Scar Treatment 101: What are the first steps?

Scar formation is a natural part of the skin healing process. It results from accidents, diseases, skin conditions and surgery. Although scars are permanent, they can improve and fade over a period of up to two years based on the severity of the injury, the size of the wound and the location on the body. After this time, it is unlikely they will continue to fade. Some people are also more prone to developing severe scars, with factors such as age, heredity and ethnicity affecting scar formation.

Standard advice in minimizing scar formation includes applying antibacterial ointments or petroleum jelly to keep the skin moist, changing bandages daily to keep the area clean, avoiding scab picking and minimizing sun exposure to the injured area. However, despite these precautions, scarring is often-times still unpredictable and results in many different forms such as flat, stretched, depressed and raised. The scarring process can be frustrating and have a significant impact on quality of life.

There are a variety of treatment options available that can help improve the appearance of scars and reduce associated discomfort. Additional reasons to seek medical care for scars include pain, itching, restriction of movement and psychosocial distress. The type of scar will also influence the kind of treatment your plastic surgeon or dermatologist recommends.

Topical treatments

Topical treatments are usually attempted before pursuing more invasive options. Over-the-counter topical corticosteroids, antihistamine creams and anesthetic ointments can help with healing and maturation of scars by reducing itchiness and discomfort. More potent corticosteroid creams requiring a prescription are sometimes used for newer scars that are pink and still healing to inhibit excessive scar formation.

Silicone has been used for decades in the treatment of scars from surgery, burns and other skin injuries requiring hospital treatment. The sheet form is a soft wound cover that works by sealing the scar and keeping it hydrated. For optimal efficacy, the silicone sheet should be worn for more than 12 hours a day for weeks to months. A more recent development is topical silicone gel, which is self-applied and quickly dries into a thin sheet within 4-5 minutes. Single-use silicone gel formats have been shown to be convenient while remaining cost-effective; they can be found in most pharmacies today.

Injection treatments

Corticosteroid injections are used to treat scars that are raised, thick or red, with more severe forms categorized as keloid or hypertrophic scars. Multiple small injections are made into the scar tissue to reduce local inflammation, itching and pain. Depending on the type of scar and response to a trial of steroid injections, sometimes injections are given at 4-6 week intervals for several months.

On the other hand, filler injections are used to fill depressed scars. Collagen and synthetic agents are injected into or under the scar tissue, producing immediate results. This procedure is mostly performed for cosmetic reasons, and since filler injections are not permanent, the procedure would need to be repeated every few years if desired.

Surface treatments

Skin resurfacing removes the top layer of damaged skin so new, smoother skin layers can form. This allows for improvement in surface irregularities and uneven coloring, making scars less visible.

Dermabrasion uses a rapidly rotating device to manually remove the outer skin layer. This technique is commonly used to minimize skin lines, acne scars, age spots and sun damage. A topical anesthetic may be applied before the procedure, and skin may be sensitive and blotchy for several weeks before returning to normal.

Superficial skin layers can also be removed chemically with chemical peels. There are multiple chemical solution options ranging from light to deep, with deeper chemical peels offering more dramatic results but also longer recovery times. Chemical peels are typically used to treat the face for acne scars, sun damage, wrinkles and melasma. In some cases, they can even help control acne. Some stinging and burning may be experienced during the procedure, and moisturizers and sunscreen are recommended for several weeks afterward.

Laser therapy pulsates concentrated beams of light at irregular skin to precisely remove skin layers. It can help flatten and soften scars, improve discoloration and give skin a tighter, younger-looking appearance. Its precision makes it very effective for small facial and acne scars, although full-facial treatments with weaker laser settings are also frequently done.

Lastly, other surface treatments include vascular laser treatment and skin bleaching. Vascular laser treatment reduces the redness of scars with blood vessels, and skin bleaching involves the use of topical creams that lighten skin.

Surgical treatment

Scar revision surgery can change the positioning and shape of scars. Surgery can also release a tight scar close to a joint to improve movement. The type of anesthesia – local or general – depends on the size and location of the scar. For scar excision and revision, scar tissue is generally removed entirely and a flap of adjacent healthy skin is manipulated to reform the area.

When a flap is not possible, a skin graft taken from another part of the body is used. The graft is usually taken from cosmetically less important areas like the buttocks or inner thighs. This approach is used to replace very large scars. Alternatively, a Z-plasty is a method that moves a scar into a natural fold or crease to minimize its visibility. It can also help relax or release tightness caused by scar tissue.

Another approach involves the use of tissue expanders, in which an expandable silicone implant is placed under the skin. Eventually, the healthy, stretched skin is used to replace the excised scar tissue.

Given the variety of scar treatment options, it is important to consult a board-certified plastic surgeon to determine which treatment is most appropriate for you. Combination therapies may be recommended. Your doctor can go over the risks and benefits as well as realistic expectations of your treatment plan.