Each wound or surgical cut leaves a mark on the skin. What do the size, color and shape of the scar depend on? Can it be reduced? According to Bartosz Pawlikowski, a dermatologist, a lot can be done to make the scar less visible and smoother. Check when creams, lasers, injections, steroids or pressure therapy will help.
When we have a wound on the skin that will leave a scar, we want it to be as little visible as possible. Much depends on how the injury occurred (be it a cut, bite, burn) and how we care for the wound during the healing period. We decided to ask the dermatologist how to improve the appearance of the scar at the healing stage and beyond. Which methods help to smooth, lighten the scar on the skin.
How is a scar formed?
Regenerating skin produces collagen fibers to close the wound. Swelling and redness often appear at this stage. An ordinary scar is formed 48 hours after the wound closes and may disappear after 3 months, but very often negative external factors (e.g. infections, clothing irritating the healing area) and genetic predisposition cause inappropriate scarring, which may last up to 18 months.
The bumps and unevenness of the scar can appear when there is disturbance in the production of collagen fibers, which form concentric layers around the wound, parallel to the skin surface. In the correct healing process, type III collagen first appears, then it is replaced by type I collagen - with shorter and stronger fibers that strengthen the structure of the scar.
What increases the risk of a noticeable scar?
There are several factors like this. The unsightly mark on the skin is often related to wound infection or healing complications. The risk of inadequate scarring also depends on age. Sometimes the skin of young people regenerates too quickly, and as a result, larger and thicker scars form on it.
Keloids, i.e. keloids, are usually formed in people aged 10-30 years. It is known that people with dark skin, as well as freckles and redheads, are more prone to abnormal scarring of the skin. Hormones also have a great influence on the healing process of the skin, which is why during adolescence or pregnancy, larger and more convex skin may appear on the skin.scars.
Does tearing the scab worsen the appearance of the scar?
You mustn't do this! Removal of scabs from a postoperative wound (e.g. by soaking them with a damp gauze pad) often has a negative effect on the appearance of the skin. A hypertrophic scar may form under the scab. Tissues should always heal on their own.
There are, unfortunately, more such "home" remedies for scars. Some people cover their scars with vitamin E from the capsules to reduce the visibility of the skin lesions. Studies show that this type of treatment not only does not bring the expected results, but can cause unwanted skin changes (e.g. local inflammation, contact allergic dermatitis, bacterial or fungal infection), which extend the time of wound healing and increase the risk of pathological scarring. or keloid
Types of scars
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They can be classified according to the cause of development (post-traumatic, postoperative) or the time that has passed since the appearance of the mark on the skin (immature, mature). Considering only the appearance of the union, we distinguish:
- Keloids , i.e. keloids (pictured) - are thick, hard, fibrous, raised and rounded, and clusters of scar tissue irregularly extend beyond the primary wound area;
- Overgrown scarsare usually red, thickened and raised, sometimes the skin in this area itches or hurts;
- Scar contracturesare formed in skin folds as a result of shrinkage of connective tissue (e.g. during scarring of burn marks), they may limit movement;
- Atrophic scars- small, round scars below the level of the surrounding skin, such as after acne or chicken pox;
- Stretch scars- These are flat, pale and smooth, appearing as surgical skin closures stretch.
How to properly apply silicone agents to scars?
Over-the-counter gels, sprays and patches are available in pharmacies. They cannot be used on open or fresh wounds, around the eyes and mucous membranes (nose, mouth). The surface of the skin must be washed and dried beforehand. The best therapeutic effects are achieved by ensuring 24-hour contact of the gel or patch with the skin. Treatment should last 12 weeks, and for people prone to scarring - at least 25 weeks.
Do all traces have to be cared for the same?
The appearance of a scar primarily depends on our diligence and the time we spend on caring for it. You need a wounded place systematicallywash with antiseptic preparation.
After abdominal surgery or caesarean section, care must be taken to maintain a he althy weight so that the skin does not stretch and is not tense.
A burn scar is most often treated with pressotherapy, which causes its softening and flattening. You should also make the skin lubricated and prevent water evaporation from the skin in order to moisturize the damaged tissues as much as possible.
It is worth asking the surgeon about hydrocolloid dressings. Thanks to their use, the healing process takes place even 20% faster, healing is uncomplicated by infection with bacteria from the surface of the skin or scar dehiscence, and the dressing itself usually reduces everyday life less compared to classic cotton dressings
How long does it take to protect a scar from the sun?
It is necessary to fully protect the scar from the sun's rays and to use a solarium for at least one year from its inception. Solar radiation stimulates the deposition of collagen in the scar, which can lead to hyperplasia, itching, burning and pain. A scar exposed to sunlight can become much darker and more visible. When sunbathing or if the scar is located in a visible place, you must (even in winter!) Use protective creams with a high filter.
What methods can be used to improve the appearance of a scar in a dermatologist's office?
Some scar treatment procedures, such as dermabrasion, i.e. removal of the outer layer of skin, can be performed at the stage of tissue remodeling, i.e. a month or two after scar formation.
Currently, however, lasers are most often used. Initially, when the scar is still red or pink, it is advisable to use a "vascular" laser - it closes small vessels within the scar, reducing congestion and minimizing the risk of keloid formation. Then ablative lasers, such as CO2 or Er: YAG lasers, are used to remodel the scar into an invisible trace. Recently, a new technology in the form of a picosecond laser has been available in Poland. Thanks to the reduction of the duration of the laser pulse to picoseconds, the effectiveness of the treatments is 60% higher, and the convalescence time is 70% shorter compared to the previously used lasers for this purpose.
The type of scar treatment is chosen by a dermatologist or plastic surgeon after carefully examining the skin.
Available methods for correcting the appearance of scars are:
- surgical excision ;
- microdermabrasion , i.e. abrasion of the epidermis (despite the persistent use of this treatment, dataclearly speak of its limited effectiveness);
- dermabrasion , i.e. removal of the outer layer of the skin - epidermis and papillary layer, e.g. with a laser (deep under local infiltration, conduction or general anesthesia);
- injectionsor lubricating the scar with a preparation with steroids,
- plasma injectionplatelet-rich
- hyaluronic acid injection ;
- pressotherapy , i.e. pressure on the scar - special clothes are sewn to the patient.
What is medical pigmentation?
The treatment consists in covering the scar with a dye the most similar to the natural color of the skin. Permanent makeup can be performed when 6-12 months have passed since the scar healed (the decision must be made by the doctor).
The linergist introduces the pigment with a special liner. Makeup is applied in two stages. During the second visit (one month after the first treatment), the dye needs to be refilled. Medical pigmentation is performed on scars after thyroid surgery, mastectomy, cesarean section, face lift.
People who are undergoing chemotherapy should take into account the current blood test results. The permanent makeup procedure cannot be performed when the level of leukocytes in the blood is too low. Medical pigmentation needs to be refreshed once a year on average. The dye exfoliates with the epidermis, gradually brightens until it finally disappears.
Bartosz Pawlikowski, specialist in dermatology, expert in the field of laser therapy, Pawlikowski Clinic in Łódź
It is estimated that every 10th patient after surgery may be at risk of abnormal scarring of the wound. Marks near particularly active muscles (breasts, back, legs, arms and joints) often enlarge and are more visible compared to scars located in areas with much less mobility (e.g. the back of the foot).
