If you have a shallow wound—a skinned knee, a paper cut, a minor burn-new skin
grows back, filling the injured area with fresh tissue that is virtually identical to the original.
If a wound has a depth of one-half inch or more—piercing the skin's outermost layer (the epidermis) and penetrating the dermis beneath it—the repair won't be perfect. To heal a deeper wound, your body relies on collagen, an elongated protein that provides structural support, like girders in a building-which often results in a scar.
Here's how to prevent scars and minimize the ones you have…
Types Of Scars
Scars are categorized by shape…
- Indented—typically caused by acne or chicken pox.
- Hypertrophic. These red, thick scars stay within the boundary of the wound but rise above the skin's surface.
- Keloid. The scar tissue is raised but also pours out beyond the outline of the wound, over the surrounding skin.
Many factors can affect how a scar develops, including…
- Age—younger skin tends to heal more vigorously, producing larger scars.
- Skin color—keloids are more common among dark-skinned people.
- Location—tighter skin, such as that along the jawbone, makes a scar more visible.
- Size of wound—larger wounds typically produce larger scars.
Preventing Scars
Proper self-care after sustaining a wound is crucial in either preventing a scar or achieving the smallest, least noticeable scar possible.
Important: Many people believe that a dry, uncovered wound heals best, but scientific studies show that keeping a wound moist is ideal for minimizing the scar as a wound heals. What to do..
- Apply an over-the-counter antibiotic ointment. Use enough to moisten the wound. This will also help prevent infection, which may create a deeper wound that is more likely to scar.
- Cover the wound. Use a bandage of some kind. Hundreds of products are available. Choose one that you find comfortable and easy to use.
- Keep the wound covered until it's healed. Change the ointment and covering every day or two. When showering, remove the bandage and replace with a clean one after the shower.
- Don't pick at the wound. Don't squeeze acne bumps, scratch mosquito bites or dig at scabs-you may increase the chances of a scar.
- Try massage. Just after healing is complete, if there is a scar, cover it with petroleum jelly and massage it gently but firmly with the tips of your fingers for 10 minutes or so every day for one to two months. This will soften the scar and help minimize its appearance.
- Ask your doctor about silicone sheeting and gels. Although scientists don't know why it works, applying a bandage like sheet of silicone gel can help stop a new scar from becoming hypertrophic or keloidal, or it can help reduce an old scar. For new scars, the sheeting should be applied about one week after the injury or removal of sutures.
Minimizing Existing Scars
Many medical treatments may minimize an old scar-but none can completely remove it. A dermatologist and/or a plastic surgeon can recommend the best treatments for the scar you have. Here, the most effective ways…
Keloid and hypertrophic scars.
- Pulsed dye laser. Although many types of laser treatments are available and widely advertised) for scar reduction, the pulsed dye laser (PDL)—which focuses ultrashort pulses of high-energy yellow light on the scar-is the gold standard. It can remove redness, flatten the scar and relieve itching (which often accompanies a scar) Two or three treatments are typical, once every one to two months.
- Cortisone injections. Injecting cortisone-a synthetic version of a hormone produced by the adrenal gland-can shrink and flatten a scar. (How it works is unknown.) Typically, three or four injections are needed, every two to four weeks.
- Interferon. The immune system produces this protein when battling viruses, bacteria and other infectious agents. When injected, it can flatten a scar and reduce redness. The number and timing of injections are the same as for cortisone.
- Aldara. A keloid scar can be surgically removed, but it's a risky procedure-chances are 50-50 it will grow back, perhaps even larger. Aldara cream is an immune response modulator that stimulates the production of interferon. Applied after surgery, it may help keep a keloid from returning. It is best for surgically removed keloids.
Indented scars.
- Laser resurfacing. This intense treatment employs the high-energy light of a carbon dioxide laser, which literally burns off the layers of damaged skin, creating an even, smooth surface. The procedure often requires local anesthesia and takes about a week to heal. The skin may remain red for months.
- Fillers. Made from a material such as collagen, a filler is injected with a fine needle two to three times over three months into one or more indented scar areas, temporarily lifting the area. It typically takes more than one treatment to see results, which last six to eight months. Popular fillers include Dermalogen, Restylane, Hylaform, Cosmoderm, Cymetra and Artecoll.
Other scars.
- Surgical scar revision. The body has skin tension lines-creases where wrinkles form, such as where the nose meets the cheek. Scars falling along a tension line are less prominent than scars at an angle to a line. In this technique, the doctor surgically repositions the scar so that it falls within a tension line
Best for: Wide or long scars, scars in prominent places (such as the forehead) and scars with irregular, rather than straight, patterns.
- Botox. The muscle-paralyzing toxin, used cosmetically to relax wrinkles, also can minimize scars from forehead wounds.
Recent study: Injections of Botox around a forehead wound from injury or surgery improved the appearance of the wound six months later by 20%, compared with non-injected wounds.
Best for: Scars on the forehead.
What Doesn’t Work
- Mederma. This over-the-counter topical gel, made from onion extract, often is recommended as a way to minimize new or established scars.
Recent study: Dermatological surgeons at Harvard Medical School studied 24 surgical patients, treating half of their scars with onion extract and the other half with petroleum-based gel. There was no difference between the two areas in appearance, redness or size of scar.
- Vitamin E. In a study conducted at the University of Miami reported in Dermatological Surgery, dermatologists found no difference in scarring of wounds treated with or without topical vitamin E.
