Often times scars are the result of a negative experience. These blemishes can come with serious aesthetic and psychological side effects that have long lasting impacts. In severe cases scarring can lead to social ostracisation. The TSLMS takes scars seriously. First of all we know that our members treat a lot of people for these unsightly blemishes. Second, as a group made up of cosmetic surgeons, aestheticians, and other practitioners whose jobs are to help people look their best, we have a lot of empathy for people who end up with scars. To us, being able to help with scars means understanding them.
Scars, by their dictionary definition are, “a mark left on the skin or within body tissue where a wound, burn, or sore has not healed completely and fibrous connective tissue has developed.” (Source). According to the American Academy of Dermatology, “A scar is a mark left on your skin after an injury heals. When you injure your skin — by accident or from a surgery — your body works to repair the wound. The body creates collagen (a tough fiber in your body that gives the skin strength and flexibility) to reconnect the tissues broken apart by the injury. While the body does this work, it creates a scab over the wound. The scab protects the wound from germs as the body heals. When the injured skin is repaired, the scab dries up and falls off. In its place, there may or may not be a scar. If there is a scar, it can be pale pink, brown, or silver.”
The entire process, explained in plain english, was described by NBC news in a story they did around why scars are permanent:
Unfortunately, many times when our skin is wounded, the cut isn’t clean, the healing conditions are not ideal and we end up with a scar. “Evolution has selected for scarring,” says Dr. John Newman, a cosmetic surgeon and researcher at the Laser Center of Virginia in Virginia Beach. “Scarring is the result of a system that has learned to respond extremely quickly to a wound.”
When the skin is split open, the body immediately starts to pull the edges of the wound together. It does this by growing epithelial tissue over the open wound at the rate of approximately 1 millimeter every 24 hours. Fibroblasts (special collagen-producing cells found in the dermis, the second layer of skin) then rush into the wounded tissue and start laying down collagen to strengthen the skin. Normally, fibroblasts produce an organized lattice of collagen that is very strong, but when in emergency-response mode, they respond by laying down collagen in a very unorganized, haphazard way. “It is kind of like nailing down a crisscross of two-by-fours over a hole in a deck,” says Newman. “It seals the hole, but it doesn’t look very nice.”
He explains that “a scar is actually a bunch of unorganized collagen in the dermal layer of the skin.” Over time, the tissue will try to reorganize, and the scar may appear to soften, but the skin may never completely return to its original state — particularly if the cut extends beyond the epidermis, the skin’s outer layer.
Skin cells regenerate from the bottom up, with a turnover time of roughly one month. “You can think of the epidermis (the top layer of skin that you see) as a staircase,” says Newman, “where the bottom stair is the base of the epidermis and the top stair is exposed to the air.” New epidermal cells are formed by cell division at the bottom of the staircase. To make room for these new cells, the older epidermal cells are pushed upward toward the top of the staircase. The oldest cells die and fall off.
The genetic material, or DNA, within any cell does not generally change, so the cells that are dividing on the bottom stairs are transmitting the same genetic characteristics from one generation of cells to the next. Unfortunately, if these characteristics are of scar tissue, that is what will be regenerated. And regardless of how much epithelial regeneration occurs above it, the scar can still show.
Types of Scarring
As noted above, some wounds are more prone to scarring than others. That said, there are also different types of scars, some of which cause more issues than others. These can largely be broken down into three types: keloid, contracture, and hypertrophic. In addition, acne scarring can cause scars that don’t otherwise fall into these categories.
The difference between these is as follows:
- Keloid: Most common in people with dark skin, these scars are larger than the original wound and can grow big and tight enough to be painful and restrict movement – besides being unsightly. These scars do not go away without medical intervention.
- Contracture: Typically these scars come from burned skin. They are called contracture because they contract, or tighten, the skin and can cause it to be difficult to move. These scars can go into the deep layers of skin and even impact the nerves and muscles in the area.
- Hypertrophic: Raised and red, these scars differ from keloid in that they stay within the area of the injury itself, instead of going beyond it.
While there are home-based treatments, like silicone sheets and creams, that are marketed for the reduction or treatment of scars, most people quickly realize that in order to really help their skin look and feel better they need the help of a professional. This is where we come in. There are many different ways that we can approach scars. Some of this is going to be based on the scar and the person’s goals, and some on our comfort level with any particular type of procedure. The more we know about different treatments the more people we can help. At SCALE 2019 Music City we will cover a lot of material on the latest research and options for helping your patients and clients.