The skin is the body’s largest organ and has several layers. A scar is a mark that remains after the skin is wounded by accident, diseases or surgery. The scar is an essential part of the healing process for the skin. The more the skin is damaged and the longer it takes to heal, the greater the chance of a noticeable scar.

There are many different causes of scarring, including trauma/accidents, surgery, burns, acne, infections, skin stretch marks and skin diseases. The scar is formed as the body lays down new collagen fibers and blood vessels to heal the wound. Part of the healing depends on genetics, ethnicity, age, location and size, infection, and nutrition. For example, a scar over a knee is subjected to a lot of stress when the knee bends and usually results in a widened scar whereas a scar located horizontally within a skin fold may heal as a thin line because there are no forces pulling across it.

Hypertrophic scars are scars that do not extend beyond the original wound margins but may thicken, become red and raised, and are often itchy or painful. Keloid scars are the result of an overly aggressive healing process. They extend beyond the wound margins and can continue to grow indefinitely. Keloids can also be red, raised and itchy or painful- they do not improve with time. As a rule, scars usually take between 12 and 24 months to mature after injury. Generally scars will be red or dark initially then fade out over time. Unfortunately, we can never totally erase a scar, but it is possible to improve the appearance of a scar. Most physicians will wait for a reasonable time before revising a scar to allow the maturation process to occur, because with time the person may be happy with the scar appearance and not need any further treatment. Scar massage, topical creams/ointments, lasers, dermabrasion, steroid injections, and surgery are techniques that can be used, but all have their limitations. The first treatment modality that is usually recommended is scar massage. Scar massage alone will help all scars in the maturation process to soften and possibly fade quicker. I generally advise patients to begin scar massage 2-3 times daily about one month after the scar has formed from surgery, but it can be earlier depending on the cause of the scarring. Adding a topical agent such as Mederma with the scar massage (3-4 times daily) usually helps fade the color quicker. Scar massage can be performed for the whole healing process for up to two years. Topical Vitamin E has been recommended in the past but some recent studies show that it can cause skin irritation and so Vitamin E should be used with caution. Removing the surface of the scar with a carbon dioxide laser or decreasing redness with a vascular laser has been used; however, there are few long-term studies to prove the effectiveness of the therapy. Dermabrasion can be used to reduce irregularities in the skin surface of a scar, but it also has limited application and takes several treatments to achieve a result. There are different levels of Dermabrasion from Microdermabrasion which is an office procedure with little “down time” to Dermabrasion that is performed in the OR and has an active recovery of a few weeks. Steroid injections, silicone sheeting, and pressure garments under medical supervision can help flatten and soften hypertrophic and keloid scars.  Surgery is usually reserved for times when these other treatment modalities fail.

However with surgery you must heal a new scar all over again. Remember, even with these treatment modalities, it will usually take one to two years for the scar appearance to improve and you will not erase a scar completely.

Dr. Contogiannis is Board Certified, American Board of Plastic Surgery Member, and American Society of Plastic Surgeons. Dr. Contogiannis has been selected as one of Americas Top Plastic Surgeons in 2006.