All About Scars – Q&A with a DermatologistScars can be a complicated subject, and patients’ feelings about their scars can vary as just as much the diverse appearances of the numerous types. While some may proudly display their scars and the stories that go along with them, others may prefer to conceal them so that they can tell their stories how they choose. Having a scar can bring up lots of questions, and the best source to answer those questions is an expert in all things skin: a dermatologist.
We interviewed Dr. Joyce Imahiyerobo-Ip, Founder of Vibrant Dermatology in Greater Boston, Massachusetts, and she shared some helpful tips for understanding, preventing, treating, and covering scars.
What causes a scar?Scars form when an injury on your skin heals. As your body works to repair the wound, it creates collagen (a tough fiber in your body that gives the skin strength and flexibility) to reconnect the tissues that were broken. The process of wound healing in the skin can take up to 1 year to be fully complete. As part of wound healing, a scar commonly occurs.
What are the different types of scars?It is important to know that a scar can mean many different things to different people. The reason for this is that there are many different types of scars.
- The majority of scars will appear flat. They can be red or dark brown depending on your skin type and on where they are in the healing phase. When scars are excessively red, dermatologists describe them as hyper-vascular (meaning a lot of blood vessels). When a scar is excessively dark, we describe this as hyper-pigmented. The change in skin color is usually secondary to marked inflammation in the affected skin.
- When the body produces too much collagen, the scar can be raised and is called hypertrophic or keloid. These are more common in younger and dark-skinned people.
- Some scars will appear as sunken or pitted which occurs when the underlying structures supporting the skin are lost. Surgical scars and scars from acne usually have this appearance.
- When the skin stretches rapidly, scarring will appear as stretch marks (which many people can attribute to excessive weight gain or pregnancy).
How can I prevent scarring?If you have a wound, it will leave a scar. There really isn’t a way to truly prevent a scar. However, with proper wound care you can help to reduce the appearance of a scar.
- Always keep the area clean and moist. Gently wash with soap and water to keep germs out.
- Keep the wound moist – petroleum jelly works great to keep the wound from drying out and will aid in quicker healing time.
- After washing and applying petroleum jelly, keep the wound covered with an adhesive bandage and be sure to change the covering daily as it heals.
- Don’t expose the wound to sunlight and once healed be sure to use adequate sun protection which may help to reduce red or brown discoloration. Always use a broad-spectrum sunscreen with SPF 30 or higher and reapply frequently.
Can all scars be treated? What treatments are available?Over time, scars will naturally fade given adequate skin care routines. Here are some specifics details on how to manage the most common kind of scars:
- Vascular scars: hese scars usually heal well with time. I always recommend sun protection, because excessive sun can enhance and lengthen the vascular healing phase of a scar. While the red is dissipating, green concealer can be used to mask a red scar. If a scar has been red for longer than 6 months, then an intervention may be necessary. Laser treatments work best for getting the red out.
- Post inflammatory hyperpigmentation (dark brown scars): Again, time is your best friend when it comes to this kind of scarring. I see these most commonly in acne patients with dark skin. Many find the post-inflammatory hyperpigmentation left behind from a scar even worse than the acne itself. The good news is that there are topical medications and topical treatments that can greatly improve these types of scars. A gold standard for treatment hyperpigmentation is a medication call hydroquinone. This is a skin lightening medication. While hydroquinone is very effective, it cannot be used for long periods of time. Overuse can even create a paradoxical darkening of the skin! Skin brighteners are an alternative to hydroquinone. They contain a blend of botanicals that work together to suppress pigment-producing cells and brighten the skin.
- Keloids/hypertrophic scars: These types of scars occur when the body makes too much collagen during the wound healing process. Some individuals are prone to keloids. If you are prone to keloids then you should inform your doctor before any surgical procedure. Treatment of hypertrophic scars can be challenging. However, there are two things that can be very helpful. The first in a medication called Kenalog, which is injected by a board-certified dermatologist. This helps to flatten out the scar. You can also use silicone dressing to help with scaring. The silicone puts pressure on the scar as it is healing, making it hard for excessive collagen to form.
Is scar removal an option?My patients often ask me whether it is possible to completely remove a scar, particularly for acne scarring. The answer to that question is no. There is no way to completely remove a scar. However, the appearance of a scar can usually be improved. For non-raised scars, surgery may be an option used to alter a scar’s shape to make it less noticeable. Dermabrasion, microneedling, and laser resurfacing can help to make scars ‘blend in’. Acne scars respond especially well to microneedling. Lastly, fillers can be effective to help raise sunken scars. These treatments are only temporary and would need to be repeated.
What type of makeup do you recommend for covering scars?Makeup is a very personal choice. However, if you are trying to cover a scar, I always try to opt for makeup that will help protect/heal the scar as well. For a cover up, you want to look for a concealer that has SPF protection as well. I recommend Cover Creme Foundation because it has full coverage, broad spectrum SPF 30, and helps strengthen and repair the skin surface barrier. For scars on the body, I recommend using Quick Fix Body for targeted coverage, and Leg & Body Makeup for coverage over larger areas of the body. To make sure your coverage lasts, set it with Loose Setting Powder for up to 16 hours of smudge- and transfer-resistant wear.
As a dermatologist, why are you passionate about helping your patients with scars?In the 10 years that I have been practicing as a dermatologist, scars have become my passion. Every day, I treat patients whose lives are affected by scars. Sometimes those scars appear on the skin and sometimes the scars are internal or emotional. Regardless of whether you suffer from physical or emotional scars, what I know to be true is that scars can have a huge impact on our mental health and emotional health. As a dermatologist, I feel honored to help my patients feel better on the inside and on the outside through scar improvement procedures. I want to help change our perception of a scar. A scar does not only represent a trauma, it also represents survival. Our scars show what we have survived. They are a sign of our strength and our resilience. Our scars make us beautiful.