Scars

Scars are normal results of skin injury, including accidental lacerations, surgical wounds, and some conditions such as skin infections and acne. They are a result of skin repair and remodelling, which occurs over many months following the injury.

Skin recovery and repair

After an injury, the skin recovers in several distinct phases.

Inflammation

This phase is the immediate response to injury, starting within minutes and lasting up to several days. In this phase, there may be swelling and tenderness around the wound and exudate, a clear straw-coloured fluid, may “weep” from the wound.

Proliferation

The proliferation phase starts several days after injury and usually lasts several weeks. During this phase, new tissue (known as granulation tissue) is formed. This tissue has many blood vessels, which make it appear pink or red. The skin develops collagen fibres to maintain its structure.

Remodelling/maturation

This phase usually lasts several months, but it can take years. Collagen fibres realign along skin tension lines, and the number of blood vessels decreases. As the re, remodelling stage progresses, the wound usually becomes paler.

What causes scars?

An abnormal scar is the result of excessive blood vessel and/or collagen fibre production during the wound healing process. This can lead to an elevated or discoloured scar. Overgrown scars are more likely to occur:

• If the skin damage is deep.
• In young people (under 30).
• In people with darker skin types.
• If the skin is stretched tightly, either at the time of the procedure or during the wound healing process.

Common types of scars

Surgical scars

Surgical scars are usually a line or long, narrow ellipse at the site of a skin procedure. If the wound has been stitched, there may be lines across the wound where the stitches were. Sometimes they become raised or discoloured.

Some surgical scars are soft and depressed due to inadequate collagen production during the healing phase. These are known as atrophic scars.

Acne scars

Acne scars are left behind after the acne condition has resolved. These scars are sometimes shallow and wide (known as rolling scars) or deeper and narrow (ice pick scars) or broader with sharp edges (boxcar scars).

Acne scars are more likely to occur after severe cystic acne, if there is a family history of acne, and if pimples have been picked, squeezed or scratched.

Acne scarring may also result in raised and discoloured scars.

Keloid scars

Keloid scars are significantly overgrown scars, spreading much wider than the original wound or injury. They may be itchy or irritated.

Treatment of scars

Fractional laser

Fractional laser treatment breaks up collagen in raised scars and promotes the growth of normal skin cells.

Microneedling

Microneedling increases the production of collagen. It’s useful for depressed scars and in cases where laser can’t be used.

Cryotherapy

Cryotherapy is a quick and inexpensive way of damaging scar tissue. It’s not as effective as laser or microneedling.

Scar remodelling injections

Injections into a scar can reduce inflammation, slow overactive scar development and encourage the growth of normal cells.

Silicone gel

Silicone gel applied for up to three months after an injury or surgical procedure can help top prevent scars.

LED light therapy

LED light therapy, administered as a course of 3 or 4 treatments 2 days apart, can speed up the early stages of wound healing.