Scars and How to Minimize Them

Scars were once prized as signs of victory among duelers and warriors. In some parts of the world, intentional scarring, like tattooing, marks one’s tribal identity or symbolizes a rite of passage. For all of us, scars are signs of survival — a wound healed, a disease overcome — but most of us don’t see them as badges of honor any more.

A new study from the American Academy of Dermatology (AAD) reports that scarring, especially in visible areas like the face, can be a significant factor negatively affecting quality of life. Whether it’s the scars or marks left behind by acne, or a healed excision or wound, many people are self-conscious about scarring.

A scar forms when the collagen structures underlying the skin are disturbed by trauma like a wound or inflammation. If the trauma stimulates too much collagen, a raised scar appears above the surface of the skin. If collagen is depleted by the trauma (as it sometimes is with acne or chicken pox), the scar left behind is pitted or sunken. People with darker skin can have a different response to skin trauma, with acne leaving marks (unwanted pigmentation) instead of pitting, or even minor trauma resulting in the hypergrowth of collagen forming thickly raised scars called keloids.

As the new study’s director notes:

“While some may consider scarring to be a cosmetic concern, it can really affect patients’ psychosocial health,” says board-certified dermatologist Joseph F. Sobanko, MD, FAAD, an assistant professor of dermatology at the Hospital of the University of Pennsylvania in Philadelphia. “Physical appearance plays a major role in how people relate to others, so scarring that alters physical appearance — even if some would characterize it as minor — can have a negative impact on patients’ quality of life.”

Conversely, the study found that treatment to minimize scarring went a long way toward improving patients’ quality of life. It’s fortunate, then, that dermatologists now have so many ways to deal with scarring. In most cases, your doctor will talk in terms of minimizing or remodeling the appearance of the scar, because there is no treatment that will make a scar completely disappear (without creating another scar in the process).

Steroid injections or pressure packs can help flatten raised scars.

Dermal fillers can be injected into pitted scars to raise the surface of the skin.

Chemical peels, dermabrasion, and laser remodeling can improve the appearance of acne scarring.

In some cases, surgery may be used to address scarring (such as that left behind by Mohs micrographic surgery) to offer better cosmetic results.

If you have very sensitive skin or a tendency to form marks or keloids, see your dermatologist for special evaluation, as many of the treatments that help with ordinary scarring will make these conditions worse.

The American Academy of Dermatology study does not recommend over-the-counter treatments (creams or lotions) as these have not been shown to be effective. Your dermatologist can recommend makeup that helps conceal scars and skin care treatments that will help prevent or minimize post-procedure scarring. Scars should always be protected from UV radiation with a full-spectrum sunscreen.