Scars & wound healing

A scar is the fiber-rich replacement tissue that forms after the destruction of the collagen network of the skin. It therefore represents the final state of wound healing. Scars are silent companions of our life stories. They talk about past adventures, minor mishaps or medical procedures. But what is the best way to deal with them? What types of scars are there and what influence does this have on treatment? Here you will find all the answers and learn about the possibilities offered by modern medicine.

  • Scars change over time. They often become paler and less noticeable, but this process can take months to years. However, modern medicine offers a range of treatment options to support the healing process and improve the appearance of scars.

  • Although a complete regression of scars is rare, treatments such as laser scar removal or special scar gels and creams make a significant contribution to improvement.

Narben: Entstehung und Behandlung
Medically reviewed by:

Medically reviewed by:

Dr. Peter Herndlhofer

Scars: Simply explained!

Scars are bookmarks in our skin that remind us of past events. In medical terms, they mark the end of a natural healing process after a skin injury, be it through a cut, a burn or an operation. When our skin is injured, our body produces a protein called collagen a few days after the injury, which fills and seals the wound. In the weeks that follow, a firm, flat scar forms. However, if the body produces too much collagen as a result of impaired wound healing, a raised and bulging scar is formed. And if only the top layer of skin is damaged, as with a minor scratch, it usually heals without visible scarring.

How do scars develop?

Scars are witnesses to our body’s natural healing process. As soon as the skin is injured, the body takes action to repair the damage. But what exactly happens?

  1. Inflammatory or cleansing phase: Immediately after the injury, the body sends blood platelets to the site of the injury to stop the bleeding. White blood cells are also sent to fight infections. This phase lasts about 4 days.
  2. Repair phase: A few days after the injury, the body begins to produce collagen. This binds the edges of the wound and helps to replace and strengthen the injured tissue.
  3. Maturation or reconstruction phase: After the wound is closed, the healing process often takes several months to years. During this phase, the skin begins to regenerate with new cells from the edges of the wound. The initially soft reddish scar tissue becomes firmer, lighter and more robust.

Depending on the depth, size, location of the wound, genetic factors and the type of injury, the appearance of the resulting scar can vary. Scarring is proof of our body’s amazing ability to heal itself, even if it can sometimes be cosmetically or functionally disruptive.

What types of scars are there?

Scars are complex structures that result from a special healing process. Let’s take a look at the different types of scars.

  • Atrophic scars

    These scars occur when skin tissue is lost. Instead of an excess of tissue, as with other scars, there is a deficiency here. Atrophic scars are often the result of skin diseases such as acne, chickenpox or certain skin infections. They appear as depressed, shallow depressions or holes in the skin. This is because the underlying supporting tissue (often collagen) has been damaged or destroyed. Did you know: Even stretch marks are atrophic scars, just like acne scars.

  • Hypertrophic scars

    Quasi the counterpart to the atrophic scars. This is because they are caused by excessive collagen formation during the healing process. Hypertrophic scars are raised and can be red and itchy. In contrast to keloids, however, they are limited to the original area of injury. Their appearance often improves by itself over time, but they can also remain permanently.

  • Keloids (scar proliferation)

    Keloids are the result of an overly aggressive healing reaction. They grow beyond the original injury and can spread even years later. The exact cause of keloids is not fully understood, but genetic factors play an important role as they are more common in some families. They also occur more frequently in people with dark skin.

  • Sclerotic scars (contractures)

    Severe burns can lead to the formation of sclerotic scars. They pull the skin taut and can restrict movement. This happens because the injured tissue shrinks during the healing process. In severe cases, contractile scars can affect joints and cause significant physical limitations.

Understanding the different types of scars is the first step to finding the right care and possible treatment. Because not every scar can be treated equally well.

How can scars be treated?

The treatment of scars depends not only on their type, but also on their size, location and individual factors such as your skin color, type, age and the age of the scar. Here are some common methods for treating long-lasting scars:

  • Treatment of atrophic scars

    • Dermabrasion: Here, the top layer of skin is abraded with a special device to smooth the appearance of the scar.
    • Chemical peels (e.g. TCA): Medium-depth peels are particularly suitable for the treatment of superficial scars, as the skin regenerates by removing the top layer of skin and the complexion improves. These stronger peelings are not commercially available.

    • Microneedling:
       Fine needles create micro-injuries in the skin to stimulate collagen production and smooth the appearance of scars.
    • Morpheus8 (radiofrequency microneedling): Here, collagen production is additionally stimulated by radio frequency. A small side effect: this can also tighten the skin.
    • Filler injections (e.g. collagen, hyaluronic acid): The principle is the same for all filler injections: the aim is to compensate for the sunken appearance of the skin by adding volume. The disadvantage is that filler injections are not permanent, so repeat injections are necessary.

  • Treatment of hypertrophic scars & keloids

    • Silicone gel pads: Especially in the initial phase of the scar and after operations, this can reduce the size and side effects such as itching and redness.
    • Pressure bandages: They are a treatment option for fresh scars to reduce the formation of hypertrophic scars.
    • Injections: Corticosteroid injections can help reduce the itching, redness and elevation of the scar.
    • Laser treatments (e.g. CO2 laser): They stimulate the growth of new collagen and can improve the appearance of the skin.
    • Kyrotherapy: This involves freezing the scar, which slowly destroys the scar tissue.
    • Surgical removal: This is only recommended if all other methods have not shown the desired success. This is because the scars often return immediately or become more pronounced.
    • Microneedling: Same principle as for atrophic scars. Needling is also used by doctors in the anti-aging field to tighten the skin.

Of course, different methods can also be combined. But remember: all treatments should be carried out by a specialist in order to achieve the desired effect and minimize risks.

Any questions? Our FAQ section has the answers!

Scars can take months to years to fade, depending on their size and type. However, most scars never disappear completely, they just become less noticeable. Did you know: Stretch marks are also scars?

Yes, some scars can become lighter and less prominent over time. Unfortunately, they rarely disappear completely. Various treatments and therapies can support the recovery process. In particular, acne scars can often be improved depending on the shape of the scar. You can find out more here: Remove acne scars.

More questions? Simply make a personal consultation appointment online.

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References

Last updated: 21.10.2023

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