Scarring is never just skin deep — this is something I can vouch for. A bad fall in childhood meant having a skin graft on my knee, which ended up resembling a sewn-on patch that was a source of both fascination and disgust among my classmates. I was tasked with applying good old E45 Dermatological Cream to it every night, and over time, as I religiously massaged in that white ointment with its distinct scent until it disappeared like magic, it became a rather pleasant self-care ritual.
Over the years, my scar has minimized in appearance and the redness diminished, along with the residual shame I felt at being less than perfect. But if writing this piece has taught me anything, it’s that I’m not alone. "Our initial emotional reactions towards a scar are often related to shock," notes Dr. Andrew Thompson, reader in clinical psychology at the University of Sheffield and British Skin Foundation spokesperson. "There also may be feelings of anxiety associated with thoughts of what the eventual scarring might look like. In addition, scarring can be associated with feelings linked to the event that caused the injury, such as anxiety, anger, and even shame. However, most emotional reactions should settle relatively quickly."
According to the experts, learning how to manage a scar is key to reducing its emotional repercussions. With that in mind, I asked some of the best dermatologists and aestheticians in the business for advice on how to treat the most common types of scarring.
"Hypertrophic and keloid scars are two types of raised scars," explains Dr. Anjali Mahto, consultant dermatologist and author of The Skincare Bible: Your No-Nonsense Guide To Great Skin. "Both types occur due to overgrowth of dense, fibrous tissue after healing of a skin injury." However, there is some difference between them. "Generally speaking, hypertrophic scars are the same size as the wound that caused them," Dr. Mahto says. This could be as a result of a piercing, burn, or cut, for example. Keloid scars, however, "extend beyond the limits of the injury," Dr. Mahto says. "This type of scarring is more common in pigmented skin. They usually do not diminish by themselves and often require intervention to soften or flatten the areas."
Rick Woodin, head of R&D and chief scientist at ZO Skin Health, also points to professional procedures as a reliable option. "Treatment can include medicinal corticosteroid injections, freezing, surgical removal, laser therapy, creams, gels, or pressure dressings," he says. "Your dermatologist will advise on which is best for you."
"Superficial scars are those pesky red blotches you can get post-acne that don’t seem to let up," Dr. Mahto explains. "Retinol is great for most skin types and works especially well for those who suffer from this sort of scarring." If you’ve been advised to avoid retinol — for example, if you’re pregnant or your skin is prone to chronic sensitivity — try a product with bakuchiol, which has been touted as a natural alternative for exfoliating and speeding up cell turnover.
According to Woodin, as the name suggests, ice-pick scars are small, deep holes caused by acne that look as though the skin has been punctured with an ice pick. Sadly, when it comes to treating them, there is no miracle product that you can pick up off a shelf. "I would wholeheartedly recommend against throwing your money at creams, lotions, potions, and oils," Dr. Mahto says. "Despite what the packaging may claim, they will simply not be effective against such scarring. Skin care in this context would be a false economy; your money really would be better spent getting an expert opinion from a dermatologist." The National Health Service suggests punch excision or punch grafting as possible treatments, but it’s always best to discuss your options with a professional.
Boxcar scars are broad depressions with sharply-defined edges that create the appearance of a "crater" in the skin. "Treatments such as dermal rolling and laser will stimulate collagen type III to plump out the skin and smooth the acne depressions," says Dija Ayodele, aesthetician and founder of the Black Skin Directory. "The earlier this is done the better, as it’s much more challenging to treat old scars."
Similar to boxcar scars, rolling scars have a deep crater-like appearance, but with more sloped edges. Generally they can be treated the same way as boxcar scars, but in more extreme cases, cosmetic treatment is another option. Aesthetic doctor Dr. Sophie Shotter offers a variety of treatments, including filler, at her UK clinic, Illuminate. "I would always recommend filler used in combination with other procedures, and I’m a big fan of stimulating collagen to treat scarring," she says. "I use a resurfacing technique with a system called Venus Viva, which uses nanofractional radio frequency," said to heat tissue and encourage collagen production.
"Deeper scarring can potentially be improved over a longer period of time, but often a number of different treatments may be needed," says skin-care and laser specialist Debbie Thomas. "Lasers like the Erbium:YAG (Er:YAG) physically remove layers of skin, the idea being that by forming a wound and removing said layers, it forces the skin to regenerate at a much more optimum level. Light to moderate peels are best, as your skin is a living organ and can only take so much trauma."
"This is a common side effect of acne," says Ayodele. "Appearance-wise, they can appear quite flat but leave dark marks in patches or dots on the skin." Treatment options for this type of skin "staining" vary. "It can be treated topically using products that fade the dark patches, such as hydroquinone prescribed under medical supervision. You should also look for ingredients that inhibit and quell excess melanin pigment, such as licorice extract, vitamin C, niacinamide, bakuchiol, and retinol," says Ayodele. "Applying a broad-spectrum sunscreen daily is also a must to prevent it getting any worse." Dr. Dennis Gross Dark Spot Sun Defense Broad Spectrum SPF 50 is a clever multitasker; in addition to protecting skin from UVA and UVB rays, it also contains three forms of vitamin C to even out pigmentation.
When it comes to minimizing the impact of scars, no matter what they look like, consultant dermatologist and British Skin Foundation spokesperson Dr. Thivi Maruthappu shares one vital piece of advice. "As tempting as it may be, it’s so important not to pick or squeeze a spot, as the pressure can drive inflammation and infection deeper into the skin," she says. "The same is true of picking at scabs, which can increase the chances of scarring, including hypertrophic scarring." And for those who find dealing with the emotional aspect of scarring particularly challenging, extra support is out there. "Help in managing scars is increasingly available through both specialist medical services and mainstream mental-health services," Dr. Thompson says.
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