All About Scars

Many people develop scars as part of the skin’s normal healing process, and though often considered unsightly, scars show your body has repaired a wound. Scars form in four phases after an injury, surgery, or lengthy chronic disease such as acne. 

The hemostatic phase of skin healing begins immediately upon injury and the cells involved work in concert to stop bleeding. Inflammation—or swelling—begins approximately one day after injury to the skin and lasts approximately three days. This second phase involves cells that produce fluid and work together to prevent infection. It is common during this phase for a wound to appear swollen, warm, red or pink in color and to be painful.

The proliferation phase begins approximately four days following an injury and deposits the collagen—the protein responsible for skin elasticity—and other framework for the skin to heal. Lasting approximately three weeks, this phase allows the skin to function once again as a barrier to the outside world. New blood vessels are formed and the wound begins to contract, so the wound can begin to look smaller, though the skin is still pink and “new.” 

Finally, the remodeling phase begins approximately three weeks following an injury and lasts for a year. During this phase, cells rearrange the deposited collagen from the proliferation phase and organize it in a way to increase tensile strength, or the ability of the wound to stay together. During this phase, wounds begin to take on their more permanent appearance.

During these healing phases, there are a few techniques you can do to improve the formation and appearance of a scar. Three weeks after surgery or traumatic repair, begin scar massage—manually compressing the wound against underlying bone—for approximately five minutes twice daily. You can use any type of lotion to reduce friction.  Protect surgical sites or traumatic wounds from sun exposure with protective clothing or SPF 30+ at all times while outside and reapply sunscreen regularly.

There are many ways in which wound healing can go awry and lead to unsightly scars or functional limitations. If a wound is unable to heal “normally,” it may become a chronic, non-healing wound or the resulting scar may be undesirable. Some scars can become so thick and tethered that it interferes with function, especially near a joint.

Interventions to improve scar appearance and/ or function include compression therapy, silicone gel sheets, scar massage, and corticosteroid injections or laser treatments. Certain scars may require more aggressive treatments like immunosuppressive agents, radiation therapy or surgical scar revision.

Understanding how wounds heal and scars form is paramount to creating the most subtle scars following surgery or a traumatic injury. When the scar has formed, there are options for treatment to improve the appearance of the scar so that it doesn’t define you.

Dr. Kathleen A. Holoyda is a board-certified plastic surgeon providing plastic and reconstructive surgery services to the Lake Tahoe region. For more information or to schedule a consultation, call 530.543.5799 or visit BartonHealth.org/PlasticSurgery.