Scars

Item: Scars
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Last Updated: 31 January 2024

Scars are permanent marks that remain on your skin after a wound or injury has healed. Scars can vary considerably in appearance and texture depending on their location on your body, how deep the wound was, and how good your body is at healing itself after it sustains damage. Your body forms scars as part of the natural process of healing wounds.

Your skin has multiple layers arranged into three primary layers: the epidermis, the dermis, and the hypodermis. The outer layers of skin form the epidermis, which acts as a protective barrier and also contributes to skin tone. The next layers of skin form the dermis, which provides structural support for the epidermis and also contains the skin’s vascular system, hair follicles, sweat glands, and oil glands. Below the dermis is the hypodermis, the deepest layer, which consists mainly of fat and connective tissue.

When your skin suffers damage, your body creates new collagen fibres to mend it. These collagen fibres make up the scar tissue, which has a different texture and often a different colour from the surrounding tissue.

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Scars

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What are the main types of scars?

There are six main categories of scars, although there is some overlap between the categories:

Hypertrophic scars. These are raised scars on the site of the original wound but not extending beyond it. Hypertrophic scars are caused by the body producing too much collagen while trying to heal the wound. Hypertrophic scars often start out red or pink before gradually fading and becoming less noticeable.
Keloid scars. Like hypertrophic scars, keloid scars are raised above the surface of the skin; but unlike hypertrophic scars, keloid scars may extend beyond the site of the original wound. Keloid scars are hard, often have ridges or a lumpy texture, and can continue to grow and expand over time.
Atrophic scars. Unlike hypertrophic scars and keloid scars, atrophic scars are depressed compared to the skin around them. This sunken state is caused by a loss of tissue. Atrophic scars often result from acne, chickenpox, and minor injuries.
Contracture scars. These scars occur when the skin contracts, such as after a burn.
Striae, also called stretch marks, are technically scars. Striae occur when your skin stretches rapidly, such as during pregnancy or growth spurts. Striae may be red or purple at first but usually fade to a silvery colour.
Acne scars. Various types of scars can result from acne, especially if the sufferer picks at the spots or scabs. Acne scars can take the form of deep pits, angular indentations, or wave-like rolling scars.

Why might I want to get rid of a scar?

From a biological perspective, a scar is a positive sign, because it means that the wound has healed. Beyond this, some people like having scars to remind themselves of events that have special significance in their lives. And some cultures practise scarification, creating scars deliberately to impart social or religious meaning.

But for many people, the presence of a scar more often acts as an unwelcome reminder of whatever caused the wound, such as an accident or a surgery. So it’s no surprise that many people would like to get rid of or at least minimise some or all of their scars.

As you’ll see later on this page, you can take various actions to reduce or minimise scars, from using home remedies or topical treatments to having tweakments performed by a practitioner.

Scars

What can cause scars?

Scars have various causes. Generally speaking, the following are the most common causes:

Accidents can cause injuries including abrasions, cuts, and lacerations. All of these can lead to scarring. The extent of the scarring depends on the severity and depth of the injury.
Any surgical procedure that requires an incision in the skin can leave a scar. If the surgery is planned, the surgeon will normally keep incisions to a practical minimum and – where possible – locate the incisions to minimise their visibility afterwards.
Severe acne can often leave scars, especially if the sufferer picks at the acne. Cystic acne is more likely to leave scars than milder acne.
Whether they’re caused by heat or flame, chemicals, or electricity, burns can cause severe damage to the skin in moments. Burns often result in scars.
Diseases and skin conditions. Chickenpox and similar diseases, such as measles or rubella (German measles), can leave scars on the skin. As with acne, scars are often caused by the sufferer picking at sores or scabs. Skin conditions, such as eczema and psoriasis, can also result in scarring.

How can I get rid of acne scars?

You can tackle acne scars in three main ways:

By using home remedies
By using topical treatments
By having tweakments

The following sections take you through each of these approaches in turn.

Which approach suits you best will depend on how severe your acne scars are and whether you want to get rid of the scars entirely or reduce their visibility significantly.

What home remedies can I use to address acne scars?

If your acne scars are relatively mild, you may be able to improve them by using the following home remedies:

Aloe Vera. Aloe vera is soothing for scarred skin and can also promote healing.
Vitamin E. Vitamin E oil can help moisturise your skin and neutralise free radicals that contribute to inflammation and aging in your body. Vitamin E may promote the regeneration of new skin cells, although studies have not yet proven this beyond doubt.
Honey can act as a natural moisturiser. It may help with scar healing, but this is not yet known for certain.

What topical treatments can I use to address acne scars?

There are four main types of topical treatment you can use to reduce the visibility of acne scars and reduce differences in their texture:

Retinoids are vitamin A derivatives; they can make scars less visible. You can get either over-the-counter retinoids, such as retinol, or prescription-only retinoids, such as tretinoin or adapalene. Retinoids can irritate and dry out your skin, so for over-the-counter products, you should start with a low-strength retinoid, apply it sparingly, and allow two to three days for the results to appear. If you need to move up to prescription-strength retinoids, consult a dermatologist who can prescribe a suitable product and tell you how to use it.
Skin peels with Alpha Hydroxy Acids (AHAs). Alpha Hydroxy Acids include glycolic acid, lactic acid, and citric acid. These acids are soluble in water. You can apply an AHA to your skin to gently exfoliate the top layer of the epidermis, revealing smoother skin beneath and encouraging the growth of new skin cells. Many skin products containing AHAs are available over the counter.
Skin peels with salicylic acid. Salicylic acid is a Beta Hydroxy Acid (BHA) widely used for exfoliation. Beta Hydroxy Acids are soluble in oil, which enables the acid to penetrate more deeply into your skin’s pores and exfoliate them. Various skin products containing salicylic acid are available over the counter.
Hydroquinone is a skin-lightening cream used to fade darker scars. Hydroquinone is not available over the counter, so you would need to consult a dermatologist who could prescribe it.

What tweakments can I have to reduce acne scars?

Here are four types of tweakments you can have to reduce acne scars:

In dermabrasion, the practitioner uses a rapidly rotating device to “sand down” the outer layers of skin and stimulate a natural healing response in the body. Dermabrasion is especially effective for raised scars and scars with uneven textures. The practitioner adjusts the treatment depth to suit the type and severity of scar.
Laser therapy. A practitioner can use a laser to remove or resurface the outer layer of the skin or to stimulate the growth of new skin cells underneath the scar.

Skin peels by a dermatologist. If skin peels using over-the-counter strengths of chemicals don’t give the results you need, you can have a skin peel performed by a dermatologist using heavier-duty chemicals. Such peels remove more layers of skin than home-strength peels, so you will typically need more downtime to recover afterward.

Microneedling uses very short, sharp needles to make tiny holes in your skin, provoking a healing response that produces more collagen and elastin. This response can gradually improve the surface of a scar.

How can I get rid of other types of scars?

If you need to get rid of, or at least minimise the appearance of, other types of scars than acne scars, you have various options, as explained in this section. Normally, your best move is to have a dermatologist examine your scars, discuss what forms of treatment are suitable for them, and agree a treatment plan.

The following list covers six common methods for improving the appearance of scars:

Topical treatments. You can use either over-the-counter treatments, such as aloe vera or vitamin E, or prescription treatments, such as high-strength retinoids and hydroquinone, to reduce the appearance of scars. See the sections “What home remedies can I use to address acne scars?” and “What topical treatments can I use to address acne scars?” earlier on this page. Another type of topical treatment for raised scars (such as hypertrophic scars and keloid scars) is applying silicone gel sheets to the scars to flatten and soften them.
Laser therapy. As for acne scars, a practitioner can use a laser either to smooth the epidermis or to stimulate the growth of new skin cells beneath the scar.
Also as for acne scars, a practitioner can use a dermabrasion tool to “sand down” a raised scar by removing the outer layers of skin.
Corticosteroid injections. These injections can flatten and soften raised scars.
Dermal filler injections. A practitioner can inject dermal filler to bring the skin of a depressed scar up to the level of the surrounding skin, making the scar less noticeable.
Microneedling can create gradual improvements on other types of scars than acne scars.

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