Scars on the skin may form from trauma, burns, surgery, and after more severe forms of acne.
There are a number of different types of scars – Atrophic (depressed scars), Hypertrophic & Keloid Scars (raised scars), stretched scars, normal scar types (neither raised nor depressed), and then Striae distensae (stretch marks) which are also a type of scaring.
More severe forms of facial acne will often produce atrophic or depressed scars, they can also be called icepick or boxcar scars.
Keloid scars are raised red scars that extend beyond the original area of injury to involve the adjacent normal skin. Unfortunately, keloid scars, if not treated properly, may slowly enlarge over time.
Hypertrophic scars are also raised red scars but the scar tissue remains confined within the boundaries of the original wound area and tends to regress spontaneously with time.
Hypertrophic and Keloid scars are more common in younger people with a darker skin tone. High-risk areas for developing such scars are the upper back and chest, upper arms, shoulders, jawline, and ears. These scars may be cosmetically unsightly and can cause a person much psychological distress.
Hypertrophic and Keloid scars are a result of excessive tissue response to injury and the overproduction of collagen in the dermis.
More severe forms of facial acne will often produce atrophic or depressed scars.
Scar Management Tips
Knowing basic management can help raised scars to become less expressed in their appearance.
– If you are young with a darker skin tone and have a personal or family history of keloid formation, you should avoid unnecessary surgical procedures in the high-risk areas of your body. For instance, avoid ear piercing or other body piercings, avoid surgical excision of benign skin lesions in high-risk areas. If a skin lesion needs to be removed for medical reasons this should be performed by a doctor with the best surgical technique, for example, a plastic surgeon.
– Keep the wound occluded and moist as this has been shown to speed up wound healing and reduce the chances of hypertrophic or keloid scar formation. In the past silicone gel sheets were used to occlude the wounds but these are expensive and cumbersome to use. Recently, lightweight, non-sticky silicone gels have been developed that can be applied to the wound once it has healed i.e. after approximately 7-10 days after the initial injury. In persons with a darker skin tone, where the wounds are on exposed areas, a high factor, broad-spectrum sunscreen can be applied on top of the silicone gel. This is very important to prevent post-inflammatory hyperpigmentation from occurring in the scar, which can often be more cosmetically disfiguring than the scar itself.
– Avoid excessive tension of the wound. This is where good surgical technique is important. Once the sutures have been removed, micropore tape can be applied to the wound which is both occlusive and also reduces tension on the surgical scar.
– With more severe forms of acne avoid excessive squeezing or picking of lesions.
Are certain skin tones more prone to developing keloid or hypertrophic scars?
Yes, darker skin tones are more prone to developing raised scars.
Would you recommend silicone gels over other scar treatments?
Silicone gels are considered more versatile as they are invisible and can be applied to areas of movement. Surgical paper tape can also be beneficial for certain scars post-procedure.
Can silicone gels work for older scars?
For very aged scars or atrophic (indented) scars, silicone scar gels will unlikely help. For the best results, it’s recommended to use silicone scar gels as soon as the wound has healed.
Do silicone scar gels help stretch marks?
I haven’t seen any clinical studies or data to support this.
Medical Scar Treatments
If you notice a scar becoming itchy or raised above the normal skin surface, it is best to contact your doctor at the first available opportunity. If you start the correct treatment earlier, generally the results will be better. You can continue with all the preventative measures as listed above but depending upon the type, size, anatomical site, and age of the scar, your doctor will decide on the best treatment options. Treatment options would include:
- Pressure dressings
- Cortisone injections
- Medical micro-needling especially for post-acne atrophic or depressed scars on the face
- Laser treatments (Vascular and Fractional lasers)
- Surgical scar revision (for stretched scars)
- Surgical excision with radiotherapy (in extreme cases)
SILICONES, hero ingredients for treating scars
- Considered gold standard with preventative & therapeutic ingredients.
- Well-known for their excellent occlusive properties.
- Prevent the excessive build-up of collagen in the dermis.
- If applied early on, and when formulated with other ingredients, silicones can help improve overall appearance, especially while the scar is still forming.
- Can help prevent the formation of hypertrophic or keloid scars.