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What Makes a Scar

The Science Behind Scars

A scar, by definition, is a mark created by the fibrous tissue that replaces the skin after an injury. But, as with many definitions, there’s much more to it. A scar can be a testament to your story.

What Causes Scars

First: the science. The top layer of skin is the epidermis. The next layer is the dermis, which has a different type of cell. If you break the epidermis, it’s a superficial cut and the skin can regenerate without scarring. "However, when the injury is deep into the dermis, the body heals the wound with a scar," explains Northwestern Medicine Plastic Surgeon Utku Can Dolen, MD.

Scars after Surgery

When it comes to surgery, scarring is virtually inevitable. “As cardiac surgeons, we focus on what happens underneath the scar,” says Northwestern Medicine Cardiothoracic Surgeon S. Christopher Malaisrie, MD.

That said, minimally invasive surgery can minimize scarring, which is one reason Dr. Malaisrie performs this type of cardiac surgery when possible. Depending on your risks, your physician will determine the most appropriate approach.

However, for those who can’t have minimally invasive surgery, Dr. Malaisrie says many of his patients embrace their scars as a badge of honor. “A scar is a constant reminder of the gratitude they have for their health,” he explains. “It represents the sacrifice and long journey the patient has made, from end-stage disease to a chance at new life.”

Scars Can Scar You

Whether you receive your scar from surgery or an accident of some sort, the psychological impact can be jarring.

“A scar can be a psychological reminder of the trauma you experienced,” says Northwestern Medicine Psychologist Stewart A. Shankman, PhD. “When people have stressful life events, there’s a cascade of neurobiological responses. This cascade effect can also drive depression and anxiety.”

Scars can also impact self-confidence and body image. Situations like dating, seeing friends and job interviews can make you wonder how your scar is perceived.

Though it may feel uncomfortable, Dr. Shankman says that just because someone is looking at you or your scar doesn’t mean they’re judging it or you. And if your loved one is dealing with a new scar, he suggests being open. “If a person seems self-conscious, discuss things out in the open in a supportive way,” he suggests.

Caring for Scars

While every injury to the dermis leaves a scar, and there is no way to fully remove them, there are ways to minimize them. According to Dr. Dolen, “Skin responds best when treatments are done immediately after the wound has healed, rather than months or years after the injury.”   

Depending on the location and depth of your wound, it may take two to four weeks for your skin to fully heal. Once your surgeon has confirmed the wound has healed, the following can help:

  • Protect the scar from sunshine. According to Dr. Dolen, this is the most important precaution, because UV light irritates the scar. Applying sunscreen or wearing sun/UV protective clothes may reduce a scar’s appearance. 
  • Keep the scar moist. Keeping the scar moist can also improve its visibility and feel. Dr. Dolen recommends covering the area with over the counter silicone scar gel or a silicone scar sheet for at least six to 12 months after the wound is fully healed.
  • Massage the scar. This prevents pulling on the surrounding skin and hardening of the scar.
  • Do these every day. All of these scar minimizing techniques are more effective when incorporated into your daily routine.

Depending on the location and the type of scar, there are different techniques that can improve the appearance of a scar. Each year, approximately 260,000 scar revisions are performed in the U.S. Treatment options can include topical therapies and minimally invasive procedures such as laser and surgical revision. Z-plasty is a plastic surgery technique that may improve the cosmetic appearance of scars. This technique uses triangular flaps to reduce pulling on the surrounding skin and make the scar line irregular, so the eye doesn’t follow it as much.