Although scars are a perfectly normal reaction of the body and nothing to hide, you might choose not to embrace all of yours, which is perfectly fine, too. But if you’ve ever tried to fade or heal your scars, you know that it’s easier said than done. To learn more about scarring, we spoke with two top California dermatologists Harold Lancer, MD, and Cynthia Bailey, MD. Together they answered our most pressing questions, from the best at-home options to what to expect at your own dermatologist’s office if you seek professional treatment.
One of the most important lessons we learned? Scarring is a complicated topic with countless treatment paths. And since all scars are not the same, they shouldn’t be treated like they are. “A scar is one thing today, and six weeks from now, it will be a different scar, so the approach to treatment should be different,” Lancer says.
New Scars or Injuries
When it comes to treatment, Lancer says for most scars, the sooner the better. “Within the first eight weeks is good; if it’s within the first several days, it’s even better,” he says. “For example, if you have a breast-lift scar that’s large, the minute that you take the stitches out, you want to start treating it.”
To prevent scarring from occurring on a recent injury, Lancer suggests cleaning the wound twice a day with water and a mild non-soap detergent then applying a thick layer of Aquaphor to reduce water evaporation from the skin. “When skin is incredibly hydrated, it can repair itself easier,” he explains. If it’s more than just a surface scrape, he suggests visiting your doctor. “They will clean it properly and maybe start some sort of pressure dressing to prevent raised scars if needed,” he says.
Post-Inflammatory Hyperpigmentation
Also known as PIH, this form of scarring can occur from any kind of injury, and it’s different from your typical textured scars. Instead of emerging as a raised bump or an indentation, PIH appears as a darkening of the skin. “This type of scarring is due to melanin pigment dropping into the second layer of skin called the dermis,” Bailey explains. “Normally, skin melanin stays inside your skin cells of the epidermis (the top layer of skin above the dermis). As that layer grows and sheds, the pigment is shed, too.
When an injury causes damage to the boundary between the epidermis and dermis, the melanin pigment can drop into the dermis where it acts like the pigment in a tattoo.”
Acne Scars
According to Bailey, all significant injuries that involve both layers of skin will scar to some extent, and since acne lesions injure both the epidermis and the dermis, you’re often left with some kind of scarring–whether small and deep or broad and gradually indented–after a breakout occurs. “A scar is the focal production of collagen that your body makes to fill in the injury,” Bailey says. “Scars contract and that causes the indentation. PIH can also happen at the site to cause brown color to the scar.”
Atrophic Scars
These are the indentations that often appear where an acne breakout once was, such as rolling acne scars or ice pick scars. For an at-home treatment, Lancer suggests applying a topical product with a higher concentration of salicylic acid or a mixture of vitamins C, A, and B complex to irritate the area. “Sometimes if you inflame a depressed, indented scar, the body will make its own collagen to repair it.” If this doesn’t get you the results you’re looking for
Hypertrophic Scars
According to Lancer, a hypertrophic scar is one that forms within the first year of an injury that is flaming pink, raised, and active. Bailey further explains them as scars that formed beyond what was necessary to heal a wound. “The body typically stops forming collagen in a scar when the wound is adequately supported and healed,” she says. “Sometimes the ‘stop’ mechanism does not work and a thick scar forms.”
Keloid Scars
As Lancer describes it, when hypertrophic scars mature, they’re called keloid scars. These are rounded, hard, and rubbery and have a shiny overlying skin, and Bailey adds, they can be red and tender as they grow. Though any part of the skin can form a keloid, Bailey says they’re not typically found on the face and appear more often in the mid-chest. Keloids occur in all ethnicities, though some people are genetically prone to them and they can run in families. A tricky kind of scar, keloids can be caused by injury but they also can form spontaneously. “They may reach a certain size and stop growing or they may grow spontaneously at any time after being stable for years,” Bailey says.
Contracture Scars
Contracture scars are often the result of burns, but Bailey adds that all scars contract to some extent. “This can cause indenting or pulling inward of the skin towards the scar,” she explains.