By Sydney Loney
When it comes to scars, your body is like a historical map, each bump and depression a memento of past accidents and adventures. Some of these marks may instill pride (“That one’s from the time I went mountaineering in Morocco. Must have fallen 20 feet before landing on the ledge!”). Others, you’d probably prefer to forget, like the remnants of your adolescent struggle with acne, or the unsightly souvenir of the first, and, last time you tried longboarding. But there are ways you can change the topography of your skin.
A recent survey of Canadian women found more than 90 percent had at least one scar somewhere on their bodies. Although most were bothered by these blemishes, few knew about their options for treatment. Dr. Lisa Kellett, a cosmetic laser dermatologist in Toronto, says while a third of her patients come in specifically for scars, the majority are seeking treatment for something else and just happen to mention a scar on the side. They usually assume nothing can be done for them. “It’s true that once you have a scar, you can never get rid of it,” Kellett says. “But with treatment you can make it flatter, less red and closer to your normal skin colour and texture.” One of the most important things is to keep a scar from forming in the first place,” she says.
Healing hints: Scars are a natural part of healing and form when your skin repairs itself after an accident, surgery or illness. The greater the damage, the longer it takes to heal and the more likely you will be left with a noticeable scar. Your chances of scarring also increase depending on the location of the wound, says Kellett. “Head and neck wounds usually heal better because there are more arteries there than in your legs, so there’s a better vascular supply.” Areas with a lot of movement and tension in the skin, such as your knees, are more likely to scar, as are dirty wounds or those that become infected.
Some people are just genetically better healers than others, or may have stronger immune systems, Kellett says. Even what you eat can make a difference. “If your diet is poor, you may be more susceptible to scarring because your body doesn’t have the vitamins and minerals it needs to heal properly,” she says.
You should eat a balanced diet with lots of fruits and vegetables and get enough vitamin C to promote healing. Smoking, and even being exposed to secondhand smoke, can affect your healing powers. A university of California study found secondhand smoke reduces the ability of new cells to get to a wound site, causing slower healing and more scarring.
Walking wounded: Once the damage is done and your skin is broken, proper wound care can prevent a scar from forming, or at least make it less noticeable. First it helps to be aware of the many misconceptions that persist when it comes to caring for a cut. “You used to keep it uncovered ‘to let air get in’, but actually the opposite is true,” says Dr. Beatrice Wang, assistant professor of dermatology at McGill University in Montreal. “It’s best to keep the wound covered and closed with a bandage. When it’s uncovered it forms a scab, which delays healing and gives you a bigger, atrophic (depressed) scar.”
Many people also believe you need to dry a wound out for it to heal. “Wounds heal better when they’re moist,” Dr. Kellett says. Basically, you have brand new cells coming in to the area, so why would you want them to dry out and die?” Vitamin E was once the balm of choice when it came to wound healing, but a study in Dermatologic Surgery found topical treatments of vitamin E after surgery either didn’t help the appearance of scars, or actually made them worse. One third of the people in the study developed an allergic reaction to the treatment. Dr. Kellett recommends using an antibiotic ointment to keep the wound moist and prevent infection. “Creams can be drying, so look for ointments and apply right away, two to three times a day,” she says.
The type of bandage you use can also make a difference. Some bandages now contain silver, a natural bacteria-fighter. “Silver has been used for years in wound healing, often in burn units,” says Dr. Kellett. “It has an antibacterial effect by disrupting the cell membrane of bacteria. A bandage with silver in it can prevent infection and improve wound healing so you will have a better looking scar.”
And don’t stop treating the area once the wound has healed. There are still things you can do to reduce the risk of a lasting scar. Minor scars can be minimized with over-the-counter products, but some require more professional help. “It’s important to see a dermatologist in the first four to six weeks after a more serious injury to determine the best option for you,” Wang says.
Scar Therapy: There are many types of scars and treatment varies for each. “For instance, acne scars can be anything from small, depressed, stellate (star-shaped) scars to pitted scars, all of which are treated in different ways,” says Dr. Frances Jang, a Vancouver-based dermatologist. “You need to have them assessed by someone who can treat them on an individual basis.” Other common scars are hypertrophic and keloid scars, both of which are caused by excessive collagen formation in a wound after injury or surgery.
“Most scars go through phases,” she says. “They may become raised, red and firm and itch or be sensitive, but usually settle down over time.” Hypertrophic and keloid scars look similar, but keloids actually expand over the surface of the wound. They can continue to grow slowly for weeks, even years, and are common in people of African and Asian descent, but can occur in all races. “Once you have a scar, it’s easier to treat when it’s still young and red-looking,” Kellett says.
Common treatment options include:
SILICONE SHEETS: Silicone gel sheets help flatten, fade and reduce the redness in both hypertrophic and keloid scars. “In the early phase, things like silicone sheets can be helpful, as well as keeping the scar out of the sun to reduce redness,” says Jang. The sheets need to be applied regularly for several weeks, but are easy to use and you can find them at most drugstores. They should never be used on open wounds.
SURGERY: Surgical scar revision involves removing an existing scar and rejoining the skin to leave a less obvious mark. It works best for long or wide scars, making them either shorter or thinner. Other surgical procedures can help if you have large, deep-seated lumps under the surface of your skin caused by nodular or cystic acne. These scars can be lifted and filled with collagen or fat transfers.
CORTICOSTEROID INJECTIONS: Cortisone is injected directly into scars to shrink and flatten them. Treatment usually needs to be repeated every four to six weeks and the procedure can be somewhat uncomfortable.
LASERS AND LIGHT: Intense Pulsed Light (IPL) and Pulsed Dye Laser (PDL) treatments stimulate collagen, flatten scars and reduce redness without affecting the surface of the skin. “They can make scars appear anywhere from 20 to 90 percent better,” says Dr. Kellett. Other than a temporary redness following the treatment, the procedure is virtually painless and you may see an improvement in the appearance of the scar after one to three treatments. “Unlike the older CO2 lasers, non-ablative lasers are safer for darker-skinned people because there’s less chance of pigment change in the skin,” says Jang. Lasers and light can also be used to improve the appearance of the stretch marks, which are like scars that have formed from the inside out and are caused by a breakdown of collagen and elastin after a growth spurt, pregnancy or rapid weight gain. Studies have shown that IPL and PDL treatments may improve the length, depth and colouration of stretch marks. “When it comes to stretch marks, these treatments can actually regenerate collagen, whereas everything else just sits on the surface of the skin and plumps it up temporarily,” says Kellett.
MICRODERMABRASION: A spray of mineral crystals buffs the outer layer of skin for a smoother appearance. “It’s a mild, low-risk way of treating scars,” says Jang. “But I see a lot of people who have had six or eight treatments with no change. It may have been inappropriate treatment for their degree of scarring, or it wasn’t done aggressively enough. It has to be done aggressively and repeatedly in order for it to work.”
PREVENTION FIRST Despite all the treatment options available, the best option of all is still to try to prevent a scar from forming in the first place. But if you happen to have a few reminders of accidents past, bring them out of hiding and get some professional advice. You just might be surprised at the results. “It’s really a matter of going to someone who knows what’s normal, and what isn’t,” says Jang. “They can tell you when it’s time to start being more interventional, rather than just biding your time and hoping the scar will go away on its own.”