Life invites scars. Being an aesthetic practitioner for over 15 years, I’ve seen patients with myriad reasons for their facial scars; from mishaps, surgeries to simply teenage acne, we all inevitably collect a few scars over the years and our appearance may well be compromised by them. This little guide will take a close look at how scars are formed and what they consist of, before describing several proven treatments for facial scars.
What are Scars, Exactly?
Scars develop whenever a damaged area of skin heals with the help of tissue that does not normally occur in the skin’s outer layers. When a wound of significant depth begins to heal, the body seeks to close the open area with collagen, the strong, flexible, fibrous protein that gives our skin its shape. Collagen is tough and somewhat flexible, but nowhere near as elastic and supple as the skin’s outer layers; it also contains none of the melanin that gives our skin its tone. Any collagen used to close a wound, then, stands out in a feature we call a scar.
We usually think of scars as resulting from cuts or abrasions, but they can also result from severe inflammation, burns, or blisters. Scars can be raised or depressed, or flush with the skin’s surface. They are usually of a noticeably different colour than the surrounding skin, making patients very subconscious of them and significantly affecting their self-esteem and social life.
What Kinds of Scars are There?
Since scars are caused by a variety of factors, it follows that there are different kinds of scars. As aesthetic doctors, we usually use 4 main categories to classify them.
Flat pigmented scars are usually formed by minor to moderate cuts. As their name suggests, these scars are flush with the skin’s surface and are distinguished by their colour. Most appear as darkened patches, but some can be white or even red.
Indented scars are usually caused by inflammatory conditions like chicken pox or acne. They appear as depressions or indentations in areas that produce too little collagen to compensate for tissue damaged during the worst of the underlying condition. Even shallow indented scars tend to be readily noticeable, but these scars can be considerably deep. They usually take on a slightly reddish or dark-brown colour compared to the surrounding skin.
Raised scars, on the other hand, are caused by an overproduction of collagen in response to an injury, usually a cut. Sometimes called hypertrophic scars, they appear as protrusions emerging from the injured area. Some raised scars are colourless, reflecting the fact that collagen contains no pigment. Many, though, take on a reddened or brownish colour.
Keloids are a special kind of raised scar caused when the body responds too strongly to a wound, usually a cut. Like raised scars, keloids are characterized by protrusions caused by excess collagen production. Unlike conventionally raised scars, keloids occur beyond the immediate area meant to be sealed, creating irregular reddish areas away from the original wound. Because they encroach on otherwise healthy skin, keloids can sometimes be sources of discomfort.
Which Kinds of Facial Scars are Most Common?
For most people, the vast majority of facial scars are caused by acne. When acne becomes severe, or when acne pimples are popped and not allowed to heal naturally, the body responds as it would to a deep abrasion or cut, and may leave a scar.
The old advice really is true: acne sufferers should be patient, however difficult that may be, and not pop their pimples (the same advice goes for external wounds: scabs should never be picked at or removed). A gentle skin-care regimen can help prepare the skin to react optimally to new acne outbreaks or the effects of the external injury.
The most common types of acne scar are ice pick scars, rolling scars, and boxcar scars.
Ice pick scars are small but deep. Rolling scars are wide, irregular depressions with rounded edges; boxcar scars are similar, but with sharper drop-offs between the skin’s surface and the scar’s concavity.
Most people’s faces contain a variety of acne scar types. Since each type of scar responds a bit differently to various treatments, the best overall approach usually involves at least two different methods. A consultation with a qualified doctor is the best way to assess a given patient’s needs and to develop the most effective treatment plan.
What Can be Done to Fix Facial Scars?
Across the years, I’ve seen scars in all sorts of shapes and sizes. Don’t be ashamed of your scars; they are inevitable occurrences during our life’s journey. Let me assure you that all is not lost; patients wishing to address their facial scars have a wide range of options. Here are some of the most proven and popular methods.
Chemical peels are essentially strong exfoliants. They use acids or enzymes to remove dead skin cells from the skin’s outer layer, encouraging new skin to grow. This can offer some improvement, especially to depressed scars.
Dermal fillers are gels injected under the skin to change its shape. Their effect is too subtle and their extent too broad to be of much use against deep acne scars, but fillers can significantly improve the appearance of deep, shallow scars.
Corticosteroids can be injected directly into keloid scars, where their anti-inflammatory properties provide relief, especially to areas outside the boundaries of the original wound.
Punch excision literally acts like a paper punch, removing a small area of skin surrounding a scar. In some cases, the puncture is then sutured and left to heal, resulting in a clear top layer of skin free of scarring. In other cases, a graft is taken from an out-of-the-way location elsewhere in the body and inserted into the area left behind by the punch before the wound is sutured.
Subcision works best for depressed scars featuring excessive scar adhesions, fibrous tissues that sometimes form under injured tissue. A needle is fed beneath the scar and breaks up the scar adhesions; it also disturbs the skin’s collagen layer, prompting the production of collagen underlying the scar and helping to bring it flush with the skin’s surface.
Microneedling works similarly to subscision, but involves the simultaneous introduction of several small needles. These needles are often equipped to deliver heat, in the form of radiofrequency energy, to the skin’s collagen layer, providing an even stronger incentive for the skin to produce more scar-raising collagen.
Laser treatment is unique on this list for being appropriate against a wide range of scar types. Lasers deliver high-powered beams of light to various depths within the skin, depending on the frequency to which they are tuned and the power at which they are calibrated to work. One popular use of lasers against facial scars is the safe and productive encouragement of collagen development. Lasers can also be tuned to resurface the skin, greatly reducing the appearance of raised scars.