A scar is a mark left on the skin after an injury has healed. Most fade over time but do not completely disappear.
The skin is the body’s largest organ and is constantly getting rid of old cells and making new ones, a process which enables it to repair itself when damaged. Scars are caused by this process.
23 million adults in the UK have some kind of scar. For many, scars don’t cause any problems, but some people can experience physical and emotional challenges as a result of scarring. On this page, we discuss scars and how they can affect your appearance, and how we can support you through the emotional and psychological challenges this may bring.
If you have scarring from a burn, you may wish to read this page alongside our page on burns.
There are many types of scars and on this page we look at seven common ones.
Normal fine-line scars
This is the most common type of scar, a raised line typically caused by a minor injury or surgery. Gradually, usually in two years or less, the scar will flatten and fade, but it is unlikely to fully disappear. You may find the scar is itchy for a few months.
Keloid scars are caused by an overgrowth of tissue which happens when too much collagen is produced at the site of a wound, causing the scar to keep growing even after the wound has healed.
Keloid scars appear raised above the skin and are pink, red, darker or the same colour as the surrounding skin. They may be itchy and painful and can restrict movement if they form on a joint.
People who have developed one keloid scar are more likely to develop further keloid scars in future and should let their doctor or surgeon know if having injections or surgery.
Like keloid scars, hypertrophic scars are the result of too much collagen. Unlike keloid scars, they don’t extend beyond the boundaries of the wound. They develop over a period of about six months, before improving.
Hypertrophic scars tend to be more common in younger people and people with darker skin.
Pitted or sunken scars
These scars are often left by spots from conditions such as chicken pox and acne. They can also be caused by injuries which lead to the loss of fat underneath the skin. They are sometimes known as atrophic or “ice-pick” scars.
Scar contractures cause the skin to shrink. The skin usually becomes tight and in some cases movement may be restricted. They are often caused by burns.
Similarly to scar contractures, stretched scars occur when the skin is stretched during the healing process. For example, broken skin on a joint may be stretched with the movement of the joint as the wound heals.
Stretch marks have a similar cause to scar contractures and stretched scars, occurring when the skin is stretched rapidly, such as during pregnancy or a growth spurt. They may appear red at first and become paler over time.
The skin is made up of three layers:
- Epidermis, the outer layer.
- Dermis, the layer of tissue just underneath.
- Subcutaneous fat, a deeper layer of fat and tissue.
A scar occurs during the healing process following damage to the epidermis or dermis. The body creates collagen fibres in the damaged area – these are proteins which form the scaffolding which new skin is built around. When these fibres are laid down, a scar develops.
The epidermis repairs itself easily, but if the dermis is affected, rebuilding is a more complex process, leading to a more noticeable scar.
Things which frequently lead to scarring are:
- An injury, such as a cut or graze, or a burn or scald
- An infection
It is not possible to fully remove a scar. Most fade over time, however, scars rarely disappear fully.
Some things can reduce a scar’s appearance, making it less visible:
- Topical silicone gel / silicone gel sheets: These are applied straight to the scar, helping to soften and flatten it and relieving itching and discomfort.
- Pressure dressings: Typically used after burns or skin grafts, to flatten and soften scars.
- Steroids: An injection directly into the scar to reduce swelling and flatten the scar. This may be repeated up to three times at intervals of four to six weeks
- Laser or light therapy: Can reduce redness by targeting the blood vessels, or reduce the appearance of a pitted scar by removing the top layers of skin and encouraging collagen to develop so the wound can re-heal with less visible scarring.
- Cryotherapy: Liquid nitrogen can be used to freeze keloid scars. If carried out early on, cryotherapy may flatten keloid scars and stop them growing.
- Dermal fillers: A temporary treatment which involves the filling-in of pitted scars. It can be costly.
- Skin needling: Involves rolling a small device covered in hundreds of tiny needles across the scar, which can reduce its appearance. Repeated treatments are needed, and it can be costly.
- Creams: Emollient creams such as E45, which act to seal in the moisture, can help stop a scar drying out and keep it supple. Sunscreen should be applied in the sun as scars are more sensitive to ultraviolet (UV) light.
Surgery is another option for more serious scars, such as scars caused by certain burns. Surgery may involve:
- A skin graft, particularly in the case of a burn.
- Releasing a tight scar to improve movement at a joint.
- Scar reduction surgery, a form of plastic surgery.
Scars can have a significant impact on the appearance, either in the short or long term. Some people find a change in appearance emotionally challenging. According to research by the Scar Free Foundation, 23% of people with a scar said they have experienced short-term emotional or physical problems.
There are a number of factors which can influence how you feel about your scar. This might be the location, how we are viewed by society because of our age, sex or other features, and how the scar occurred. Society often uses scars as a shorthand for villainy, and at Changing Faces we are fighting that stereotype through our I Am Not Your Villain campaign.
If your scarring is significant, and particularly if it was caused by burns, you may be referred to a clinical psychologist. They will help you with post-traumatic stress disorder (PTSD), anxiety surrounding treatment, sleeping problems, pain management, self-confidence and adjustment to change of appearance.
If you are struggling with the emotional or psychological impact of scarring, support services are available.
Here at Changing Faces, we may be able to help through our counselling and wellbeing support service. Over a series of sessions, our trained wellbeing practitioners provide social, emotional and psychological support, and many people find it useful to be able to talk through their thoughts, feelings and experiences. We also have a wide range of self-help materials including guides which cover loss of identity, self-esteem and confidence-building exercises.
You do not need to change your appearance to fit in with society’s expectations. However, some people decide that reducing the appearance of their scars is the right option for them. If this is the decision you have reached, you may find our Skin Camouflage Service useful. Skin camouflage is the use of specialist, highly pigmented creams and powders that can be used to reduce the appearance of a mark, scar or skin condition. Our service is recommended by the NHS and you can read more in this dedicated section of our website.
Skin camouflage can reduce some of the effects of scarring by matching to the surrounding skin but it does not change the texture of the skin or alter raised/indented skin. We cannot apply skin camouflage to skin that is infected, inflamed, or broken.
As well as our Skin Camouflage Service, counselling and wellbeing support and self-help guides, there are a number of ways we can support people with scars here at Changing Faces:
- Online Community: A moderated online forum administered by Changing Faces staff, where you can talk to others with scars and other visible differences.
- Peer Group Chat Service: An online support group of up to 8 participants, taking place on Zoom or in a chatroom and facilitated by Changing Faces staff.
- Workshops for children and young people and their parents: An opportunity to meet others and learn tools, tips and techniques for managing challenges with your visible difference.
- Real stories: Read stories by other people living with scars.
If you wish to access our services, please contact our Support and Information Line. As well as connecting you with our services and providing information, our team can offer support calls which provide a space for you to talk about the impact of scars on your life.