Scars are a significant aesthetic defect. Depending on their type and origin, an experienced aesthetic medicine specialist can select the appropriate therapy to improve their appearance. Surgical, laser, acid, and even filler procedures.

A scar is an aesthetic defect resulting from damage to the dermis, after which the defect has been replaced by fibrosing tissue – so-called hypertrophic scars or by defects in the thickness of the skin – so-called atrophic scars. In the initial phase, due to increased neoangiogenesis, scars are red, then pink, and over time they fade to a pearly glow. Due to their structure, scars usually do not have:

melanocytes, so they are always lighter than the surrounding skin,
glands (e.g. sebaceous or sweat glands)
they do not have hair follicles (so no hair grows on their surface).

Scars usually form:

as a result of injuries, cuts
burns, most often thermal, less often chemical
in the course of certain diseases, infections, herpes, chickenpox, bacterial infections, acne
after road accidents
as a result of surgical interventions (e.g. cesarean section, removal of the thyroid, removal of the appendix, etc.)

In most cases, scars heal properly and do not pose an aesthetic problem. In some cases, especially on large areas of the body, scars grow over, are pulled into the tissue and excessive fibrosis occurs. Then they can cause pain, limit the range of movement and sometimes make it difficult to perform everyday activities. Scars located on the face are a huge psychological problem, because they focus the eyes of others, leading to embarrassment and even disorders of the patient’s self-esteem.

The best solution and prevention is immediate, proper care of scars in the initial stages of their development. Many patients do not start treating scars until several years after they appear, which unfortunately significantly limits our options.

Currently, plastic surgery and aesthetic medicine try to improve the appearance of scars as much as possible, but they will never be 100% removed.

Depending on the type of scar, appropriate treatment methods can be used:

Hypertrophic (hypertrophic) scars

They are characterized by significant overgrowth of connective tissue above the skin surface. They may be the result of mechanical damage, frequent violation of tissue structures during the healing period, or even an infection during treatment. In this case, an appropriate steroid injection is most often performed, which causes the scar to sink and become level with the healthy skin surrounding it. Sometimes after the procedure, the scar is bright red – then, after healing, a laser procedure can be performed to close the blood vessels. Scar injection procedures are performed gradually and the therapy proceeds differently for everyone. Sometimes the effect is spectacular after just one injection, and sometimes it requires multiple procedures.

Atrophic scars

They are the result of disruption of the healing process, associated with insufficient collagen synthesis. Due to their relatively thin surface, these scars are often red, cherry or purple in color, sometimes with small red vessels visible through them. They can be the result of:

incorrect use of steroids
overuse of retinol and its derivatives, which results in thinning of the epidermis during the scarring process
scarring during concurrent radiotherapy

Atrophic scars are shallow, but can be quite large.

Acne scars

Many young people struggle with acne. In some, especially with simultaneous infections and frequent squeezing of skin lesions, scarring occurs. Acne scars can be divided into:

Ice Pick type

They are usually the result of removing deeply embedded and dried blackheads. Scars of this type have a small diameter (up to 2 mm) and sharp edges, and are also very deep. They often look like holes from earrings. Tergo type scars are extremely difficult to remove and require many treatments. Usually, strong chemical peels combined with surgical dermabrasion and laser treatments are used alternately. Sometimes surgical dermabrasion is necessary. When deciding to start treatment for an Ice Pick scar, the patient must be prepared for a long-term cooperation with the attending physician.

Rolling type

They have a fairly large diameter (4-5 mm), but their edges are quite gentle, and it often happens that their bottom is attached to the subcutaneous tissue. Often, in addition to exfoliating the upper layer of the epidermis, it may be necessary to cut or even transplant fat into the place of the defects. In the case of this type of scars, the effects of the procedure are usually spectacular and satisfactory. The described procedures are complemented by improving the thickness and tension of the skin with laser treatments.

Boxcar type

Scars of this type have a large diameter (1-5 mm) and sharp edges. Their depth can reach 0.1-0.5 mm. During the treatment of this type of scars, their edges are alternately softened and collagen production is stimulated inside them. When planning your therapy, it is worth considering procedures such as:

needle mesotherapy using platelet-rich plasma
chemical peels
microneedle fractionation with Dermapen
surgical dermabrasion combined with chemical peeling
laser fractionation procedures combined with fat grafting

Adhered (attached) scars

They are characterized by significant fibrosis and adhesions in the subcutaneous tissue, which can cause considerable discomfort during movement, and in some cases even pain and limitation of range of movement. Adhered scars are characteristic of extensive wounds, especially burns and post-accident wounds, located in the limbs, and can, for example, effectively impede straightening of the arm or leg. Scars grow into deeper tissues in post-operative scars (e.g. after a caesarean section) and rolling acne scars. In such cases, during treatment, it is necessary to initially cut the scar and free it from internal structures. In some cases, fat grafting directly under the scar is also recommended, as well as platelet-rich plasma mesotherapy.

Keloids/keloid scars

They appear immediately after the scar has healed and are characterized by uneven bulges that significantly exceed the area of the injury. They are often the result of the so-called keloid disease. Scars of this type are often red for a long time and can be painful. They are the result of the body’s excessive tendency to produce collagen. In patients suffering from keloid disease, virtually every injury can result in the formation of a keloid. In such cases, unprofessional performance of the CO2 laser procedure or microneedle fractionation is strictly prohibited, which can only worsen the appearance of the scar. Usually, treatment involves direct administration of a steroid, which is intended to cause the keloid to collapse. Sometimes keloids are surgically removed or rubbed off in combination with steroid therapy

Self-harm scars

These types of lesions are usually very narrow, but long and dense. They often remind us of tragic memories from childhood and youth and cause great discomfort in adulthood. Unfortunately, because they are often located on the inner part of the forearm, where the skin is poor in subcutaneous tissue, their treatment is difficult and may initially give the opposite effect to the expected one.

Regardless of the type of scars you are dealing with, in order to treat them correctly, a thorough analysis by a specialist is necessary. Never try to remove them yourself, as this can end in serious complications and a deterioration in appearance.

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