How Do Scars Form on Our Skin?

Like it or not, scars are a natural part of life, and most of the time, it’s hard to escape childhood without racking up at least a few cuts and bruises along the way. In order to make it easier to learn how to heal scars and how to further care for your skin, it is vital to better understand the process behind skin and scarring.

The skin is a sensory organ, the body’s largest organ, and when opened, either by accident or through surgical incisions, the injury typically results in a scar. As such, scars represent the final phase of the body’s healing or repair process after skin is damaged, occurring as a direct result of everything from burns, surgery, or skin conditions to any significant traumas. Even a procedure as simple as ear-piercing can sometimes cause a deforming scar or keloid.

Scar Formation

Scars form due to damage of the dermis (deep, thick layer of skin), as the body works to form new collagen fibers that then result in a scar.

Initial phases of the wound healing process include control and cessation of bleeding and sealing the wound to prevent the penetration of bacteria or potential infection. Collagen is then used to repair and close the wound. Scars form after a wound heals, usually having a different texture and quality than the surrounding tissue. The entire healing process can be imagined as human cement that is utilized by the body to fill up a hole—i.e. the wound.

Types of Scars

There are various different types of scars, ranging from the more typical flat and pale-looking to more raised scars called hypertrophic scars or keloid scars that occur when the body produces too much collagen. Other scars have a more sunken or pitted appearance, occurring when underlying structures supporting the skin (ex. fat or muscle) are lost.

Scars can also appear in the form of stretched skin. These occur as a result of rapid skin stretching, as in growth spurts or during pregnancy, or when the skin is under tension or near a joint during the healing process.

Best Scar Treatments

Like scars themselves, the various treatment options for scars range widely. If very early on, some scars should be vigorously massaged with a moisturizer several times a day for about one minute, as the active movement helps reorganize not yet mature collagen bundles that are forming during the repair of the injury. The moisturizer not only decreases friction on the tender new scar but also provides moisture to the area. Some choices such as cocoa butter and vitamin E oil are often quite effective.

One important thing to remember is to stay away from sunlight because immature scars need to be amply protected from the sun in order to prevent hyperpigmentation or becoming overly dark. Some of the best scar treatments available include:

Steroid injections: Long term courses of steroid injections into a scar may help flatten it by helping soften the appearance of keloid or hypertrophic scars.
Dermabrasion: Removes the surface of the skin with special equipment and is especially useful when a scar is raised above the surrounding skin (though it is less useful for the treatment of sunken scars). Microdermabrasion, a less invasive form of dermabrasion, can also be minimally useful for very superficial scars.
Laser Resurfacing: Similar to dermabrasion, resurfacing removes the surface layers of the skin using different types of lasers. The advanced technology results in little down time as opposed to traditional laser resurfacing and dermabrasion, which both require a long recovery.
Radiotherapy: Low-doses of superficial radiotherapy can be used to prevent the recurrence of severe keloid and hypertrophic scarring.
Filler injections: Though the effects of injections are only temporary, they can be used to raise sunken scars to the level of surrounding skin. Procedures need to regularly repeated and there are many newer forms of injectable fillers now on the market that may be good to consider.
Surgery: Although it is not recommended in cases of hypertrophic or keloid scarring (raised scars), surgery can be used to alter a scar’s initial shape or to make it less noticeable.

The formation of scars after surgery or trauma to the skin is an inevitable fact of life that needs to be dealt with as it occurs—whether we like it or not. It is important to be proactive in regards to the treatment of scars early on in order to maximize the outcome of their final appearance.

Let Dr. William J. Binder, an experienced, acclaimed, and world-leading facial plastic surgeon help with the best scar treatments available today. Contact his office today to find out more about ways to prevent scarring or to schedule a consultation.

Surgical Reconstruction for Extreme Physical Damage

Plastic Surgery

When many people hear the words “plastic surgery” they immediately think of breast augmentations, liposuction, and age-defying Botox injections. Of course, there are many other procedures in the realm of plastic surgery than the purely cosmetic. In many cases, plastic surgery is performed for reconstructive or reparative purposes, rather than cosmetic or aesthetic reasons. Following physical trauma that leaves lasting damage, certain cosmetic surgery can restore not just the physical appearance of damaged tissue, but also physical function.

Why Might Someone Need or Want Reconstructive Surgery?

Following an accident or other injury that results in physical trauma, once a patient’s overall health has become stable again, thoughts begin to turn to repairing the damage, particularly in the case of severe or disfiguring facial trauma. Studies have shown that patients with uncorrected facial trauma have a higher incidence rate of body-image issues, depression, and post-traumatic stress disorder.

Types of Reconstructive Surgery

This type of surgery takes many forms, and the number of techniques and procedures is growing every day. Facial reconstruction in particular is a rapidly growing field, and now includes techniques that would have been impossible even just a decade ago.

Facial reconstructive procedures can include:

Reconstruction of the Skin

Skin treatments typically take the form of chemical peels or laser treatment to lessen the raised appearance of scars, or to eliminate excessively darkened or lightened pigmentation following a burn or skin graft. These same procedures can also be used to reverse the appearance of fine lines and wrinkles that comes as a result of passing time.

Laser treatments, particularly C02 laser treatment, can also be used to “sand away” a raised or hypertrophic scar in order to bring it in line with the rest of the skin on the face, thereby making it far less noticeable and obtrusive. The same can also be done with dermabrasion, and often the two techniques are used in conjunction with chemical peels and other deeper reconstructive options to achieve the very best result.

Skin Treatments Beneath the Skin

For deeper damage that causes the skin to be raised or lowered, particularly following trauma such as a burn, there are more intensive options that can aid in scar removal. This typically takes the form of collagen or other fillers, but it can also include tissue expanders that help to bring the skin together to promote smoother, more aesthetic healing. This procedure is a bit more involved than other simple skin treatments, but it can also be used in combination with Z-plasty to help bring severe scars more in line with the natural lines of the face in order to more effectively blend them into the surrounding skin

What Reconstructive Surgery Can’t Do

Despite the advances in modern cosmetic surgery, there are some things it just can’t do. For one, deep burns are particularly problematic to reconstruct, as there is often very little tissue left to work with. There is likely to always be some measure of visible damage following a severe burn. However, even the most severe scarring can be lessened with the proper techniques. By combining several different types of reconstructive procedures to achieve a customized solution, severe scarring can be improved and the physical and emotional after-effects of trauma can be lessened.

Why Choosing the Right Surgeon Matters

The most important part of any surgery is choosing the right surgeon. The very best reconstructive surgeons are the ones that specialize in particular areas of care, so be sure to find one that is specifically focused and well versed in facial reconstruction, before choosing to undergo such delicate procedures. Facial scarring can easily be made much worse with improper or poorly performed scar removal procedures, making it especially important that you choose a reliable physician with an excellent track record.

Dr. William J. Binder is one of the world’s leading facial reconstructive experts, and has a long history of innovation and creative application of advanced reconstructive procedures. He is based out of Los Angeles, but due to his expertise and experience, patients from around the country and even the world come to receive treatment from him. Dr. Binder is extensively published and is board certified by both the American Board of Otolaryngology and Head and Neck Surgery and the American Board of Facial Plastic and Reconstructive Surgery. If you have questions about facial reconstruction and want a consultation with the very best, contact Dr. Binder’s office today.