What Is A Scar?
Any incision or break in the skin may form a visible area that appears different from surrounding tissues—a scar. Burns that break the skin and damage the upper layers may also leave a scar.
Our bodies have an amazing ability to repair injuries. If a skin wound stays superficial and doesn’t penetrate completely through the layers of the skin, then the skin is able to repair itself without leaving a visible scar. This kind of wound is similar to a scraped knee, or an intentional wrinkle-reducing laser burn. A visible scar forms when an injury breaks the integrity of all the layers of the skin to the underlying subcutaneous tissues.
As the wound heals, new, tiny red blood vessels are stimulated to grow toward the wound to provide more avenues to transport bacteria fighting cells and collagen producing cells. The fibroblast, the collagen producing cells, lay down new collagen, and we see evidence of their presence as the edges of the skin contract to close the wound.
As the wound heals, the collagen continues to remodel itself in an attempt to fall within the natural tension lines of the skin. As time passes, the wound contracts and often forms a depression in the skin. When they’re no longer needed, red blood vessels retreat, which is why the scar becomes pale white. New collagen layers do not contain pigment or hair cells, in contrast to the tissues surrounding the wound. If too much collagen is laid down in a haphazard manner or the normal process of collagen remodeling doesn’t occur, then a hypertrophic or a keloid scar forms. In general, those who are older with thinner, fair skin tend to heal with less chance of scarring than a younger person with thicker, darker skin. Younger people with thick skin tend to have robust collagen-producing cells that respond strongly to an injury by creating an abundance of collagen.
Both hypertrophic and keloid scars are more common in the thicker, oilier skin of those of African descent, including African Americans, and those of Mediterranean descent. A hypertrophic scar is an enlarged, widened scar, but it stays within its borders and does not grow in size. Hypertrophic scars can usually be eliminated by excising (cutting) it out and re-sewing the edges back together. A keloid scar is bulky and tumor-like, in that it outgrows its borders and becomes increasingly larger and potentially disfiguring. Keloids are commonly seen on ear lobes, shoulders, and the chest. There is a general range in the aggressiveness of keloids: some are more aggressive than others and continue to grow to great sizes while others grow slowly. Why this happens is not well understood.
How To Prevent A Scar
Most relatively minor injuries, even those that are closed with sutures, will heal on their own and not require further treatment. Here are a few guidelines to prevent or minimize a scar:
Don’t smoke! This will significantly increase your chance of noticeable scarring.
Following a repair, with or without sutures (see below), unless otherwise instructed, be sure to the wound is kept moist and clean. Vaseline and Aquaphor are good moisturizing products found in your local drugstore. If you use a topical antibiotic ointment, such as Bacitracin or Neosporin, on any healing wound, apply it for only 24 to 48 hours and then switch to Vaseline or Aquaphor. This can be left on for approximately a week. Antibiotic ointments can irritate the skin and you don’t need the topical antibiotics after 48 hours anyway because the body in most cases has already placed a protective film over the wound. After sutures are removed, treat the area gingerly to avoid re-injury. Avoid exposing the injured/repaired area to the sun, and protect the area with sunscreen. Sun exposure may lead to permanent skin color changes to the scar.
Topical And/or Oral Treatments
Tissue glues are similar to the Super Glue or Krazy Glue you find in your local hardware store. Although I wouldn’t recommend using hardware store glue on your skin, I’ve seen maintenance workers who knew about the action of these glues and repaired their own skin wounds using just such a product—and rather successfully, too.
Over-the-counter topical agents, such as Mederma, are reported to improve the appearance of scars, but most do very little if anything to help the appearance of the scar, especially if it is an old scar. OTC products such as Vaseline and Aquaphor will help keep the tissue moist while it heals, thus minimizing the scar.
Procedures And Other Treatments
When Sutures are recommended
If an injury penetrates through the skin to the subcutaneous tissues, then we need to help the repair process through sutures (stitches), which give us the best chance to minimize the scar. If the injury is on the face, it is important to have the wound seen by a physician within 12 to 24 hours following the injury.
After that 24-hour window, an open wound is at high risk for infection and may not be treatable with stitches. In such a case we will have to allow it to close on its own over time, which will leave a noticeable scar.
Cosmetic doctors recognize the importance of bringing the edges of the skin together in a way that gives a wound the best chance to heal well. In addition, certain inherent lines of resistance exist in the skin; in order to be hidden, it’s important that the scars fall into the lines of least resistance. A scar that goes against the normal tension of your facial skin is worse than one that “works” with the lines of least resistance.
After a wound is closed with stitches, you’ll likely be instructed to use a topical ointment on the wound’s surface for one week. With the exception of a few rare situations, moist wounds always heal better than dry wounds. Dry wounds lead to scabs, which increases the chances of scarring.
Once the stitches are removed, the wound is weakly held together, so you have to be careful not to re-injure the area and reopen the wound. During this early healing phase, there are things we can do to end up with the least noticeable scar possible, such as trying the OTC gel Mederma.
Scarring may be treated with lasers as early as six weeks after surgery. Dr. Edgar Ardila achieves excellent outcomes using short pulses of micro-fine laser light to reach deeply into the skins sub layers. The body’s natural healing process sweeps away the damaged tissue and rebuild it with fresh new collagen and elastin- the building blocks of normal looking skin. This FDA cleared procedure is best for lighter skin types, easy to tolerate, can be accomplished in as little as 30 minutes and requires little to no down time.
In just a few, fast, easy treatment sessions, scars are much less visible, leaving behind smoother more attractive skin.
Contact Riverwalk Medical and Wellness to learn about FDA cleared scar treatments.