What is a scar?

Scarring is the procedure by which wounds are repaired. Damage to the deeper layer of the skin, the dermis, is necessary to produce a scar. Damage to only the epidermis, the most superficial layer of skin, will not always produce a scar. Scars produce a structural change in the deeper layers of the skin which is perceived as an alteration in the architecture of the normal surface features. It is not just a change in skin color. Fetal tissues and mucosal tissues have the capability to heal without producing a scar. Understanding how and why this is possible could lead to better surgical scar outcomes.

A scar is a permanent textural change to the skin that is often associated with color and contour changes. Scars develop from an injury to the dermal and subcutaneous layers of the skin, whether from external trauma or inflammatory skin situation such as acne. Many types of scars can happen including keloidal and hypertrophic, which are often red and rose from the skin. Atrophic scars appear as a depression in the skin. Acne scars can be classified further by their appearance with each type of acne scar requiring a specific method of treatment.

What are the different types of scars?

There is only one type of scar. The appearance of a scar depends on the nature of the wound that created the damage, the anatomical location of the wound, and a variety of genetic factors that are different for each individual.

A defective healing procedure can result in a keloid, an unsightly, itchy, thick, red, knobby bump that often continues to enlarge over time. Keloids often are larger than the margins of the original wound.

What are symptoms and signs of a scar?

Scars happen at the site of tissue damage and appear as firm red to purple fibrous tissue that over time generally becomes flatter and lighter in color.

What is the treatment for a scar?

Since scars are part of the normal healing process, ordinary scars are not treated. Only when superficial scars become cosmetically undesirable do they necessitate treatment. This would contain scars in those who are predisposed to develop keloids, as well as scars in anatomical regions known to produce thick scars and scars that produce a significant, unpleasant distortion of adjacent anatomical structures. Thick scars and keloids often flatten out after injections of steroids straight into the fibrous scar tissue. They can respond to the chronic application of pressure and the application of sheets of silicone rubber. Thick scars can be flattened by Dermabrasion, which utilizes abrasive devices to sand down elevated scars. Certain types of depressed scars can be elevated by the injection of cosmetic skin filler. Certain types of facial scarring respond well to forms of laser treatments. Occasionally, surgical revision of scars can result in a different scar that is much more cosmetically desirable. Since it takes about a year for scars to mature, it is frequently prudent to wait before starting any invasive surgical revisions.