An essential part of the body’s natural healing process, scars are the result of the skins’ repair of wounds caused by accident, disease, or surgical incision (hair transplants). The more the skin is damaged and the longer it takes to heal, the greater the chance of a noticeable scar. That is why picking at healing wounds only make them scar worse.
Typically, a scar will become increasingly prominent at first, then gradually fade; many disfiguring marks which seem unsightly at three months may heal quite satisfactorily if given more time.
Scars can be classified as hypertrophic (seen as a ridge within the confines of the original wound), keloid (large sometimes dumbell shaped scars that grow out of the confines of the original wound) or widened & depressed.
A scar’s visibility will depend on a number of factors, including its difference in topography or color from the surrounding normal skin i.e. color, texture, depth, length, width or direction. If the skin scar adheres to deeper structures such as muscle or bone the skin may bunch up with animation or movement as it is tethered to deeper structures. How the scar forms will also be affected by an individual’s age and by its location on the body or face. Younger skin, for instance, makes strong repairs and tends to over heal, resulting in larger, thicker scars than on older skin. Skin over the jawbone is tighter than skin on the cheek and will tend to increase a scar’s prominence. If it is depressed, it will make skin seem shaded, and if it is higher than surrounding skin, it will cast a shadow. A scar that crosses natural expression lines will be visually striking because it will not follow a natural pattern, and a scar that is wider than a wrinkle will stand out because it is not a naturally occurring line.
Any one, or a combination, of these factors may result in a scar that, although healthy, may be improved functionally or cosmetically by treatment. The techniques used to make scars less noticeable are changing scar direction so it lies within a normal skin crease or fold, debulking procedures, scar taping, scar massage, local steroid injection, medical grade skin tatoos, dermabrasion, collagen injections, chemical peels, cryosurgery, application of a pressure dressing or silastic sheeting, laser treatments & separation of the skin scar from deeper structures. Which technique or combination of techniques to apply for the best result requires a qualified trained physician. Keloids in general require debulking, steroid injections & pressure garments or earrings. They require long term follow up with the treating physician as they are not cureable only controlable. Keloids do not respond to silicone sheeting. Hypertrophic scars are sometimes treated in the same fashion but are more amenable to laser treatments, silastic sheeting & pressure garments.
There are certain areas such as a good quality scar on the face or neck of an adult male where a tattoo to simulate early beard growth is the best technique. The problem is that most tattoo artists are great when it comes to drawing anchors etc. but not very good at simulating natural skin color or beard growth. Although a repaired laceration or incision heals so that it won’t come apart within 14 days it takes months to mature. During the maturation phase which can last up to 8 or 10 months the scar is malleable & sensitive to external treatments as well as local skin surface tensile forces. These forces can be distracting causing the scar to widen or parallel to the length or height of the scar causing scar thickening. There can even be a combination of forces. These forces are greatest in areas where the skin is not lax i.e. it is difficult to pinch a significant amount of skin. Just try this on your chin, knee cap area with the knee bent or scalp vs.back of the hand or neck. To diminish these forces elective incisions are placed along lines of least tension & patients follow a skin taping or silicone sheet regimen for all incisions/laceration repairs. Thus, you can see that how an incision line is treated for the months following surgery has greater impact on the final look of a scar than the initial stitching procedure. Simple excision of a scar usually does not work. Removal of skin increases tension around the scar & results in a high recurrence rate of unsightly scars. Keloids are not cureable they can only be managed by debulking & then treatment with pressure, steroids etc..
The problem with the facial area in men is they try to grow a beard to hide the scar. The scar then widens & one is left with a bald area. The better treatment is a close shave & taping.