What Is A scar?

The skin is the largest organ in the body. Once an injury has occurred from either trauma, surgery, a burn or a sports injury, the healing process begins and scar tissue replaces normal skin. Wound healing is complex and occurs in phases.

Phase 1: Initiation 

This first phase begins immediately after the injury and is completed within a few hours. During this phase, there is the formation of a blood clot. In addition, proteins in the body, called fibrin, create a matrix for reparative cells to enter the site and start the healing process.    

Phase 2: Inflammatory 

This phase begins soon after and new cells start to grow in order to cover the wound surface. Granulation tissue (early scar tissue) begins to form and new blood vessels start to sprout in order to nourish the reparative cells. A collagen matrix replaces the fibrin matrix and inflammatory cells enter along the wound’s new scaffold. Altering the inflammatory cells during this phase can dramatically improve the appearance of a scar.

Phase 3: Remodeling 

This is the last phase of wound healing. A strong type of collagen slowly replaces the blood vessels and reparative cells.  Specific cells, called myofibroblasts, remain in this collagen matrix and contract, which ultimately leads to a decrease in the size of the scar. Reparative cells continue to enter and survey the scar for months and even years after the injury, which is why scars tend to look better at 1 year than at 1 month. 

The wound environment changes dramatically during the course of healing and the formation and appearance of a scar is directly related to the events described above.

Types Of Scars

Acne Scar. Acne is a skin disease that causes the eruption of pimples, pustules, blackheads and whiteheads. When the dermis becomes inflamed, this can leave scarring that often appears as reddish/purple lesions that are either raised to depressed.

Burn Scar. These scars typically appear after burns from chemicals, heat, fire, steam, or hot liquids. There are various ‘degrees’ of burns:

  • First degree burn refers to mild burning that injures just the top layer of skin. This may be caused by sun exposure, friction, hot water, or steam and causes the skin to be red, swollen, and itchy.
  • Second degree burns are more serious and result in injury to the top layer of skin and tissues. This is often caused by hot flames, severe sun burns, and hot liquids. Second degree burns cause blisters on the skin.
  • A third degree burn is the most serious type of burn and causes injury to all layers of the skin (epidermas, dermis, and subcutaneous fat). The skin can be severely blistered with large welts and appear white and leathery. Third degree burns are typically the result of catastrophes with fire, chemical explosives, or electricity.

Keloid. Smooth, thickened, overgrowth of scar tissue that builds up after an injury has healed.

Post-Surgical Scar. After surgery, the incision heals and can leave a scar that is raised and dark reddish in color. The site of the surgical incision and post-surgical treatment plan will determine how noticeable the scar is after surgery. Common post-surgical scars that patients often want to fade or ‘go away’ include those resulting from a c-section, tummy tuck or abdominoplasty, breast augmentation, cancer reconstruction, and facial surgery.

Wound Scar. A wound scar can be the result of an abrasion or cut in the skin. Most commonly, these arise after a fall injury and oftentimes occur on the face or extremities. Other wound scars can be caused by minor cuts/incisions in the skin that require stitches (sutures or dermabond).