Scar Wars: Strategies for Minimizing Every Type of Scar
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Acne Scars: Simple Fixes
Those dreaded zit "pits" (more flatteringly known as atrophic scars) occur when an inflamed pimple damages your skin's collagen layer.
Topical fillers and primers: Wrinkle fillers that contain hyaluronic acid, such as Lancome High Resolution Refill-3X Cream, $84, pull water to the skin's surface, giving the illusion of a smoother complexion. Makeup primers help temporarily fill depressions with ingredients like silicone or dimethicone; try Per-fekt Skin Perfection Gel, $48.
Prescription tretinoin: Creams such as Renova help build collagen and jump start cell turnover, evening out your skin. However, topicals are best for fading flat, red acne scars, since they usually don't produce enough collagen to treat deeply pitted ones.
Acne Scars: The Big Guns
Injectable fillers: Hyaluronic acid injections like Restylane and Juvederm aren't just wrinkle erasers—they also help swell indented scars, says David J. Goldberg, MD, clinical professor of dermatology at New York City's Mount Sinai School of Medicine. Results last for six months to a year; expect to pay around $600 per treatment.
Fractional laser treatments: Intense beams of light fade red marks and boost collagen to prop up pits. Your complexion may be slightly red and flaky for a few days afterward. At about $1,300 per session, this treatment isn't cheap (and most women need three to five sessions), but doctors do offerpackage deals.
Stretch Marks: Simple Fixes
Essentially scars within your skin, stretch marks occur when you gain weight quickly (puberty and pregnancy are causes), which tears collagen. The resulting inflammation creates red or purple streaks that eventually turn white. To make matters worse, sometimes overstretched skin gets thinner, so the marks are even more noticeable.
Prescription tretinoin: One study found that it may help improve the appearance of newer stretch marks. It also amps up collagen production and thickens the top layer of your skin, diminishing marks, says John Canady, MD, president of the American Society of Plastic Surgeons. The drawbacks? Tretinoin may cause side effects such as redness and flaking and it may be risky for nursing moms.
Stretch Marks: The Big Guns
Pulsed dye laser therapy (best for light skin tones): If you have recent, darker-red stretch marks, pulsed dye laser treatments can significantly fade and reduce them within six months, says Dr. Goldberg. Expect to undergo about five 10-minute sessions.
Excimer laser (best for light-colored stretch marks on darker complexions): Pulses of low-level UV light wake up pigment-producing melanocytes within older, white stretch marks, allowing them to blend with the surrounding skin. (Rest assured that there's no risk of significant UV damage, says Dr. Goldberg.) You'll need 10 to 20 biweekly sessions, and thetreatment can be very pricey.
What Are Keloid Scars?
Collagen is usually your friend—it's what helps keep skin youthful and firm—but it also has the power to produce lumpy, bumpy keloid scars. Why? When you get a cut, your bodyproduces new collagen to close the wound; a scar marks the spot where the old and new collagen connected. Normally collagen production shuts down after the wound closes, leaving you with a flat, reddish-pink scar that typically fades in time. But in people genetically prone to keloids, collagen continues to proliferate, says Tina Alster, MD, director of the Washington Institute of Dermatologic Laser Surgery. They can result from minor or deep wounds and are more common in dark-skinned people. Others may develop hypertrophic scars, which are lumpy like keloids; the main difference is that hypertrophic scars cover the wound only, while keloids grow outside the cut's boundaries.
Keloid Scars: Simple Fixes
Silicone sheeting, gels, and liquids: Silicone seals in moisture, helping to calm inflammation and tame overactive collagen production, says Dr. Alster. Try Scar Fx Silicone Sheeting, $22, or Scarguard MD liquid (which contains cortisone, another inflammation fighter), $30, or both—thecombination of a sheeting product and a gel or liquid may be more effective than either treatment alone, according to a study published in the British Journal of Plastic Surgery. In general, the earlier you start treating a scar, the better the results; just make sure that the wound is fully healed before you begin using any OTC products.
Compression therapy: Applying pressure to a keloid or hypertrophic scar deprives it of blood and oxygen, which may break up excess collagen and flatten it, says dermatologist Vermen M. Verallo-Rowell, MD. Place a cotton ball (or silicone dressing) over the scar nightly and wrap the area with an Ace bandage.
Keloid Scars: The Big Guns
Pulsed dye laser therapy: This technique seals off the blood vessels within a scar, reducing redness. It also appears to trigger the release of histamine and other substances that help repair collagen and iron out the lumpiness, Dr. Alster says. (Another perk: Pulsed dye laser therapy can also soothe the itching and burning sensation that accompanies some scars.) Most people need two or three treatments, which can run from $250 to $500 each.
Imiquimod 5 percent cream: Though it's FDA-approved to fight certain skin cancers and genital warts, many dermatologistsuse this potent lotion to "switch off" a newly developing scar's hyperactive collagen production, says Dr. Berman. Ask yourdermatologist if you're a candidate.
Burn Scars: Simple Fixes
Burns can cause thick bands of collagen to form during healing. If they cross a joint, these scars, called contractures, may be painful and restrict movement.
Silicone sheeting, gels, and liquids: For minor contractures, silicone products may help soften the stiff bands of collagen, says Dr. Alster.
Burn Scars: The Big Guns
Pulsed dye laser treatments: The same laser that shrinks raised scars also improves a contracture's appearance and eases pain and tension.
Z-plasty: Large contractures may need Z-plasty, a "tissuerearrangement" procedure that helps restore range of motion, says Dr. Canady. The surgeon makes a Z-shaped incision around a scar to create skin flaps, then repositions them in a smoother, more even way. The new scar is often less noticeable.
Are some people more prone to scarring than others?
Yes. Keloids are more common in people of African, Asian, andHispanic descent, and there may be a genetic component as well, says Brian Berman, MD, PhD, professor of dermatologyand internal medicine at the University of Miami Miller School of Medicine. People with darker skin tones are also at greater risk of developing brownish-black spots—called hyperpigmentation marks—that remain after a wound has healed, Dr. Goldberg says. The good news is that products that contain hydroquinone, such as Ambi Fade Cream, $5, can help lighten the area.
What can you do about stubborn red, flat scars that don't seem to fade?
The silicone treatments recommended for keloids may get the job done, says Dr. Berman. But if the scars really bother you and you have the means, pricier pulsed dye laser therapy will likely yield faster and better results.
Can anything really improve the appearance of older scars, or is it always a lost cause?
There's no simple answer, as everyone's skin responds differently. But you can often diminish the look of a scar. OTC products could do the trick, but certain laser treatments will probably show more dramatic improvement.
Scars are much simpler to avoid than to erase. Here's how to steer clear of them the next time you…
Have a breakout: Two words: Hands off! Squeezing zits worsens inflammation and increases the chance they'll leave a mark. If you have a large cystic pimple, see a dermatologist: She'll tame it with prescription treatments or a cortisone injection to prevent scarring.
Need surgery: Ask your doctor if she'd recommend prescription imiquimod cream. It may produce a less-noticeable scar when applied after incisions heal.
Cur, scrape, or burn yourself: Forget the old advice to "let wounds breathe"—that actually delays healing. (Ditto for applying vitamin E.) Dab antibacterial ointment on the wound daily and keep it bandaged until skin heals.
Originally published in Ladies' Home Journal, September 2009.