A scar is a growth of collagen that forms as a natural part of the healing process following an injury to the skin. While scar tissue will go through numerous changes as it matures, it will never attain the normal strength of the surrounding skin. Hair follicles and sweat glands at the scar site will not grow back.
When an injury to the skin occurs, the body acts as quickly as possible to repair the affected area, devoting its energy and resources to healing quickly rather than perfectly. As a result, there is an overproduction of collagen at the site of the wound which leads to scar tissue.
Depending on the size and depth of the wound, scar formation can take up to two years, and consists of the following three stages:
Haemostasis & inflammation
Proliferation
Maturation & remodelling scar formation
Due to the fact that everyone heals differently, the final appearance of a scar will vary from individual-to-individual. Factors like skin type, scar location, type of injury, age and even nutritional status will play a role in determining what a scar will look like. Scar types can be divided roughly into the following categories:
Atropic – Typically small and form indentations below the surface of the skin, for example surgical incision. Indented or depressed/sunken scars are also described as atrophic, for example like those from acne or chickenpox.
Hypertrophic – Take the form of red lumps, raised above the surface of the skin. They can continue to thicken for up to six months, can be itchy or painful, but remain within the boundaries of the original wound site.
Keloid – Raised scars that spread beyond the original area of skin damage may be minor or major. They continue to grow over time, and usually recur after excision.
Scar contractures – Develop when scars cross joints or skin creases at right angles, often as a result of burn injuries. They can cause tightening of the skin, and may cause discomfort or affect movement. If a patient is experiencing these symptoms, referral to a plastic surgeon should be discussed for scar revision.
Stretch marks (striae) – The result of the skin suddenly stretching. The dermis breaks in places, allowing the deeper layers to show through. Often occurring in a period of rapid weight gain, pregnancy or during growth spurts in puberty.
A scar is a growth of collagen that forms as a natural part of the healing process following an injury to the skin. While scar tissue will go through numerous changes as it matures, it will never attain the normal strength of the surrounding skin. Hair follicles and sweat glands at the scar site will not grow back.
Scars usually fade over time, and while there is no product that can make a scar disappear entirely, there are various solutions which offer an opportunity to improve the scar’s appearance.
Medical intervention:
Should further medical intervention be required for the treatment of a scar, the options below are available for consideration:
Aesthetic treatments, which wouldn’t be available on the NHS include:
Following a wound or procedure, there is a window of opportunity to help ensure a scar heals well. Factors such as bleeding, infection and wound opening up (dehiscence), as well as smoking, can delay the healing process. There are a number of measures patients can be advised to take to counteract these.
To minimise bleeding, patients can be advised to:
To minimise wound dehiscence, patients can be advised to:
Post-healing, patients can be advised to:
In an image-conscious society that places a large importance on how we look, scars can cause some people to experience a loss of confidence and self-esteem. In a recent survey only a third (36.6%) of women described themselves as happy with their appearance.3 These psychological effects often vary depending on the location of the scar, how it occurred, as well as the age and sex of the person. Studies show that one in two women suffer ongoing psychological issues due to scarring.4 One in 10 (8.9%) people have reported feeling isolated as a result of their scar.3 In addition to the psychological effects of scarring, in some instances scars can cause physical discomfort, including pain, itchiness and tenderness. This is particularly relevant if the scar occurs across a joint, where it can limit mobility.
After battling breast cancer, Tricia is proud of the scar that shows she survivied.
Tricia was diagnosed with breast cancer – multiple invasive tumours and node spread. She needed a breast removed and lymph nodes removed. She chose not to have reconstruction because (in her case) it would have meant “harvesting” a strip of shoulder muscle, and as she loves to rock-climb she would have lost too much power and mobility.
She then had aggressive chemotherapy and more surgery to finish removal of the lymph nodes. She chose a second round of surgery rather than radiotherapy, again, because she wanted to maximise her long term mobility. This all means that she has a stunning scar from her sternum to the back of her arm-pit. Stunning because it is perfectly straight and flat, no wrinkles or puckers, to her it is clean and beautiful – she is proud of it because it represents that fact that she has overcome cancer.
When it was new, Tricia says that it itched as it healed. Her friend Gemma sent her a bottle of Bio-Oil as it had really helped her scar when she had pins put in her ankle. Tricia started using it twice a day. Then she started using it on her face too. At her check-ups the surgeon commented on how well it was healing and how the skin was recovering from the trauma really well.
It is now nearly 2 years since the second surgery and she still regularly oils her scar after she showers. The chemotherapy has left her skin really sensitive – many of the creams and cleansers she used before now make her skin red and rough, but she says that Bio-Oil always leaves her skin soothed and soft. Tricia is now cancer free, and getting better and stronger and fitter every day.