Scars can’t be removed entirely, but they can be helped to heal well. In this blog we look at how you can best support your healing, and what options you have if your old scar hasn’t healed well.
How does a scar heal?
Scars are the result of the body mending an injury that goes down to the deepest layer of skin. The tissue used to rebuild the damage isn’t the same as the surrounding tissue; it’s less flexible and is structured differently, but it needs to protect the body from infection as quickly as possible so a speedy covering over an open wound is top priority.
Healing takes up to 18 months to complete, and happens in distinct stages.
In the first, inflammatory stage, blood rushes to the site, leading it to look flushed and swollen. White blood cells fight off infection, and the scab begins to form. In the second stage (known as proliferation), the body starts to form scar tissue, sending collagen-producing fibroblast cells to the area, and making new blood vessels. This rebuilding takes about three weeks, and during this stage the scar gets thicker, togher and tightens over the wound. Finally, the remodelling stage takes place over the following year or more, and changes a thick, red, raised scar into a flatter, paler, smaller scar.
What might a scar look like?
As well as feeling less flexible, smoother and tighter than surrounding skin, a new scar doesn’t contain the melanocyte pigmentation cells that give the skin its colour, so scars are generally different in tone and colour to normal skin.
Texture: at first, a scar tends to look swollen, raised, bumpy, thick. Final texture will depend on the condition of your skin, your age, where on the body it occurred, whether you’re prone to keloid scarring, if there has been further damage to the scar, including sun damage, but after a year, your scar is likely to be softer, flatter and smoother than in the first stages of healing.
Colour: a new scar is usually darker than the surrounding area during the proliferation stage of healing because of the new blood vessels and new tissue being built. It looks red or red-purple, depending on your natural skin colour. As it heals, a scar will generally fade. Sometimes the scar will remain darker than the surrounding skin (hyperpigmented from the overproduction of melanin) or without any pigment at all (hypopigmented, when there are no melanocytes in the new tissue).
The general rule of thumb is that a scar’s final appearance will be pretty much set by a year down the line from the original injury or operation. It’s very hard to do much about its appearance after this point, and the best strategy for scar healing is prevention, rather than cure! That means looking after it very well in that first year.
- Use an intensive oil-based emollient ointment around the wound to keep skin soft and flexible as the scar begins to tighten.
- Once the wound has healed over, use a nourishing oil or ointment to keep the scar as soft and well-conditioned as possible. Apply twice a day for three months.
- Protect scars from the sun, as the lack of pigment and sensitivity of new tissue can mean the skin can burn very easily; hypo or hyperpigmented scars can get damaged by sun exposure so use high factor sunscreen and/or cover up with clothes in sunlight.
What are the options for treating an old scar?
If a scar hasn’t healed well, then there are unfortunately limited measures you can take. You can try using rosehip oil to soften and feed thickened scars, and this can certainly help to keep skin moisturised and reduce the chance of skin cracking. Rosehip oil or nourishing balms can help with itchiness too.
Problems really arise if a scar has healed so that it restricts movement, feels tight, or you consider it disfiguring. In that case, you can ask your doctor what treatments are available to remove or remodel a scar, although it’s not possible to remove a scar entirely.
Options for treatment include:
- Surgery: a surgeon can try to remodel, abrade or excise scar tissue. They might suggest using lasers, cryotherapy (freezing the tissue), or excision with surgical instruments to reduce the scar. Unfortunately, there is a risk with surgery that the new scar created will not be any better than the original scar.
- Silicone sheets or gel: worn for at least 12 hours a day for at least three months to flatten a raised scar
- Steroid injections, particularly for raised keloid scarring
- Pressure dressings: stretchy elastic worn for constantly for 12-24 months to flatten scars
Balmonds Intensive Hand Cream
with shea butter and sea buckthorn oil
Balmonds Skin Salvation
with hemp and beeswax
If you require medical advice we recommend you always contact your healthcare professional.
If you or someone you are caring for seems very unwell, is getting worse or you think there's something seriously wrong, call for emergency services straight away. For general medical advice, please contact your healthcare professional, this article does not contain or replace medical advice.
Do not delay getting help if you're worried. Trust your instincts.