Scars can be a delicate subject. While some people don’t mind showing off their scars and sharing their stories, others prefer to conceal them. Having scars can bring up lots of questions, and the best source to answer those questions is an expert in all things skin: a dermatologist.
We spoke with Dr. Joyce Imahiyerobo-Ip, Founder of Vibrant Dermatology in Greater Boston, Massachusetts, to help us understand scars and to share some helpful tips on preventing, treating and covering scars.
How do we get scars?
Scars appear when your skin is healing from an injury. To repair the wound, the body creates collagen (a fibre responsible for skin elasticity) to reconnect damaged tissues. Skin can take up to a year to fully complete the healing process.
What are the different types of scars?
There are many different types of scars. It is important to know that a scar can mean many different things to different people.
- In most cases, scars are flat. Their colour can go from red to dark brown, depending on your skin type and on where they are in the healing process. When scars are excessively red, dermatologists describe them as hyper-vascular (meaning a lot of blood vessels). When a scar is excessively dark, we describe this as hyper-pigmented. The change in skin colour is usually secondary to marked inflammation in the affected skin.
- When too much collagen is produced by the body, the scar rises and is called hypertrophic, or keloid. These are more common in dark-skinned and younger people.
- When the structures underneath the skin are gone, scars will appear as sunken or pitted. This occurs with surgical scars and acne scars.
- When the skin stretches in a short time period, which many people associate with weight gain, weight loss or pregnancy, stretch marks will appear.
Can I prevent scarring?
There really isn’t a way to truly prevent a scar. If you have a wound, it will leave a scar. However, with proper wound care you can help to reduce the appearance of a scar.
- Keep the affected skin clean and moist at all times. Gently clean with soap and water to avoid germs.
- Keep moisturizing the wound – avoid drying out the wound by applying petroleum jelly. This will reduce the healing time.
- When the skin is clean and moist, cover the wound with an adhesive bandage, which you can change daily.
- Avoid direct sun exposure and once the wound is healed, use a sunscreen with SPF 30 or higher which may help to minimize red or brown discoloration.
What treatments for scars are available?
Scars fade over time when we take care of our skin. Here are some tips to manage the common types of scars:
- Vascular scars normally heal well with time. Sun protection is highly recommended to avoid enhancing and lengthening the vascular healing phase of a scar. To cover up a red scar, use green concealer. An intervention, such as laser treatments, might be in order if the scar has been red for over six months.
- Post-inflammatory hyperpigmentation (dark brown scars): Again, time is your best friend when it comes to this kind of scarring. These mostly appear with dark-skinned acne patients. Many find the post-inflammatory hyperpigmentation even worse than the actual acne. Fortunately, there are topical medications and treatments that can significantly improve this type of scar. A medication called hydroquinone, a skin-lightening medication, is a champion for treating hyperpigmentation. While it is very effective, it can only be used for short periods of time. Overuse can even darken the skin! Another option is skin brighteners. They are composed of botanical ingredients that can suppress pigment-producing cells and brighten the skin.
- Keloids/hypertrophic scars: These types of scars occur when too much collagen is produced while the wound is healing. People who are prone to keloids should tell their doctor before any surgical procedure. Treating hypertrophic scars can be a challenge. However, two options can be helpful. A medication called Kenalog, which is injected by a board-certified dermatologist, can help flatten the scar. Silicone dressing is also used to help with scarring. The pressure it puts on the scar while it is healing makes it difficult for extra collagen to form.
Can I remove a scar?
I am often asked by patients whether removing a scar is possible, mostly for acne scarring. Unfortunately, no. There is no way to completely remove a scar. I can only help reduce the appearance of a scar. A non-raised scar can benefit from surgery to alter its shape to make it less visible. Microneedling, dermabrasion and laser resurfacing are great options to make scars “blend in.” Microneedling works well on acne scars. Sunken scars can be raised by fillers. However, these treatments are not permanent and will need maintenance.
What type of makeup is recommended to cover scars?
There are many options to choose from. To cover a scar, I recommend makeup that can protect/heal it as well. Look for a concealer that has SPF protection, like Cover Creme Foundation which also has full coverage and helps repair the skin surface barrier. To cover up a scar on the body, try using Quick-Fix Body for smaller coverage, and Leg and Body Makeup for larger areas of the body. Loose Setting Powder will make it last for up to 16 hours.
Why are you passionate about helping your patients with scars?
Being a dermatologist for 10 years, scars have become my passion. I get to help people whose lives are affected by their scars, whether they appear on the skin or are internal/emotional. Regardless of the type of scar, what I learned is that scars can affect both our mental and emotional health. As a dermatologist, I feel honoured to help people feel more comfortable in their own skin through scar improvement procedures. Our perception of a scar needs to change. A scar represents trauma and survival. Our scars tell the stories of what we have survived. They prove that we are strong and resilient.