Scars are pretty unavoidable. Whether you have scars from surgery, falling over, picking at acne, an accident, or pushing out ingrown hairs, we all have them, and they’re just a part of life. If you’ve ever tried to get rid of yours and you’re yet to find something that works, we’re here to help. We spoke to leading dermatologist, queen of lasers, and author of Beyond Beautiful, Dr. Doris Day, to get the down low on all the types of scars, and the most effective methods for treating them.
Interestingly, Doris told us “Most people don’t know that a scar is a change in the texture of the skin. I see patients every day with discoloration or redness at the site of trauma or after acne, and they call that discoloration a scar.” Which means those acne ‘scars’ we thought we had, might not actually be scars at all, and the good news is: “We can treat the discoloration relatively easily with creams and lasers.” However, if it is a ‘true’ scar, that means the collagen in the skin has been damaged, which she tells us, is more complicated to treat.
Whatever type of scar you have, Doris explained that “it’s important to exfoliate on a regular basis to remove the outer layers of dead skin cells before applying the scar treatment.” But there are different types of scars, and they each need to be treated differently, “it’s important to note this because some are genetic and some are easier to treat than others.” Doris explains the different types of scars and the appropriate treatments, plus her fav over-the-counter products below.
Types of Acne Scars:
What I’ve observed over my 20 years in practice is that acne scars that look mild when a person is in their 20’s can look much worse and deeper when that same person reaches their 40’s or 50’s. This is because over time there is collagen loss to the skin, which is accelerated with chronic sun exposure over those years, which makes the scar deeper and more obvious. For this reason, I’ve started treating even mild acne scars in my younger patients to help them avoid having that issue later in life. There are different types of acne scar, and these are the most common:
These are essentially a very deep pore that can look like a hole. This is the hardest type of scar to treat since it’s small but goes very deep so getting to the bottom of it would lead to a bigger scar. We often see it in the cheeks and temple after acne has cleared.
Treatment: One treatment that has worked well is using trichloroacetic acid. This is very delicate work and must be done by a trained dermatologist to avoid worse scarring.
Boxcar scar and Rolling scar:
These are more superficial but larger scars than the ice-pick scar. It can happen anywhere on the face.
Treatment: Over the counter treatments include retinol (vitamin A) and niacinamide to help with improving collagen and evening out the skin tone in the area. The retinol should be applied to the entire face. Microneedling can also help but should be done by a board-certified dermatologist. There is one device by Belus Medical called Skin Pen that is FDA approved in the US for acne scar treatment. It’s the only microneedling device that has an FDA approval.
Types of scars:
Body scars after trauma or surgery:
The chest and back heal much more poorly than the face, and scars here can be harder to conceal cosmetically. They can be slightly under (atrophic) or raised (hypertrophic) and can itch or hurt for months to years.
Treatment: The best over the counter treatments include silicone sheets or gels. Try to use them as early as possible after the skin has healed to minimize the scar and keep it as small as possible. In-office treatments include microneedling and lasers, which can sometimes even erase a scar
There are some who are genetically more prone to scarring, and they may form a particular type of scar called a keloid. This is when the collagen grows too much and is raised up and over the original site of the wound. It feels hard to the touch and can be painful and itchy. It can happen after any trauma to the skin; even just a pimple can lead to a very large keloid in someone who is prone to making them. In those people, we need to be very careful to treat acne more aggressively and to not create any wounds in the skin, but they are fortunately an exception since most scars don’t behave this way. It can also happen after surgery or ear piercing. If you are prone to keloid scarring avoid any piercing or surgery if possible.
Treatment: Over the counter treatments include silicone gel sheets or topicals that have a high concentration of silicone. This helps put pressure on the scar, and that compression seems to help flatten and even lighten it. There is no cure, so it has to be done intermittently over time as needed to maintain results. Your dermatologist may do cortisone injections into the scar to soften and flatten it. I also do pulsed dye and fractional CO2 resurfacing laser for keloids with excellent results.
Over-the-counter scar treatments:
Bio Oil, $7, can really help approve the appearance of new scars when massaged into the skin twice daily. Avene Cicalfate cream has a sucralfate and copper-zinc sulfate complex to help improve scars. LaRoche-Possay Cicaplast, $10, is very hydrating and is paraben and lanolin-free for those who are sensitive to those ingredients. I also like Kelo-Cote Scar Gel, $35. It’s silicone-based, and it can be used for two to three months. These treatments can be tried on their own but may need to be done along with in-office treatments for best results. The sooner you treat a scar, the better!
As well as the over-the-counter treatments that Doris mentions (we swear by Bio Oil) we also have a few tried and tested techniques of our own.
Massaging: For new scars, as well as using an oil like Bio Oil, vitamin E or Rosehip Seed Oil, it’s important to massage the scar for five to ten minute every time you apply the oil. Try to do this at least twice a day, even three times if you can. By massaging in circular motions, you help to remove excess fluid surrounding the scar, keep it flexible to stop it stretching, and help the oil to penetrate further and heal.
Keep it covered: If you have a scar on an area that stretches, like your elbow, knee or other joint, wear a plaster over the area to keep the skin tight and prevent stretching of the skin, which makes the healing process slower.
Avoid: Keep scars covered or wear high SPF (factor 50) when you’re in the sun, as this can increase pigment causing the scar to get darker. Above all, avoid picking at it, this will only make it worse!
New in-office scar treatments:
Threads: I’ve used EuroThreads with amazing results in acne and other scars. The threads are smooth or twisted and made of the same ingredient found in absorbable stitches. When carefully inserted in the right plane of the skin under and around a scar it helps erase it, by smoothing the skin and stimulating more collagen. I find it to be more effective and reliable for this purpose and also have been using it for stretch marks, which I consider to be a type of scarring since there is a loss of collagen and a change in the texture of the skin. It costs around $600 or more, depending on the scar, and it can take two to three sessions. Results can be permanent.
Microneedling: This is relatively new for treating scars. I don’t recommend at home devices since they don’t go deep enough and they can lead to infection and worse scarring. If you want to have microneedling, I advise seeing a dermatologist to get the best and safest treatment possible.
We hope you guys found this helpful and let us know if you have any other questions in the comments below. x