What is the cause of scars? What is the main cause of scars? Scar formation is a natural body process of healing and it is not an abnormality. Whenever there is break in the skin continuity due to injury or any other reason. When a gap in the skin continuity is caused, the body starts a healing process that quickly fills up that gap with collagen tissue. Imagine it like a patchwork done by the body on a torn cloth - the patchwork material is not the same as original material, but it protects the fabric.
What is the first stage of a scar? What determines if a scar will form? What body parts scar the most? Moment you get an injury or there is breach in the skin continuity, the body starts with the following response:
Inflammatory stage : It is like the body has got alerted to a breach in its security (breach of skin barrier) and it immediately dispatches its soldiers (the white blood cells) to the site. In this stage, the body is trying to prevent an infection or entry of any foreign object. In this stage the wound appears swollen and red and can be accompanied by painProliferative stage : Once the body has protected itself against external threat of infection or foreign objects, it starts to rebuild the lost tissue by its repair workers, the fibroblasts cells. These cells produce repair material called fibrin. New blood vessels are also formed to give blood supply to the new cells. This stage can last for 3-4 weeksRemodeling stage : Until now the primary cells were fibroblasts that were helping to seal off the wound. In this stage the body tries to send original cells to the site and tries to regain the earlier structure. In this stage the scar becomes flatter and blends more closely to the nearby skinThe more successful the remodeling is, the lesser the scar appears.
The formation of the scar is determined by the following factors:
Wound depth : Injuries that are limited to only epidermis do not leave scars - that’s why scratch marks do not leave scars. Wounds that extend into dermis or deeper tend to leave scars. Genetics : determines the initial inflammatory stage and how the body reacts first. Darker skin types are more prone to forming thicker, darker scars. Also people with keloid tendency determined by their genetics, can have abnormal inflammatory stage leading to thicker and more visible scars Body parts that tend to scar the most are: Face and hands are exposed parts and can get darker scars due to exposure to UV light Other areas like elbows and knees or skin over other joints tend to form scars. Due to constant movement on this skin the healing process constantly gets disrupted leading to scar formation
Why do people get keloids? Who is most likely to get keloids? Do Indians get keloids? Why do I scar so easily? Why does every cut turn into a scar? People who scar easily or tend to form keloids belong to African, Asian, and Hispanic descent, suggesting a genetic link. People with keloid or scar tendency seem to have a longer inflammatory response. The underlying genetic mechanism is complex, but it is clear that Asians, including Indians, tend to get thicker and more visible scars. We Indians also have a tendency for excess pigmentation in the scar - which is also called Post inflammatory hyperpigmentation (PIH).
People with this genetic predisposition can form scars at not just cuts, but also at injection sites, insect bites, and sometimes even on tattoo sites and piercings.
It can be helpful to inform your doctor if you have a keloid tendency, so that you can discuss concerns of scar formation in more detail.
Why are scars permanent? Do scars ever go away? In the above writeup we have explained the process of formation of the scar. The scar tissue formed during the process of healing is different from the nearby skin cells. Scar tissue mainly comprises collagen, which is a connective tissue which has very different properties and appearance. In scar tissue the collagen arranges itself in an interconnected manner - this is to ensure that it provides adequate protection from external entities like infections. In the remodeling phase of scar formation the scar tissue just turns from immature to mature tissue.
Superficial scars do fade away with time as the depth of the scar tissue formed is also less.
What are the different types of scars? There are 5 different types of scars:
Flat scars : as the name suggests these are flat scars and while they have initial redness during the inflammatory phase they eventually fade away as the healing progresses. This is the best kind of scar to have as it can heal pretty well over time. These happen when the injury is superficial and there was proper wound care immediately after the injury.
Flat scar
Hypertrophic scars : These happen in deeper wounds when the body produces more scar tissue. These are raised and can also be darker than the surrounding tissues, especially in Indians. These are very common types of scars and they do not extend beyond the boundaries of the injury. So if you get a deep knife cut, the scar will stay limited to the cut.
Hypertrophic scar
Keloid scars : These are similar to hypertrophic scars with one main difference - the scar tissue extends beyond the injury. So in the knife cut example, this scar tissue will become broader than the actual cut. These scars are usually seen in people who have genetic predisposition which is also called as keloid tendency
Keloid scar
Depressed / atrophic scars : Probably the hardest to treat. These scars are depressed in comparison to the nearby tissue. A typical example of a depressed scar is acne scar - where you see pit-like formation on the skin. These occur when the body is unable to generate adequate amounts of scar tissue and the surface of the scars is stuck to the deeper layers.
Depressed / atrophic scar
Contracture scars : Typically happens in burn scars. In these scars the scar tissue pulls on or contracts the nearby tissue, as there is not enough scar tissue formation. These scars can restrict movement and cause functional issues and the main objective of these scar treatments is to first restore movement. Contracture scars need specialized and long term treatment.
Contracture scar commonly seen in burns
Do C-section scars go away? Will stitches leave a scar? The C section scar is deliberately placed below the bikini line so that the woman can hide it under her clothes. These scars are 10-20 cms. Long and do not go away, but will fade over time.
If you are still concerned about C section scar, there are treatments available that can help you fade them. Remember, they cannot be completely removed, but can be made more faded.
Stitches can also leave scar but there are newer techniques of subcuticular stitches that can remove or reduce the risk of scar. In this technique the stitches are placed below the epidermis. It can be given in certain conditions and specific wounds - which your doctor will be able to decide. Taking post op care after stitches and avoiding infections is critical to avoid scarring after stitches. Removing them on time as per the recommendation of your doctor is also important to avoid scars.
Can you still be pretty with scars? How do celebrities hide scars? The perception of scars in our Indian community is more tightly associated with gender. Although in the social media age, these have changed over time. Example, in the olden days, men having scars symbolized strength - which is no more a wide perception.
Treating scars and how you perceive is a very individual decision. Some people are not too concerned about their scars, while others can have deep psychological impact.
The location of the scar also determines your comfort with them. Scars on the face can be of a higher concern compared to scars that are not in the exposed part of the body.
Having said that, there are many celebrities who sport their scars - e.g. Amitabh Bachchan from his scar during the accident of coolie movie shooting.
You can be pretty with scars, and that beauty comes from your own confidence. But if you are overly concerned about your scar, you can contact smart surgeons to explore treatment options.
