I wish that there were some miracle cream that you could just slap on a scar, and it would instantly get better. Unfortunately no such thing exists but there are things that can be done to improve scars. But we are getting ahead of ourselves

First Things First… What Is a Scar?

It is the result of your body trying as quickly as possible to protect your insides from the outside environment. There is another form of healing that takes more time called regeneration where wounds are perfectly repaired, but this only happens to fetuses in the womb, and I am willing to guess that does not apply to you.

In everyone else, when your skin gets injured your body prepares to defend against intruders. Blood flow increases to the wound and your immune system sends soldier immune cells for protection against bacteria. This is what causes the initial redness of a wound. Shortly after this your body sends builders to start to close the wound. Now they could take time and repair the tissue perfectly but with the imminent threat of the outside world they just haphazardly build as fast as they can in really any direction. This is why a scar does not look the same as regular skin. This is obviously overly simplified but the real deal is very complicated and honestly is not really fully understood.

What Comes Next?

Now after the initial scar forms the body will go back and look at the scar and say, “we can do better.” It will start reorganizing the building materials to make them more organized and increase strength. The initial pinkness or redness of a scar is caused by the increased blood flow to the scar, as well as new blood vessel growth. Think of these blood vessels as the highways that were needed to bring in the military immune cells and the builders to fix the wound. After these are no longer needed, these blood vessels get absorbed over time and the pink/redness improves. This whole process takes a year or more from the beginning of injury to a soft scar with minimal pink/redness.

This is what happens with normal scaring. When scaring goes wrong you can get several issues such as:

1. Hyperpigmentation: Darkening of skin
2. Hypopigmentation: Lightening of skin
3. Keloid scar: Irregular growing scar
4. Hypertrophic scar: Painful raised “angry” scar

I will address poorly healing scars in later posts to give them the time to fully explain what they are and how they are treated.

How Should I Care for My Wound Once I Get Injured?

Well it really depends on many factors. Deep wounds where the skin does not easily come together may benefit from sutures to bring the edges closer together. This lets the “builders” have less to build and leaves the edges flatter and less uneven. Burns or abrasions benefit more from keeping the wound clean and dressings that keep the wound well-hydrated.

But What Can I Do at Home to Get a Better Scar?

1. Sunscreen: Radiation from the sun damages your extra sensitive healing tissue and can cause a worse scar. I recommend sunscreen or avoiding sun for about 1 year after injury.
2. Scar massage: This can start about two weeks after the wound has been fully closed in most healthy people. This breaks up the rubbery scar tissue and makes the scar softer.
3. Silicone dressing: Many studies have shown improvement in scar formation when used for several months after the wound is closed. Check below for more information on this.

PSA on vitamin E: I am sorry to say it does not work. In a very well done paper featured below vitamin E actually showed an increase in contact dermatitis or rash with use and no improvement in scar formation.

At this end of the day if you really do not like your scar you can seek medical help from a provider trained in taking care of scars. Surgical and medical options I will cover in more depth in later posts but include:

1. Laser treatment: Can soften and decrease pinkness/redness
2. Steroid injection: Used on certain types of poor healing scars like hypertrophic and keloid scar
3. Scar revision: Where poor scar is removed surgically and re-closed
4. Chemotherapy/radiation: Typically for difficult to treat keloid scars

Scars are very frustrating, and unfortunately some people are just worse healers than others. Even within the same person scars on different parts of the body can heal differently.

Recap:

1. Scars suck, and they take about 1 year to fully heal
2. Sun screen, scar massage, and silicone sheeting are the only things that really have shown benefit to help scar formation
3. Vitamin E does not improve scars and can cause skin rashes

Additional Reading:

Review of Silicone Gel Sheeting and Silicone Gel for the Prevention of Hypertrophic Scars and Keloids.

The Efficacy of a Silicone Sheet in Postoperative Scar Management.

The effects of topical vitamin E on the cosmetic appearance of scars.