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Scarring

Scars form when the dermis is disrupted and healing replaces normal tissue with collagen. Treatment depends on scar type, age, and how the scar formed.

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Overview

What is Scarring?

A scar is what the body builds when injury reaches the dermis. Instead of restoring the original tissue architecture, the body lays down collagen fibers in a disorganized pattern. That disorganization is why scarred skin behaves differently: it lacks normal elasticity, and it typically does not regrow skin appendages like hair follicles and sweat glands.

Healing runs in phases. Type III collagen is deposited first, then gradually replaced by stronger Type I collagen over months. Active remodeling continues for roughly 6 to 12 months, and full maturation can take 12 to 18 months. Most patients judge a scar far too early, around week six, when it is still inflamed and actively rebuilding.

 

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Common Types of Scarring

Scars are categorized by how the tissue responded during healing, whether it overproduced collagen, underproduced it, or contracted. The type determines which treatments work and which ones make the scar worse. 

Hypertrophic Scars

Raised, firm, and often red, hypertrophic scars stay within the original wound boundary. They result from excess collagen deposition under tension and frequently improve with time, pressure, silicone, or injection.

 

Keloid Scars

Keloids grow beyond the original wound edges into surrounding skin. They are strongly influenced by genetics and skin type, recur readily after excision alone, and typically require combination treatment rather than surgery by itself.

 

Atrophic Scars

Atrophic scars sit below the surrounding skin because collagen was lost rather than overproduced. Acne and chickenpox are common causes. They respond to resurfacing, collagen induction, subcision, and volume-restoring approaches.

 

Contracture Scars

Contracture scars tighten as they heal, pulling surrounding tissue inward. They most often follow burns or large-area wounds and can restrict movement when they cross a joint, which makes them a functional concern, not only a cosmetic one.

 

Surgical Scars

Surgical scars are planned and controlled, which is what separates them from traumatic scars. Placement along natural skin tension lines, layered closure, and early tension management determine how visible the final result becomes.

 

Acne Scars

Acne scarring is a distinct pattern of atrophic change, often appearing as ice pick, boxcar, or rolling depressions across the cheeks and temples. Texture, depth, and distribution guide which treatment approach fits.

 

What Causes Scarring

Every scar reflects a combination of how the skin was injured, where the injury sat on the body, and how that individual heals. Some of these factors are controllable and some are not.

Wound Depth

Injuries confined to the epidermis generally heal without scarring. Once damage extends into the dermis, healing relies more heavily on collagen repair, increasing the likelihood of a visible scar.

 

Tension Across the Wound

Skin under tension pulls a healing wound apart at the surface. Areas with high natural movement or tightness, including the chest, shoulders, and back, tend to produce wider and more raised scars.

Genetics and Skin Type

A family history of keloid or hypertrophic scarring meaningfully raises risk. Skin type and ethnicity also influence how much pigment change and collagen buildup occur during healing.

Surgical Technique

Incision placement, closure method, and suture selection can significantly influence the final scar. Incisions aligned with natural skin tension lines and existing anatomical creases heal flatter and less visibly.

Infection and Delayed Healing

An infected or slow-healing wound extends the inflammatory phase, which drives more collagen deposition. Wounds that reopen or require prolonged healing may scar more noticeably.

Sun Exposure During Healing

Ultraviolet exposure on an immature scar drives persistent pigment change. Protecting a healing scar through the first year is one of the few things fully within a patient’s control.

Treatments That Remedy Scarring

Raised and depressed scars behave differently and often require different treatment strategies. Raised scars may require treatment aimed at excess collagen and tension, while depressed scars often require approaches that stimulate collagen, release tethering, restore volume, or combine these methods. 

Scar Treatment & Revision

Direct management of established scars, from conservative protocols through surgical revision that re-excises and re-closes the scar under reduced tension. Reserved for mature scars that have stopped actively changing.

Scar Treatment & Revision

Acne Scar Treatment

Targeted treatment for atrophic acne scarring, selected by scar shape and depth. Ice pick, boxcar, and rolling scars each respond to different techniques, and most patients have a mix of all three.


Acne Scar Treatment

Laser Skin Resurfacing

Removes damaged surface layers and stimulates new collagen beneath, softening scar edges and improving the height difference between scarred and surrounding skin.

Laser Skin Resurfacing

Ablative Fractional Resurfacing

Creates controlled microscopic injury columns that trigger collagen remodeling while leaving untreated skin between them to speed healing. Effective on deeper textural scarring where surface-level treatment falls short.

Ablative Fractional Resurfacing

ProFractional Laser

Fractional ablative treatment with adjustable depth, allowing the same session to address shallow textural irregularity and deeper indentation across a single treatment area.

ProFractional Laser

Microneedling / Collagen Induction Therapy

Controlled needle injury that stimulates collagen production without removing the surface layer. Suited to atrophic scarring and appropriate across a wider range of skin tones than ablative options.

Microneedling / Collagen Induction Therapy

Related Concerns to Scarring

Scarring rarely presents alone. The same healing process that produces a scar often changes surface texture and pigment in the surrounding skin, and many patients are treating several of these together. 

Acne Scars

Atrophic depressions left by inflammatory acne. The most common scarring concern patients present with, and the one most often treated alongside general textural irregularity.

Acne Scars

Uneven Texture

Roughness, indentation, and surface irregularity across an area rather than at a single site. Scarred tissue frequently sits within a wider zone of textural change.



Uneven Texture

Hyperpigmentation

Darkening within or around a healing scar, driven by inflammation and sun exposure. Common in deeper skin tones and often more noticeable to patients than the scar contour itself.

Hyperpigmentation

Asymmetry

Difference in shape or position between paired features. Contracture and surgical scarring can pull tissue out of alignment, making asymmetry a scarring-related concern rather than a separate one.



Asymmetry

Skin Sensitivity / Irritation

Healing and scarred skin reacts differently to products, friction, and sun. Sensitivity in the surrounding area is common during the months a scar is still maturing.



Skin Sensitivity / Irritation

Scar treatment and Revision

Scarring is central to breast surgery outcomes, whether from reconstruction, implant procedures, or revision. Incision pattern and placement drive the visible result.



Scar treatment and Revision

Frequently Asked Questions

Scars generally do not disappear completely. As collagen remodels and blood vessels decrease, they can become flatter, softer, and closer in color to the surrounding skin. Some mature scars eventually become difficult to see.

 

Active collagen remodeling runs roughly 6 to 12 months. Full maturation, meaning final color and texture, can take 12 to 18 months in some patients depending on location and healing response.

 

Conservative measures such as silicone therapy may begin once the wound has appropriately closed, depending on the procedure and the clinician’s guidance. Surgical revision is generally considered only after sufficient scar maturation.

 

The typical arc is red and raised, then pink, then pale and flat. Patients frequently judge results at six to eight weeks, when the scar is still inflamed and nowhere near its final appearance.

 

Yes. Incision placement along natural skin tension lines, layered closure that reduces surface tension, suture selection, and an early post-operative protocol can significantly influence the final result.

 

Sources & studies

The information presented on this page is supported by data and insights from the following trusted sources:

American Society of Plastic Surgeons

What is scar revision?

National Library of Medicine (NIH)

Wound Healing Phases

National Library of Medicine (NIH)

National Library of Medicine (NIH)

Hypertrophic Scarring Keloids

Laser Revision of Scars

All sources are reviewed for accuracy and credibility to ensure the content remains reliable and up to date.

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