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Scars: Types, Revision, and Repair

Scars form when injury occurs to the skin. A scar is the body’s natural biological response to trauma, as the body attempts to heal the skin. Scarring often fades over time and may become barely noticeable over the years. However, sometimes the healing process leads to ugly scar tissue, while other times it leads to overaggressive scarring that affects mobility. Unsightly scar tissue can be treated to minimize its appearance and yield smoother, clearer skin. Scars that affect mobility can also be treated to improve day-to-day function.

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Types

Different types of scars may form due to a combination of factors, including the injury type and location, severity of the injury, patient’s age, patient’s health, and individual healing properties. Here are some of the most common types of scars:

  • Hypertrophic Scars: red, raised scars with excess collagen; while they may be itchy or painful, they do not extend beyond the original scope of the injury
  • Keloid Scars: overgrown scar tissue that is irregularly shaped, raised, red, or pink and may continue to grow over time; most commonly form on the face, neck, ears, shoulders, and chest
  • Contracture Scars: scars that restrict movement due to excess skin and tissue tightening during the healing process; most often occur after significant tissue loss, burns, or joint wounds
  • Acne Scars: scars left by acne, especially chronic or cystic acne; may appear as discolored, hypertrophic, keloid, boxcar scars, ice pick scars, or rolling acne scars

Treatment

Scar treatment varies widely depending on the location and severity of the scar, as well as the patient’s age, overall health, and desired scar revision. A dermatologist can provide the following treatments for scars:

  • Subcision (for depressed scars): a needle is used to break up the scar fibers, raise depressed scars, and promote new connective tissue to smooth the skin
  • Excision (especially for severe contracture scars): surgical removal of the scar and surrounding damaged tissue; may use a skin graft or flap to restore the skin and improvement movement and flexibility
  • Punch elevation (especially for certain acne scars): punch tool removes small quantities of tissue to elevate the base of the scar
  • Cosmetic treatments such as microdermabrasion, chemical peels, skin bleaching, or laser treatments to improve discoloration, remove damaged surface skin, and promote collagen formation for future healing
  • Fillers (for depressed scars): temporarily restore volume to the skin and reduce the appearance of depressed scars; maintenance treatments are necessary
  • Creams, Ointments, and Gels: over-the-counter or prescription options are most effective if applied to newly forming scar tissue
  • Antihistamines or corticosteroids: for sensitive or itchy scars
  • Silicone gel sheets: for scar prevention and minimization, especially after surgery
  • Cryotherapy (for keloid scars): freezes and removes overgrown scar tissue
  • Steroid injections (for hypertrophic or keloid scars)