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All About: Scars

  • Writer: Leilani W
    Leilani W
  • Jan 25
  • 9 min read

Many of us have likely experienced getting a scar. Whether it be from falling off your bike, having to deal with the aftermath of a pimple, or following a life-altering surgery, each scar represents a moment in our lives. Now, most probably wish to erase said scar, including myself. But as the word suggests, they're a lasting mark.


Today, we'll be answering some questions regarding scars, including why exactly scars occur, the different types of scars, and things we can do to minimize them.



What are Scars?

A scar is formed as part of our skin’s natural healing process when a skin layer deeper than the epidermis (outermost layer) is penetrated. As a way to prevent infections, our bodies evolved in a way that, after an injury, fibrous tissue quickly replaces and repairs the lost or damaged skin. The primary protein active during this is called collagen, the protein that gives skin its structure and strength. Scars can happen anywhere on the body and take many different shapes, colors, and textures.


Some scars may have the following symptoms:

  • Itching

  • Pain

  • Disruption of daily life, for example, sleep

  • Anxiety or depression

  • Red, swollen surface if infected


Many things can determine how your scar might end up appearing, including:

  • The size and depth of the wound

  • The cause of the injury (acne, burn, surgery, cut, etc.)

  • Genes, skin color, age, gender, and ethnicity

  • Body part where the wound occurred

  • And how you treat the wound



Types of Scars

Depending on the factors that play a part in how one's scar may appear, a scar can look very unique. This leads us to the different categories of scars and what defines each one.


  • Flat (Cicatrix):

These are scars that become flatter and change color as they heal. They usually look at first slightly raised, pinkish/reddish in color, and may be itchy or painful. As it heals, the flattened scar matches your skin color, but it may look paler or slightly darker.

Flat (Cicatrix) scar, showing it initially red and pink, then over time becoming a lighter, white scar.

  • Depressed (Atrophic):

Are sunken scars that are commonly caused by chickenpox or acne. They are more frequently seen on the face and look like small, circular pits/indentations on the skin. As you age over time and your skin loses its collagen and elasticity, these scars become more noticeable.

These acne scars are really common after severe acne clears and can be divided into 3 types:

  1. Boxcar acne scar→ more rounded dents that look like craters

  2. Icepick acne scar→ smaller pits that get deeper into a point towards the center

  3. Rolling acne scar→ look wave-like, giving the skin an uneven textured appearance

Example of acne scars on a person's cheek

  • Raised (Hypertrophic):

These scars rise over the skin, making them visibly firm. They can fade over time (months to years) but never truly flatten out. Some can feel itchy or painful, and they’re commonly formed on the chest, upper back, or shoulder area; depending on the location, they can restrict movement.

A raised (hypertrophic) scar on someone's shoulder. It is red and elevated above the skin.

  • Keloids:

Large hypertrophic scars that go beyond the boundaries of the wound that caused the scar. They can feel painful or itchy, and can also lead to impaired movement when over a joint. A keloid can appear way after the injury took place (between a month and a year). Keloids, unlike flat or raised scars, never go away/fade away with time without treatment.

A keloid scar on a woman's ear; it appears like two large, round bubbles on the ear following a gone-wrong ear piercing.

  • Contracture:

It’s any scar that is located along a joint leading to restricted movement. They are hypertrophic scars and are typically produced following a burn. They can also develop if a large keloid scar forms. If you’ve ever experienced the healing of a scar, you’ve probably noticed that the new tissue tends to be tighter and thicker than your skin; this tightening (contraction), when located on muscles, tendons, and joints, makes it hard to move. 

Contracture scars can cause a lot of discomfort and frustration, but there are several ways to treat them (more on this in the treatments section).

A contracture scar on a man's wrist, arm, and hand. It is red and looks like a burn


  • Stretch Marks (Striae):

Very commonly heard of, but not many know that they are a type of scar, stretch marks are formed when the skin stretches or shrinks quickly, causing the connective tissue underneath to be damaged. You commonly see this form during pregnancy, puberty, or rapid weight loss or gain. Stretch marks initially look red, purple, or dark brown, but over time, they lighten to a white/silver color.

Stretch marks on a person's lower stomach/belly.

  • Adhesions:

This type of scar is different from the others in that it occurs internally between unconnected organs. The buildup of scar tissue inside the body can bring complications during certain surgeries, making them life-threatening.



Treatments/Cure

Scars aren't something you can completely erase, but there are options that help make them less noticeable and minimize symptoms:


  • Surgery:

    Many different surgeries can help improve the appearance of a scar, but as you could imagine, it’s like exchanging a scar for another, more preferable, less obvious scar. They help reduce the size of a keloid and help improve mobility when restricted by a scar. This option is usually taken when other treatments don’t work because a scar can still return following the surgery (there’s a high rate of ever larger keloids forming).


    Some surgical operations include:

    • Skin graft: healthy skin taken from another part of the body (the donor site) is transplanted to cover the damaged or missing skin after the scar tissue is removed.

    • Skin flap: similar to skin grafts in that healthy skin is taken from another area; the difference is that the skin has its underlying tissue (including the fat, muscle, and bone) partially detached, keeping its blood supply. Are used when the area that has damaged/missing skin doesn’t have a good supply of blood.

    • Punch graft: a type of skin graft where a hole is punched in the skin to remove the scar, then it's replaced with healthy skin (usually from behind the earlobe); commonly used to treat deep acne scars.

    • Tissue expansion: involves adding a silicone balloon expander under the skin that is gradually filled with saline over time to stretch the skin and increase the amount of existing tissue to replace damaged skin; often used with skin flap surgery.

    • Z-plasty: uses a Z-shaped incision to essentially improve the way the scar looks; it decreases the amount of contracture around the scar, releasing tension and improving its camouflage.


  • Silicone gel:

    Come in two forms, sheet or ointment, but the silicone gel sheets are overall more effective than ointment. Very easy to find in the market and has been shown to make scars less noticeable. Daily application (usually for months) can cause some possible side effects like the skin breakingdown or a rash developing.


  • Cryosurgery:

    A treatment that involves freezing the top layers of the skin to help reduce its size. The scar tissue is slowly destroyed, leading to reduced size, pain, itch, hardness, and discoloration of the scar.


  • Chemical peels:

    Remove the top layer of the skin with a chemical application, which allows the regenerated skin to look better; mostly used for sun-damaged skin, pigmentation irregularities, and superficial scars.


  • Pressure:

    Involves applying any type of pressure appliance, including an elastic bandage, dressing, or stocking, over the scar location during the healing process. This helps prevent a scar from forming, from returning (if after a surgery), and decreases its size. For results to show, one must wear the pressure appliance for as long as a year, but there is speculation regarding their usefulness, especially considering the discomfort felt by patients. This treatment is mostly useful for those who tend to form keloids.


  • Dermabrasion:

    A procedure that uses an electrical machine that essentially sands down your skin, removing the top layer. As the skin heals, the new surface becomes smoother, improving the appearance of smaller scars, surgical scars, and acne scars.


  • Injections:

    There are several different injections that are directly injected into the scar to help reduce its size, soften it, and decrease itchiness, redness, and burning sensations.


    Common ones include:

    • Cortisone injections: commonly used to treat keloids or hypertrophic scars. More than one treatment is needed for some to shrink the scar (sometimes even becoming invisible) and reduce itchiness/pain. Possible side effects include skin thinning, dark spots (at the injection site), and the scar returning; to lower the chances of these side effects, other treatments are also received.

    • Steroid injections: usually the first treatment for hypertrophic scars; can also be applied as a topical cream, but it’s not as helpful. Are injected directly into the scar and can include side effects such as atrophy (cell degeneration) and skin discoloration.

    • 5-FU (fluorouracil) injection and bleomycin injections: drugs that are used to treat cancer; injected to treat keloids and hypertrophic scars, and include the same side effects as cortisone injections.

    • Collagen injections: injected beneath the skin to replace the loss of natural collagen; also used to treat wrinkles and facial lines


      Many times, injections are used in combination with other treatments, including surgery. Depending on the severity of the scar, injection treatments can continue up to 2 years after surgery to ensure that the scar doesn’t return and improve healing.


  • Laser:

    Laser therapy treatments out there are the go-to option for all scar types. Depending on the wavelength of the light, a specific action is evoked in the skin. They help prevent scars from forming, make them less noticeable, smooth their complexion, decrease the color of the scar, increase the ability to move (in cases where the scar limits movement), and relieve pain, itchiness, hardness, and swelling. Another pro of laser therapy is that there are little to no side effects; however, hyperpigmentation (skin darkening) or hypopigmentation (skin lightening) are a possibility. For best results, other treatments like the injections mentioned earlier are also used.


    Common laser/light treatments:

    • Pulsed dye laser: a V beam laser that targets the small blood vessels in the skin that remain when a scar forms. Blood vessels are developed to heal a wound, but never leave after the healing process is done, giving some scars their pink or red appearance. This laser helps reduce the color of the scar whilst flattening or thickening it (depending if the scar is hypertrophic or atrophic). Known for being a good choice for keloids.

    • Fraxel laser: helps scars become more flexible by breaking up the collagen fibers.

    • Laser resurfacing: high-energy light burns away damaged skin, which helps decrease wrinkles and improve hypertrophic scars.


  • Radiation therapy:

    Used mostly when other treatments don’t work. It’s not as common as the other treatment options due to the concern of radiation causing cancer, plus there are a few side effects, such as dark spots and swelling, which make it a last resort option.



Effects on Daily Life

It's not hard to imagine how a scar can bring struggles to one's life. In addition to some scars causing physical discomfort and limiting mobility, the psychological distress, anxiety, and depression that come with the reminder of a scar can be detrimental. Scars that reduce mobility make everyday tasks challenging, facial scars have been found to bring self-consciousness, and scars from any traumatic injury can impair emotional well-being.


Applying this to myself, I've had my fair share of scars in my life, many ranging from scabs from falling or cuts from playing outside, but none as serious as two incidents I've had. The first one was while playing tag, and I cut my scalp and had to get around 6 stitches. The second time was on my lip while doing gymnastics, and I got 3-5 stitches. Both were quite traumatic experiences. An injury like this, especially during my early teens, led to the constant belief that people only saw my scar. This imaginary audience is still on my mind, even as my scar becomes less noticeable.


Internally, despite wavering self-esteem, I've gotten used to it. Before, it used to be the first thing I noticed, but now it's something that I'm briefly reminded of. Life continues, and I've learned to carry it through a neutral coexistence.



Final Thoughts

Scars can carry a lot of weight with them; each of them has a story behind it, but that story belongs to the person who carries it. Some scars are minor; others come from deeply traumatic events. Some people see them as milestones; others want to erase them completely. Whichever way someone chooses to live with their scar, whether it be covering it up or showing it off proudly, is something we should respect. Ultimately, being more aware of a common injury that millions of people face can not only help us better understand the boundaries of those who carry scars, but also remind us to be mindful of our own assumptions.



Flat scar on skin that appears a bit red on the edges and white inside.

Sources

1 Comment

Idamei Montenegro
Idamei Montenegro
Jan 27

Wow!!! This is a lot of great info you should definitely be a Dermatologist!! Keep at it!! ( p.s I'm definitely not secretly your cousin 😜 pretending to be a random person.)

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