What is a scar?

A scar is the body's natural way of healing and replacing lost or damaged skin. It's often made of fibrous tissue. Scars may form due to infections, surgery, injuries, or inflammation of tissue. They may appear anywhere on the body. A scar may look flat, lumpy, sunken, or colored. It may be painful or itchy. The final look of a scar depends on many factors. These include:

• Skin type.

• Where the scar is on the body.

• The direction of the wound.

• The type of injury.

• Your age.

• How well-nourished your body is.

What are the different types of scars?

Abnormal scars sometimes form after a wound has healed. There are many different types of scars, including:

• Keloid scars: These are thick, rounded, irregular groups of scar tissue. They grow at the site of a skin wound. But they can be much larger than the wound itself. They can expand outside of the area of the initial wound. They often look red or darker in color, compared to normal skin. Keloids are formed from collagen that the body makes after a wound has healed. These scars may appear anywhere on the body. But they are more common on the chest, back, shoulders, and earlobes. They occur more often in darker-skinned people. Keloid scars may appear for up to 1 year after the original skin injury. Treatment for keloid scars varies. There is no simple cure. It's common for these scars to come back after treatment. Often more than one treatment is needed.

• Hypertrophic scars: These are similar to keloid scars. But they don't grow as big as keloids. And they stay within the area of the original injury. They may also respond better to treatment. Hypertrophic scars may look red. They are often thick and raised. They often start to develop within weeks after the skin injury. Hypertrophic scars may get better on their own. But that may take up to a year or more.

• Contractures: These happen when a large area of skin is damaged and lost, resulting in a scar. The scar formation pulls the edges of the skin together. This causes a tight area of skin. It can then affect the muscles, joints, and tendons. This causes a decrease in movement.

• Adhesions: These are fibrous bands of scar tissue that form between tissues and internal organs that are not normally connected. Some causes of adhesions may be surgeries, infection and inflammation, medical conditions such as Crohn's disease, trauma, or radiation therapy.

How can a scar be reduced?

Treatment will depend on your symptoms, age, and general health. It will also depend on how bad the condition is.

Scars often fade over time. Makeup can help cover the scar while it's healing. Some scars can be reduced by certain treatments. But treatment may only improve the look of a scar. It may not completely remove it. Everyone's body heals differently. The procedures listed below may not work for everyone. And trying to reduce a scar can make it worse in some cases.

Here are some of the more common scar-reducing procedures:

• Dermabrasion. This may be used to reduce small scars, minor skin bumps, surgical scars, and acne scars. It removes the top layers of skin by scraping (abrading) the skin. As the skin heals, the surface looks smoother and fresher.

• Pressure therapy. A type of pressure wrap is worn over the scar area. These may be worn day and night for up to 4 to 6 months. It's not clear how well this treatment works. It may be used to treat keloids.

• Silicone dioxide. This is applied in the form of a gel or pad. It can help soften and decrease the redness of keloids and hypertrophic scars.

• Chemical peels. Peels are often used to minimize sun-damaged skin, irregular color (pigment), and small scars. A chemical solution is put on the skin. This makes the top layer of the skin peel off. After the top layer is removed the skin regenerates. This often improves how the skin looks.

• Dermal fillers. These are mainly used to treat wrinkles, scars, and facial lines. Dermal fillers are given by a shot (injection). Some of the choices include synthetic solutions, semi-permanent fillers, collagen, autologous fat injections, and hyaluronic acid. Talk with your doctor about which type is best for you.

• Cortisone injections. A steroid is injected directly into the scar. This can help soften and then shrink hard scars. Keloids and hypertrophic scars often soften after this treatment.

• Cryosurgery. This can help reduce the size of scars by freezing the top skin layers. The freezing causes the skin to blister. It may be used to treat keloids.

• Steroid shots (injections and topical). Steroids are injected directly into the scar tissue. This helps reduce the itching, redness, and burning that these scars may produce. Sometimes the injections help make the scar smaller and soften the scar tissue. The main side effects are skin discoloration and a sunken area of skin at the injection site (atrophy). Steroid shots may be used to treat keloids and hypertrophic scars.

  For hypertrophic scars, steroids may be the first treatment used but may not be the only one. Steroids may be injected. Often steroid injections are used along with surgery. The injections may be needed up to 2 years after the surgery. This is to help maximize healing and decrease the chance of the scar returning.

  Steroids may also be placed right on the scar, though it may not be useful in some cases.

• Laser resurfacing. Scars may be treated with a variety of different lasers. This will depend on the cause of the scar. The treatment uses high-energy light to burn away damaged skin. It may be used to reduce wrinkles and refine hypertrophic scars.

• Laser surgery. Lasers may be used to smooth a scar, remove the abnormal color of a scar, or flatten a scar. Most laser therapy for scars is done together with other treatments. These include steroid injections, special dressings, and bandages. Many treatments may be needed, regardless of the first type of therapy. A pulsed-dye laser is a typical choice for keloids.

• Punch grafts. These are small skin grafts to replace scarred skin. The surgeon uses a small tool to make (punch) a small hole in the skin and remove the scar. Then the scar is replaced with a small piece of unscarred skin. Punch grafts can help treat deep acne scars.

• Z-plasty. This type of flap uses a Z-shaped incision to help decrease the amount of contractures of the nearby skin. It also may try to fix the scar so that its edges look more like the normal lines and creases of the skin. Small stitches may be used to help hold the skin in place.

• Surgical scar revision. This is surgery to remove the entire scar and rejoin the skin. A new scar will form. The goal of this surgery is to create a less obvious scar. This procedure is often done on scars that are wide or long, have healed in an abnormal way, or are in very visible places. It may be used on keloids and hypertrophic scars. But with keloids, scars can come back again, and sometimes even larger keloids are created.

• Skin graft or skin flap. These are done after the scar tissue is removed. For a skin graft, skin is replaced or attached to a part of the body that is missing skin. This is done by taking a piece of healthy skin from another area of the body (called the donor site) and attaching it to the needed area. Skin flaps are geometric cuts near the scar. They allow local skin to be moved over the scar area. Flaps may be used when the area that is missing the skin does not have a good blood supply. That may be due to the location or damage to the vessels. Skin grafts may be used to treat contractures.

• Tissue expansion. This method makes more of existing tissue available for treating a scar. It's often used along with the flap surgery. It may be used to treat contractures.

• Radiation therapy. This is not used often. It's used mainly for scars that don't respond well to other treatments. It may be used to treat keloids.

Recovery from scar revision surgery

Follow all instructions to help maximize your recovery and healing. Your doctor will tell you what you can and can't do. These will depend on the type of surgery that was done. Scars can't be removed fully. Many factors will affect how your particular scar heals. It can take some scars more than a year after surgery to look better.