have already healed. Steroid injections, which a dermatologist or plastic surgeon does, use cortisone to thin out scars. Some even have minimal amounts of 5-fluorouracil (5-FU), a cancer drug that slows the growth of scar tissue by reducing the activity of fibroblasts. Cortisone can darken the injection site, but when injected into a keloid, it makes the scar softer and less intense.


Best for acne scars that are sunken and depressed, like ice-pick scars. For the past few years, doctors have treated scars by injecting fillers. Dermal fillers add volume to a scar to make it look more like the rest of the skin around it. Depending on what the patient wants, hyaluronic acid fillers can be used for immediate improvement, or bio-stimulatory fillers can stimulate collagen production around the scar like a scaffold. Some doctors combine hyaluronic acid filler with platelet-rich plasma (PRP) to even out the scar and change how the skin looks around it. Just like when you put filler in your face to make it look better and slow down aging, the results are not permanent and need to be done again.


Best for surgical scars and scars in places where there is bone. Neurotoxin is one of the newer ways to fix scars. It can be injected into the scar to relax the muscles that are pulling on the scar tissue. Using Botox or other neuromodulators to reduce or stop muscle contraction in and around the scar has been shown to reduce hypertrophy and to reduce fish-mouth or spread scars.


Best for scars from acne, keloids, scars that are raised or flat, scars that are red or discolored. Therapies that use light or a laser to stimulate new collagen can make the scar look less noticeable. Scars on lighter skin respond well to treatments that use light, like intense pulsed light and broadband light. Pulsed dye lasers, which target blood vessels in the skin, are best for making scars less red while resurfacing lasers can make the scar look and feel less harsh. With these lasers, tiny wounds are made on a certain percentage of the skin in a controlled way. This starts the body's natural healing process.


Best for Superficial surgical & acne scars. Micro-needling, also called collagen induction therapy, maybe the most popular way to get rid of scars, especially acne scars. It makes tiny holes in the skin to stimulate new collagen growth, which then smooths out the skin and the scar. It can also be used with PRP to improve the results even more. Micro-needling does work, especially when it is done with PRP, and some studies prove it.


Best for acne marks. Subcision is one of the best ways to pull a deep scar out from under the skin and make it more even with the surface. In this classic method, a hypodermic needle is put into the skin right under the scar to loosen and break the fibers that hold the scar to the tissue underneath. This helps mainly to lift depressed scars, but it can also help release collagen when the needle is inserted to speed up the healing process.


Best for Stubborn keloids. One scar treatment that does not get as much attention is radiation therapy, which is suitable but only used to treat keloids. It is used as a last resort for keloids that are very hard to treat. If you're wondering how this therapy is like treating cancer, the answer is that it is. Ionizing radiation is used to treat cancer and tumors. It is usually put on the outside of the body to kill collagen-producing cells and stop the body from making more.


Surgical scar revision is usually done to fix a horrible scar, like after a C-section. It works best when a piece of the original scar is cut out. However, here is the kicker: any time you have surgery to fix a scar, you'll end up with another scar, though it might be thinner and flatter. Remember that the only way to remove a scar is to cut it out and put another scar in its place. Nevertheless, sometimes, we can get a new scar to cover up the old one.

The Take-home message

Scaring is like a child you want to control but cannot. While scarless procedures sound promising, they are far from reality, and you cannot do much to prevent occasional nicks and scratches. Fortunately, there are more treatment options than ever for virtually every type of scar.

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