Are scars actually permanent?

Table of Contents

What are scars?

Scars are areas of fibrous tissue that replace normal skin after injury. When the skin is wounded, the body triggers a healing process that aims to repair the damage quickly. This process results in scars, which look different from normal skin because the tissue is fibrous rather than smooth.

Scars form for a variety of reasons, including:

Cuts
Burns
Acne

Surgery
Stretch marks

The severity of the wound impacts how noticeable the scar will be. Deeper wounds that damage more layers of skin are more likely to result in thick, raised scars while minor cuts that only impact the top layer usually heal with barely visible scars.

Are scars permanent?

For the most part, scars are permanent. The scar tissue that forms after an injury does not have the same composition and structure as normal, undamaged skin. However, that does not mean scars cannot fade over time.

Here are some key points on the permanency of scars:

Scars can continue to mature for up to 2 years after the initial injury as collagen production and remodeling occurs.

Thick, raised scars may flatten out and become paler over time, but will remain visible.
The appearance of a scar depends on factors like skin type, age, location on the body, and genetics.
With treatment, scars can be made less noticeable, but true scar removal is not possible.

So in summary, while scars are permanent, their appearance can improve gradually on their own or with treatment. But even faded scars will remain visible. The damaged skin cannot be restored to its pre-injury state.

What affects the appearance of scars?

Many factors influence how noticeable and dramatic a scar will be, including:

The severity of the original wound – Deeper cuts or burns, surgical incisions, and injuries with lots of inflammation result in more significant scarring. Minor scrapes and surface injuries tend to scar less.

Genetics – Genes play a role in wound healing and collagen production. Some people are just more prone to raised, thick scars called hypertrophic or keloid scars.

Ethnicity – Those with darker skin tones have higher risk of raised scars and keloids. Lighter skin is more prone to red or purple scars from inflammation.

Age – Younger skin heals more efficiently. Scars tend to be more dramatic in older adults since skin loses collagen over time.

Location on the body – Areas prone to motion or friction, like joints, are more likely to develop stretched, widened scars. The face and neck scar more prominently since they lack fat tissue beneath the skin.

Sun exposure – UV rays can damage scar tissue and cause red or brown discoloration. Sunscreen helps limit this.

Skin type – Dry or sensitive skin is linked to more visible scarring. Oilier skin types tend to scar less.

Infections – Wounds vulnerable to bacteria introduce more inflammation and increase scar formation.

So while scars are permanent, their ultimate appearance depends on many factors related to the skin and healing process.

Do scars fade over time?

In many cases, scars do fade and become less noticeable over time. Here’s why:

Collagen remodeling occurs up to 2 years after the initial injury as the body reinforces and organizes scar tissue.
Scars may flatten out and become softer and more pliable as they lose the swelling and excess collagen typical of newer scars.
The red or purple tone from inflammation fades, causing scars to appear more skin-toned.

Surrounding skin that was stretched or damaged during the injury can regain a more normal texture, blending the scar.

In general, a scar reaches its mature state around 1-2 years after the injury that caused it. During this time, the scar naturally regresses and improves in appearance.

However, the degree of fading depends on the nature and depth of the original wound. For example:

Minor scrapes or cuts may heal with barely visible thin white lines.
Surgical incisions typically mature into soft, pale scars over time.
Deep lacerations are likely to leave permanent, though flatter and paler, thick scar tissue.

Full thickness burns often result in textured patches of scar tissue that remains substantially different from surrounding skin.

So while scars generally tend to fade, more severe injuries will leave more prominent evidence of scarring even after maturation.

Can scars be removed completely?

True scar removal that restores skin to its original, pre-injury state is not possible. Scars form to quickly replace missing skin after an injury, not regenerate like normal undamaged skin.

However, there are ways to make scars less noticeable, including:

Laser treatments – Laser resurfacing removes outer layers of scarred skin to promote new collagen growth and remodeling. Can reduce the appearance of scars significantly.

Dermabrasion – Uses a rotating instrument to abrade the scar and surrounding skin to improve texture and appearance.

Steroid injections – Injections of corticosteroid medications can flatten and soften scars, especially hypertrophic and keloid scars.

Filler injections – Fillers like collagen or fat can be injected to plump depressed scars and make them smoother. Results last around 4-6 months.

Silicone sheets/gels – Softens and flattens scars while protecting them from sun exposure. Shown to improve scar appearance over time with consistent use.

Compression – Applying gentle pressure consistently to new scars can prevent collagen overgrowth leading to hypertrophic scars.

Surgical revision – In some cases, scars that limit function or remain dramatically visible after other treatments may be surgically revised for aesthetic improvement.

The goal of these therapies is not to remove scars completely, but rather make them less noticeable. They work by smoothing textures, reducing discoloration, and minimizing scar size and thickness.

With a combination of time and the right treatments, most scars can be significantly improved. But some amount of visible scarring will always remain.

What is the best treatment to remove or minimize scars?

The most effective scar treatment depends on the scar’s location, thickness, and your skin type. Here are top options:

For surgical incisions: Silicone sheets and gels are first-line for flattening and fading surgical scars. Starting use once any stitches are removed can make a significant difference in final scar appearance.

For hypertrophic scars: Corticosteroid injections combined with silicone gel sheeting provides the best reduction of scar thickness, hardness, and redness. Compression also helps.

For minor acne scarring: Laser resurfacing treatments like Fraxel lasers give excellent improvement of shallow acne scars and pockmarks on the face. Chemical peels can also help.

For deep acne scarring: Tissue fillers work best for rolling and depressed acne scars that cause divots, shadowing, and uneven skin texture. Fat grafting and fillers like Bellafill provide long-lasting plumping.

For keloid scars: Cryotherapy (freezing), corticosteroid injections, compression, silicone gel, and laser excision are all used alone or together to flatten and shrink aggressive keloid scarring.

For large surgical scars: Scar revision surgery removes and re-approximates scar tissue for a thinner, cleaner scar line. Dermabrasion afterward improves appearance.

For burned skin: Laser skin resurfacing can reduce skin discoloration and uneven texture from healed burns. Fat grafting also helps fill out depressed areas.

Always consult a dermatologist to determine which option is right for your particular scar type, thickness, and location on your body. Procedures can be combined for optimal results.

Can you prevent scars from forming?

There is no way to prevent scars completely after a skin injury. They are simply part of the healing process when damage occurs. However, proper wound care can help minimize scarring.

Tips for reducing the appearance of scars include:

Clean the wound daily and apply antibacterial ointment to prevent infection.
Keep the wound moist with products like petroleum jelly to optimize healing.
Avoid picking scabs or reopening wounds.

Apply silicone scar sheets or gels twice daily to reduce collagen production.
Follow doctor’s directions for care of surgery wounds to optimize healing.
Avoid sun exposure while scar is healing. Wear sunscreen on the area afterwards.

Massage the scar to increase circulation and prevent bands of scar tissue.

If you are prone to hypertrophic scars or keloids, talk to your doctor about using compression, corticosteroid tapes, or gel sheets on any wound. This can help avoid excessive scarring.

While scars cannot be prevented completely, taking proper care of wounds can keep them thin and faint.

When to see a doctor about scars

Most scars can be managed at home with over-the-counter treatments and time. But it’s a good idea to see your doctor or a dermatologist for evaluation in these cases:

The scar is widespread, covers a joint, or limits your movement or function
You develop a bumpy, thick, raised scar more than a month after an injury

The scar continues to remain reddish or dark purple for more than 6 months
Your scar frequently feels painful, tender, or itchy
You have a history of scars that turn into dark, raised keloids

Dermatologists have access to prescription strength treatments and procedures to improve scar appearance. Early intervention can help minimize scarring.

Surgical scar revision may be an option if the scar is interfering with movement or activities.

Home treatments to reduce the appearance of scars

While most scars take around a year to maturity fully, you can use home treatments to help them fade and flatten more quickly. Options include:

Silicone gel sheets and creams – Silicone is shown to soften and flatten scars. Apply gel or sheets after any sutures are removed. Use for at least 12 hours a day.

Moisturizers and ointments – Keep the scar hydrated with products like vitamin E oil, cocoa butter, or petroleum jelly to improve healing.

Onion extract gels – Onion extract gel helps minimize redness and flatten raised scars.

Aloe vera – The soothing properties of aloe vera gel may help reduce inflammation in newer scars.

Compression garments – Wearing tight sleeves or bandages helps prevent excessive collagen deposits from forming a hypertrophic scar.

Massage – Lightly massaging the scar improves circulation and helps soften and flatten it.

Sun protection – Prevent UV damage to a scar with clothing or broad spectrum SPF 30 sunscreen.

Talk to your dermatologist to develop a routine with home remedies and over-the-counter products tailored to your scar type. Consistency is key to seeing results.

How to prevent scars from worsening

Once a scar forms, it’s important to avoid anything that could worsen its appearance. Tips include:

Avoid direct sun exposure. Always apply sunscreen to prevent discoloration and damage.
Don’t pick at scabs or re-injure the area. Let healing occur naturally.
Follow wound care instructions from your doctor to prevent complications.

Avoid harsh products like skin lighteners or exfoliants on the scar.
Stop activities that cause pain or irritation to the scar area.
Manage conditions like acne or eczema that could damage the scar.

Quit smoking to optimize skin health and postoperative healing.
Follow up with your doctor if you notice the scar worsening or new symptoms.

While scars are permanent, avoiding irritation or inflammation to the area can prevent the scar from becoming more raised, discolored or noticeable.

Scar revision surgery

Scar revision is surgery to remove or improve the appearance of problematic scars. It can be done when:

The scar limits mobility or function
The scar is widespread, raised, and cosmetically distressing

Other scar treatments have not improved its appearance

Procedures may include:

Excision – Cutting out the scar to remove excess tissue and improve contour of the skin.

Dermabrasion – Resurfacing the skin around the scar to blend its edges.

Laser resurfacing – Laser treatment to smooth the scar’s texture and reduce discoloration.

Z-plasty – Reshaping the scar into a Z shape allows it to lie flatter.

Tissue expansion – Using fillers or an expander implant to stretch healthy skin over the scar.

Grafting – Adding healthy skin from another part of the body to the scar.

Scar revision is typically done under local or general anesthesia. Several treatments may be combined to achieve optimal smoothing of the scar.

While scar removal is impossible, revision can often substantially reduce the scar’s size and visibility.

Coping with scars

Scars can sometimes have an emotional impact, especially on visible areas like the face or neck. Adjusting to a scar can be difficult. Strategies include:

Give it time. Scars continue to mature and fade for up to 2 years.

Remind yourself that everyone gets scars. They are a natural part of healing.
Talk to friends and loved ones about your feelings regarding scarring.
Avoid focusing only on the scar – you are still the same person.

Use makeup, clothing, or hairstyles to camouflage scars if self-conscious.
Trust your doctor to recommend treatments to improve appearance.
Consider counseling if struggling with self-esteem due to scarring.

While scars don’t define you, it’s normal to feel a sense of loss about injured skin. Having patience and using available treatments can help you move forward.

Conclusion

Scars form as a natural part of the healing process when skin is damaged. While true scar removal is not possible, most scars do fade and flatten somewhat over time. Proper wound care during healing can help minimize scarring, and treatments like silicone gel sheeting, steroid injections, laser resurfacing, and surgical revision can improve scar appearance. However, some degree of visible scar tissue will always remain. With time and the right care, most people find scars become an accepted part of their skin’s story.