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Minimizing Scars in Wound Healing

May 4, 2022

We all have scars. Paper cuts, scrap on the knees, surgeries big or small ... they all leave scars. Scars on children are very much part of their childhood stories. But like many, minimizing scars is part of achieving that flawless skin. 

Scars come from the tearing of the dermis, our lower level of skin, which is rich in collagen — the elastic fibers that keep our skin springy (among other bodily benefits). Scarring can happen after any injury to the dermis. The appearance of a scar often depends on how well the wound heals. When our skin is cut, burned, or damaged in some way, it goes through phases to heal the wound: First it stops any bleeding and calms inflammation and pain, then it creates cells and tissue to repair skin damage. And with the right amount of nutrients and proper wound protocol to support the natural healing process, it’s possible for it to heal with minimal scar tissue.

We break down wound healing into four stages. The entire process of wound healing, be it wound of a cut or surgical wound, is very complex but yet, interconnected. 

1. Blood clotting: Minimizing blood loss with blood clotting is the first step. Immediately after an injury, platelets and fibrin (a fibrous protein) begin to stick together at the site of the injury to form a clot that stops the bleeding and protects the wound from the outside environment. At the same time, inflammatory molecules from the damaged cells trigger blood vessels to narrow (vasoconstriction) to also help slow the bleeding. This process lasts for 5 to 15 minutes. Then blood vessels widen (vasodilation) to help a variety of inflammatory and immune cells come to the injured site and start the healing process. The entire clotting process can last for up to three hours.

2. Inflammation: While blood clotting occurs, immune and inflammatory cells—neutrophils and macrophages—cleanse the wound by removing debris and bacteria so the healing process can take place. This is the time, about three to four days, when the wound becomes swollen, inflamed, warm, and sometimes painful as part of the process.

3. Proliferation: During the proliferation stage, new skin, connective tissue, and blood vessels are formed, and the edges of the wound close. Depending upon the size of the wound, this stage can last for 3 to 21 days.

4. Remodeling: Fibroblasts, cells that make up connective tissue, secrete collagen protein to restructure the collagen matrix. Scar tissue develops during this stage, which can last for years—it’s the process most responsible for scars fading over time.

Now having the understanding of wound healing, it is possible to minimize scaring. First and foremost is proper wound care. Having proper wound care ensures proper wound healing. It is important to know to keep the wound covered. Adequate levels of skin hydration help the healing process, because wound dressings keep moisture in the wound and surrounding tissues, using them can help accelerate healing and minimize scarring. Then a wound will scab. Leave those scabs alone: Scabs are our skin’s natural bandages, so keep your fingers off of them and let them do their thing. Picking will only prolong your injury and keep it from healing. Lastly, sunscreen will be critical: After the wound has closed, a high-SPF sunscreen is essential to prevent cellular damage and post-inflammatory hyperpigmentation. On a side note, in our aesthetics clinic, we do sometimes give surgical patients silicone scar sheets, but they do come with instructions on when to be used. Silicone scar sheets can help improve prevent new scars, but only if you use them in the first few weeks after an injury. 

While no scar can be completely eliminated, most scars fade over time. If you’re worried about the appearance of a scar, scar intervention with a dermal specialist or board certified dermatologist could help significantly. Previously it is believed that scar remodeling process can take up to one year, but there is new focus now ... doctors can influence a scar’s healing by getting involved sooner rather than later. Scar intervention can begin as early as at one month post injury. In-office procedures such as lasering and microneedling — which trigger a controlled wound response — can reduce the appearance of scars by 50-60%.

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