I really want to get rid of the scar. What can be done?

If the injury is recent, it is advisable to take measures to prevent the development of a prominent scar

Scars, which people usually want to do something about, can be divided into atrophic (which result in a depression, i.e. the tissue becomes less than it should be) and convex – hypertrophic or keloid scars. Hypertrophic scars are dark, bulky scars that stop growing when the wound heals and may even decrease over time. Keloid scars are also bulky, but they grow beyond the wound and can reappear even if removed. Both keloid and hypertrophic scars can be painful and itchy.

It is believed that preventing the development of a large scar is easier than getting rid of it later. Usually, to prevent it, the following rules are recommended:

• If you have just been burned, you need to place the burn area under cold or cool (but not icy) water for at least 20 minutes. This reduces damage and the size of the scar.
• If there is already a wound, it should be moist and covered for the first time. Vaseline can be applied (if it is not infected, that is, there is no inflammation, pus). Special non-adhesive dressings can also be used.
• The skin around the wound should not be stretched. To avoid this, various types of dressings can be used.
• When the wound has healed, silicone gel dressings can be used. They are applied for three to six months and worn for 12 to 24 hours a day. If using dressings is technically impossible (for example, the scarred area is too large), a special silicone gel can be applied. For superficial burns, a single moisturizing is enough and silicone dressings are not needed.
• For burns, you can also use pressure devices for up to a year. For example, compression stockings. However, this can be done only when the wound has healed.

Unfortunately, these methods have a rather weak evidence base, but in the absence of anything better, they are recommended in various guides for doctors and knowledge bases. Especially since there is little harm from these methods, and how they can work in theory is more or less clear.

And a couple more preventive recommendations:

• People who already have raised scars are advised to avoid, for example, piercings or the removal of moles for aesthetic reasons, that is, any unnecessary trauma. There is a high likelihood that the next injury will result in the formation of the same type of scar.
• In the case of acne, treatment of the disease is the best prevention of scars.

Avoid sunbathing

If you don’t want the scar to become more noticeable, it’s better to protect it from the sun. The problem is that according to some data, UV radiation on a recently healed wound can cause the scar to darken. It’s better to protect it from UV rays for at least a year. You can use tight clothing, bandages, sunscreens with SPF 50, and avoid the sun in general.

See a physician

If a scar has already formed and you want to make it less noticeable, it’s better to see a doctor. The specialist will determine the type of scar (if it is a scar at all, and not some kind of disease). It’s not always easy to do it yourself. “Sometimes there are difficulties in determining whether it is a hypertrophic scar or a keloid,” writes dermatologist at DocDeti Clinic, Maria Zhuravleva, in response to “Meduza” question. “There are criteria that help the doctor determine who is who.” The doctor will also suggest treatment options depending on the type of scar. Here’s what the specialist will most likely tell you:

• Silicone bandages and gels are used not only for the prevention of keloid and hypertrophic scars, but also for treatment. They help reduce the scar, make it softer, and reduce itching and pain.
• Pressure is also used for both prevention and treatment of keloid and hypertrophic scars.
• Corticosteroid injections help to soften the raised scar and reduce its size. Pain and itching can also be reduced.
• Cryotherapy (scar removal using low temperatures) may be effective (especially in combination with other methods) for keloid scars.
• A raised scar can be removed (but if it’s a keloid scar, it’s likely to grow back and preventative measures need to be applied after removal).
• Laser therapy is also used for convex scars to correct the color and reduce their volume. For atrophic scars that have arisen due to acne, laser therapy can also be used as a first step in treatment: one of its varieties can help to remove redness, while laser resurfacing can even out the skin.
• If the scar is atrophic, then fillers are used: a “filler” is injected into the damaged area, which evens out the skin.
• Small surgical interventions can also be performed to “lift” scars that have formed due to acne.

This is not a complete list of treatment methods, and it should be said that there is no single algorithm of actions now: all these interventions have pros and cons that play a different role for different people. In addition, again, these methods have problems with proving their effectiveness.

Make a tattoo

One way to make a scar less noticeable is to cover it with a tattoo (including one that matches the skin tone or imitates hair on a hairy part of the body). However, this cannot always be done. For example, if the scar remains after the removal of melanoma or lymph nodes, tattooing on this spot is not recommended. “Covering scars after malignant skin neoplasms is dangerous,” writes dermatologist Maria Zhuravleva. “If not all tumor cells were removed, its recurrence is possible, but because of the tattoo, we may simply not see it. It is also not advisable to apply tattoos to keloid scars as this could trigger their growth.”

From other relative contraindications:

• reception of isotretinoin (this medication is used for acne)
• A mole or a melanocytic nevus in a place that will be covered by a tattoo.
• Psoriasis, vitiligo, red flat lichen and other diseases, the symptoms of which manifest where the skin is damaged.
• Immunodeficient conditions (for example, due to chemotherapy);
• Blood coagulation disorders or taking anticoagulants.

It is not advisable to get tattoos on unhealed scars. “Attempts to tattoo on unhealed scars can lead to even greater damage to the skin, inflammation, and then instead of a beautiful tattoo, there will be a smeared spot and a new scar,” writes the tattoo artist and founder of the charity project “Show Me All Your Scars” Rin Tsunami in response to our question. “Correcting such work is even more difficult and time-consuming than just doing a cover-up.”

Tattooing on scars is more difficult than on normal skin, because due to the peculiarities of the structure of such tissue, the ink can behave unpredictably. “Scarred skin is heterogeneous in density and texture, which adds complexity to the work – it is necessary to take into account the difference in sensitivity and ‘strength’ on clean and scarred skin in order to adjust the depth of the piercing, skin tension, density of filling, and even the working settings of tattoo equipment,” writes Rina Tsunami.

It is possible that the brand of paint and the influence of the sun also affect the result, but this has not been intentionally studied.

“The problem may also be due to the master’s inexperience. The most common problem with beginner masters is uneven piercing of the contour,” continues Tsunami. “At the start, it is difficult to achieve a firm hand placement where the needle would pierce the skin at the same depth. In the case of clean skin, this can lead to poorly healing lines, “overlaps” when the pigment is inserted too deeply and spreads under the skin, or the loss of paint with insufficient piercing depth. And if the master works with scars, this will lead to additional trauma and instead of covering it, the person will receive a wound that will take a long time to heal, and a new scar.”

Tattoos in skin color are mainly used when the scar is lighter than the surrounding skin. The downside of such a tattoo is that due to tanning or any other natural changes in skin color (in cold weather, due to heat), it may become more noticeable.

If the scar is dark, has a different texture, or covers a large area (and it is certain that it is not a keloid scar), tattoos in the form of images are often used. When asked whether one should choose a design so that the scar fits into the tattoo, Rina Tsunami says, “It will be as you come up with it. Covering up will not smooth out the scar’s relief, so we work with a visual “anchor” – the tattoo will be more noticeable than the scars. To enhance the visual effect, choose a sketch that completely hides the damage and covers an even larger area of ​​the skin. But there are also many options when the scar can be incorporated into the design, combined with other elements, and turned into part of the sketch. Make a scar a fin of a goldfish, a twig for a small daring bird, or a scatter of flowers.”

Unfortunately, there are very few studies that examine how satisfied patients are with the results of various types of tattoos, but according to the available modest data, 78% of people were satisfied with the outcome.

There are plenty of tattoo artists specializing in scars. Some even offer discounts or tattoo for free if the scar was the result of domestic violence, cancer surgery, or for any other reason that the artist finds particularly important.

But choosing a specialist can be difficult.

Rina Tsunami recommends paying attention to two factors first and foremost: whether you like the artist’s work and whether they regularly work on cover-ups. “Tattoo artists work in different styles and techniques, not every watercolorist can deliver realism or geometry,” writes Tsunami. “Pay attention to the displayed works, fresh and healed. Find out if the artist works with scars. Many refuse to do cover-ups, and if there are no such works in their portfolio, perhaps they have no experience working with traumatized skin and you should consider other artists.”

Tsunami also advises choosing a specialist whom you like communicating with. “Covering scars can be emotionally stressful, not only because of pain, but it is also an important and significant step for many,” explains Rina Tsunami. “See if the tattoo artist suits your mood, communication style, if you find their work interesting, and if you liked their consultation. You will have several hours of close communication in a not entirely comfortable situation – choose a person with whom you will enjoy spending that time.”

Learn how to apply camouflage makeup

Camouflaging makeup using special products is more reliable than regular makeup and can be used to hide scars of different colors. These products are extremely long-lasting, allowing you to shower and swim without affecting them. As Anastasia Romanova, a Kryolan brand consultant, explains, it’s important to consult with a specialist to select the proper products, especially since they need to see the person in person. In the UK, for example, a doctor may refer patients to a specialist in camouflaging makeup who will provide free assistance in selecting the necessary products.

The Department of Regulation of Medicines and Health Care Products in the UK classifies only four brands of products as camouflage cosmetics: Covermark, Dermacolor (Kryolan), Keromask, and Veil. Some organizations and individual specialists also use products such as Dermablend, Cover FX, CoverBlend, Colorescience, and Kevyn Aucoin for camouflage cosmetics. Companies that manufacture regular cosmetics may also have products suitable for camouflage makeup, but they may not be as long-lasting.

Consultation with a specialist is necessary not only to learn how to apply these cosmetics, but also because experts say, basic knowledge of how to apply regular makeup is not enough here. In addition, to apply these cosmetics, a corrector is likely needed – it will help neutralize the different color of the scar. It is also useful to have the skill of working with darkening and highlighting certain areas, which also helps make the scar less noticeable. For example, here is a video from the British non-profit organization Changing Faces about the specifics of applying camouflage makeup.

Speak with a psychologist

Maria Zhuravleva, a dermatologist, states that from a medical perspective, a scar that doesn’t restrict movement is not dangerous. However, the psychological aspect of scars is powerful. People may want to make their scars less noticeable because they can remind them of a painful or traumatic event.

Sofia Safonova, a psychologist at the Mental Health Center, explains that the way a scar was obtained plays a significant role in how a person feels about it. If a scar resulted from a traumatic event, such as a car accident, where the person survived, they might view the scar as a symbol of a second chance. Such scars are usually easier for people to accept, and they come to terms with them more quickly, especially if the person has reevaluated their life after the incident.

However, in many other cases, such as violence or oncological disease operations, scars can cause shame and an identity crisis. Safonova explains that scars resulting from violence are painful reminders that can be difficult to accept, and people often try to conceal them by wearing long clothing.

It is natural for a person to feel uneasy when faced with questions or comments about their scars, and if they haven’t yet come to terms with their scars, they may not be able to react calmly. Safonova suggests finding a supportive environment where the person can gradually develop a new experience where people react calmly, even to stories related to their scars. It is also important for people on the path to acceptance to understand what their scars mean to them and to seek help from a specialist if scars significantly reduce their quality of life.

Safonova emphasizes that working with a psychotherapist and reading stories about similar experiences can help in coping, and people can find support from others who have had similar experiences. However, it is essential not to compare one’s story with others’ and not to feel ashamed that others in a “more difficult” situation have coped better. Instead, it is better to focus on body positivity and look at examples of people with scars or disabilities being celebrated in fashion shows and photoshoots.