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What Makes a Scar

The Psychology Behind Scars

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

What Causes Scars

First: the science. “Whenever the skin is broken, the basic layer is the epidermis. The next layer is the dermis, which has a different type of cell.” Therefore, if you break the epidermis, it’s a superficial cut and the skin can revitalize. However, when you impact the dermis, the body reacts a different way for healing, explains Northwestern Medicine Facial Plastic Surgeon J. Regan Thomas, MD.

You can take action to minimize the appearance of your scar and promote healing, like placing vitamin E oil on it or avoiding sunlight. But ultimately, once you have a scar, you’ll always have a scar, Dr. Thomas cautions.

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. “The bone has to heal properly to have a good — and quick — recovery.”

However, minimally invasive surgery can minimize scarring, which is one reason Dr. Malaisrie performs this type of cardiac surgery when possible. He explains that rather than opening the chest during a sternotomy, minimally invasive surgery is performed through small incisions near your ribs. In this case, the scars are very small. Depending on your risks, your physician will determine the most appropriate approach.

However, for those who do have a sternotomy, Dr. Malaisrie says most 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. Dr. Thomas, who focuses on facial scarring, says this is particularly the case in his practice. “A facial scar can impact your social interactions, like dating or being with friends. If you go to a job interview, you might be concerned if they’re evaluating you or your scar,” he explains. “That scar has an impact.”

Dr. Shankman also cautions 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.

That said, depending on the type of scar, some techniques are available that can improve the appearance of a scar. Each year, approximately 170,000 scar revisions are performed in the U.S. Treatment options can include topical therapies, minimally invasive procedures and surgical revision. Z-plasty is a plastic surgery technique that improves the cosmetic appearance of scars. This technique uses triangular flaps to reduce the scar tension line. Dr. Thomas likens this to an optical illusion. “It irregularizes the line so your eye doesn’t follow it as much. We’re not removing a scar in a true sense, but making a better scar.”

Looking Towards the Positive: Randy’s Story

For some, changing or fixing their scar is simply not an option because the scar has become embedded in their story. For example, following a lung transplant, Randy Wilgus used his scar to help others.

Randy was diagnosed with pulmonary fibrosis, a lung disease that occurs when the tissue has become damaged. It causes the lung tissue to become hard and stiff, making it difficult to take in oxygen. Randy learned he would need a lung transplant, but other health issues threatened to jeopardize that.

“I had three stents put in, which was devastating. I was concerned I wouldn’t be able to have my transplant in time,” he says. “There was a major concern I wasn’t going to make it through.”

But he did. Ankit Bharat, MD, surgical director of the lung transplant program at Northwestern Medicine, performed Randy’s transplant. Randy recovered well, and credits his faith and his support system for getting him through. “Your mind and body are connected, so your mind has to be right. You have to have acceptance of what’s going on in your body,” he says. “I had the help of others, but there is a surrendering feeling. You have to make yourself vulnerable.”

Now, Randy hopes to share his story to help others know that they are not alone. “There is a light at the end of the tunnel,” he says. And much of that journey, he notes, is exemplified by one thing: his scar.

“My scar is sacred because it’s not just me involved,” says Randy. “There’s someone who allowed me to have this. That, to me, is priceless, and I hold that close to my heart.”