Scarring can be very troubling, especially if it’s on the face or somewhere else that isn’t easily covered by clothing. Permanent marks can remain on the skin after injuries, inflammation, burns, surgery, or acne. Any time damage to the skin goes beyond the top layer (the epidermis) and disrupts the deeper layer (the dermis), a scar forms. Fortunately, there are several options available for improving the appearance of scars.
How Scars Form
The body makes collagen to help repair or replace damaged skin. If too much or not enough collagen is produced during the healing process, a raised or depressed mark can remain.
Though made of collagen, scar tissue is different than the skin it replaces. The body goes about repairing itself in a hurry, and the new collagen gets laid down haphazardly. For this reason, scar tissue doesn’t have sweat glands or hair follicles and is more susceptible to sun damage. Sunscreen can help fade existing scars or keep scars from darkening.
Scars come in different shapes and sizes. Some are flat, while some are lumpy or sunken. Sometimes they’re painful, itchy, or restrict movement. The type of mark you end up with depends on how you were wounded, the size, depth, and location of the wound, and how you care for it as it heals.
Types of Scars
Flat scars are pink or red and slightly raised when they first appear. Over time, a flat scar changes color and flattens, eventually becoming the same color as your skin. Sometimes flat scars will end up paler or darker than the surrounding skin.
Hypertrophic (or raised) scars are a result of an overproduction of collagen during healing. Hypertrophic scars resemble a lump or mound. They’re similar to keloids, except they don’t expand beyond the original wound. Severe acne can cause this type of scar.
Hypertrophic scars are most common in men and generally found on the chest, shoulders, and back (but can form anywhere). These scars can look worse than the original blemish because they’re more substantial than the initial injury or inflammation.
Keloids are raised, firm, smooth scars, that become much bigger than the original wound. Flat and hypertrophic scars become less noticeable with time, but keloids don’t improve without treatment. They can increase in size for months or even years after they appear. Sometimes they’re painful or itchy. People with darker skin are more prone to keloids. Any injury can become a keloid; even ear piercing and tattoos have been known to cause keloids for some. Keloids are challenging to treat, as when they’re removed they often return.
Atrophic (or depressed) scars are divots left in the skin because of damage to the underlying collagen or fat. Inflammation like cystic acne or chickenpox often causes depressed scars.
These depressions or pits in the skin generally appear worse with age. Loss of firmness and sagging makes them more apparent.
There are three categories of atrophic acne scars:
Small, deep marks that penetrate the entire top layer of the skin. These scars usually look like tiny holes or oversized pores.
Much larger than ice pick scars, boxcar scars are larger depressions with a more defined border. When a cyst destroys fat cells below the dermis, the result is a boxcar scar.
Rolling acne scars resemble crater-like depressions. A few of them close together leads to a rippling appearance on the skin’s surface. During healing, fibrous bands of tissue develop beneath the epidermis that pull down on it, causing a rolling, wave-like effect.
Some acne scars fall into the hypertrophic (raised) category:Picking pimples can also lead to scarring. It’s best to keep your hands off of blemishes. See a dermatologist or esthetician, as they can extract acne without causing scars. A dermatologist can prescribe something to get acne under control, lessening the chances of scarring.
Contracture scars form when a large area of skin is removed or severely burned. The scar tissue pulls the edges of the skin together, making the area tight. This tension can sometimes interfere with movement. If a contracture scar is on the elbow, for example, it can prevent full extension of the arm. When a contracture scar limits mobility, see a physician.
Stretch marks form during rapid weight gain or growth. Pregnant women, adolescents, bodybuilders–just about anyone can get them. When the skin stretches quickly, the connective tissue beneath breaks, leaving behind marks.
Naturally occurring cortisol in the body or corticosteroid medications make the skin less elastic, increasing the risk of stretch marks. Rapid weight loss can also cause stretch marks.
At first, the marks appear red, purplish or brown, but over time they fade to white or silver.
Treatments for Scars
Keloids and atrophic scars don’t fade on their own, but many scars will eventually become nearly invisible. If you have a mark that’s less than a year old, be patient. With time it could become barely noticeable. If your scar is more than a year old and you’d like to improve its appearance, there are several options available.
It’s important to have realistic expectations when it comes to scarring. Scars are permanent, and the best possible outcome is significantly reducing their appearance. A combination of modalities to target scarring will yield the best result.
A chemical peel is effective for superficial scarring and textural irregularities. A course of several peels can make a significant improvement in the appearance of milder scarring. During a chemical peel, a gentle acid is applied to help break up the top layer of skin. The practitioner will choose the appropriate depth of peel depending on your skin type and concerns.
Laser resurfacing works well for scar reduction. Targeted heat and light erode the surface of the scar, decreasing both color and size. Lasers also stimulate new collagen that will gradually replace tissue lost to scarring.
Clear + Brilliant Laser
The Clear + Brilliant laser creates millions of microscopic wounds over the skin’s surface, breaking up damaged cells. It gently resurfaces skin and encourages the production of healthy new collagen. Clear + Brilliant also diminishes hyperpigmentation, pores, and fine lines while improving overall skin tone and texture. It’s a very gentle type of fractional laser without the week or more of downtime that typically follows.
After treatment, your skin will feel a bit rough (think sandpaper) for a day or two, but nothing anyone except you will notice. By day three or four you’ll see new, fresh skin emerge. Multiple treatments produce a significant improvement.
The Aerolase LightPod is an Nd: YAG 1064 nanometer laser with a 650-microsecond pulse duration. This rapid pulse of energy keeps skin from overheating, making it one of the most comfortable laser treatments on the market. Aerolase helps to break up and resurface scar tissue while also reducing pigment. The Aerolase can also be used to get rid of unwanted hair, fade hyperpigmentation, tighten lax skin, and erase veins, wrinkles, enlarged pores, red moles and more. It’s safe for use anywhere on the body.
There’s no downtime after an Aerolase treatment. At most, your skin will lightly flake over the next couple of days, but it won’t be evident to anyone but you. Six to eight treatments are recommended, depending on the severity of scarring. Read more about Aerolase here.
Microneedling with PRP
Sometimes referred to as collagen induction therapy, microneedling creates minuscule channels in the skin with a device that resembles a pen.
Tiny needles within the pen inflict controlled, localized damage that stimulates a healing response. The body produces collagen to repair the skin, gradually filling in atrophic scars. Microneedling also breaks down hypertrophic scar tissue.
Platelet-rich plasma (PRP) is full of naturally occurring growth factors that enhance collagen production and expedite healing. When applied during microneedling, PRP penetrates the surface of the skin, increasing its effects.
Your skin will be a bit pink following microneedling but will return to normal within 24 hours. You may have some light flaking a day or two after. Multiple sessions yield optimal results — repeat treatment every six weeks or until you achieve the desired level of improvement.
Bellafill is the only dermal filler FDA approved to correct atrophic acne scars. Most fillers last for a few months, but Bellafill lasts indefinitely, making it an enduring solution for filling out depressed areas of the skin.
Bellafill is composed of 80% bovine collagen and 20 % polymethyl methacrylate (PMMA). Upon injection, Bellafill provides instant volume, raising divots to the level of the surrounding skin. Over time, the body absorbs the collagen, while the PMMA microspheres remain. They act as a scaffolding, providing sustained support under the previously depressed areas. The microspheres eventually mingle with your body’s collagen giving a smooth, natural look and feel.
Dr. Pierone at One Aesthetics uses a combination of treatments to tackle atrophic acne scarring: Subcision (a minor surgical procedure that loosens the fibers that tether scarred skin down), placement of PDO threads (to encourage collagen and tightening of the skin), and Bellafill. Ultherapy can be used to help build up collagen as well.
Steroid injections help reduce the size of hypertrophic scars or keloids. Multiple treatments may be necessary to shrink and soften the raised scar.
Silicone Gel Sheets
Hypertrophic and keloid scars can benefit from the use of silicone gel sheets, which are available over the counter or by prescription. They soften scar tissue, flatten and reduce the size, and improve redness. Silicone sheets can also help prevent scarring and are sometimes recommended after surgery for this reason.
Silicone gel sheets are self-adhesive and must be worn every day for six to twelve months. The exact mechanism by which silicone gel sheets improve scarring isn’t fully understood, but their ability to do so is undisputed in the medical community.
More Invasive Modalities
Depending on the type and severity of the scar, a physician may recommend more invasive treatment options such as punch grafts, cryosurgery, or even radiation. Surgical intervention to treat scarring will leave a scar behind. The goal is for the new surgical scar to be much less visible than the old one.
Schedule a consultation with your aesthetic practitioner to find out the best course of action should you have scarring that bothers you.