Scars are your body’s way of repairing wounds caused by accidents, disease or surgery and are a sign that your skin’s natural healing process is doing its job. Almost every wound and many forms of acne will leave behind at least a small scar, but in some cases, scars can be larger, deeper and unsightly. Even with treatment, your skin will never look exactly the way it was before, although you can greatly improve the scar’s appearance.
There are several types of deep scars: ice-pick scars that are usually small in diameter with deep sides; depressed fibrotic scars that also have steep sides, but are typically larger with sharp margins; and superficial and deep soft scars, which are variable in size with more gentle sloping edges that gradually merge with normal skin.
Scars occur when collagen within your skin repairs a wound, which is part of the natural healing process. The more your skin is damaged from inflammation and the longer it takes a wound to heal, the greater your chance of a noticeable scar. Deep scars can occur when there is a lack of underlying tissue such as fat and muscle, allowing the scar to pull the surrounding skin down and cause an indentation.
Your doctor may prescribe more than one kind of treatment, depending upon the type and extensiveness of scarring. These treatments can include dermabrasion, which uses abrasive tools to remove the outer skin layers; laser scar revision that beams a high-energy light to remodel unwanted, damaged skin; soft tissue fillers like collagen, hyaluronic acid or fat injected into your skin; and punch excision and grafting that features a cookie-cutter instrument to remove the scar. Before heading to the doctor, you can try over-the-counter silicone-containing gels, creams and bandages for newer wounds and scars or use a skin lightener containing a product like hydroquinone. You’ll have to be patient, since these treatments can take months to show improvement and aren’t always helpful for many deeper scars, especially older ones.
Some treatments like dermabrasion may require several sessions and weeks of healing time, with a higher risk of complications such as infection, prolonged healing, hyperpigmentation, and scarring, although improvements can continue for months after the last treatment while the collagen restructures your skin. With excision surgery and ablative laser treatments, you might not see immediate improvement and there may be downtime while you continue to change bandages and soak the treated skin. Subcutaneous incisions may result in bruising that can last up to two weeks, and even fillers can cause temporary redness, swelling and bruising. Since these treatments are considered cosmetic in nature, most won’t be covered by health insurance.
Not everyone is a good candidate for these treatments, which is why it is advised that you consult with your physician about what is right for you. For example, with dermabrasion, if you have active acne, infections or other scarring conditions, then this particular treatment won’t be a good choice. Dermabrasion also isn’t recommended if you have darker skin due to the risk of hyperpigmentation, or patches of skin that turn darker than the surrounding areas.