Facial Scars: Types and Treatment Options

Introduction

The scar is a mark left on the skin as a part of the normal healing response which follows a wound or injury. The wound can result from burns, acne, surgery, infection, or any injury. A scar can not be completely removed, only the size can be reduced, and the appearance is changed for the better.

Dermatologists and plastic surgeons are the ones who treat scars. In some cases, even home remedies can be used. Scars vary in composition and can be flat, lumpy, or colored. It may be painful, itchy, and unsightly. The face is a part of the body in constant contact with the outside environment, which further affects the healing process. Facial scars can be distressing and can affect one’s self-esteem. There are a lot of treatment options for facial scars.

What Are the Types of Facial Scars?

• Normal Fine-Line Scars: These are usually seen after a minor wound (or cut) and after surgery. The wound heals, leaving a raised line that gradually fades over time. But it leaves a visible mark. In most cases, they are not painful but can be itchy.

• Keloid Scars: Keloid scars occur as a result of an overly aggressive healing process. A tissue overgrowth occurs at the wound site due to increased collagen production leading to keloid scar formation. These scars are raised above the skin and are often itchy or painful. They can be pink, red, the same color, or darker than the surrounding skin.

• Hypertrophic Scar: These are similar to keloid scars and appear red and raised. These are also produced due to excess collagen production but do not extend beyond the boundary of injury, unlike keloid scars.

• Scar Contracture: These are caused by burns. In this case, the skin shrinks, and movement is restricted. These scars can go deeper, affecting the muscles and nerves.

• Pitted or Sunken Scars: Some skin conditions like acne and chicken pox can lead to scarring. These are also called atrophic scars and develop due to an injury that causes loss of underlying fat. Severe acne leaves acne scars. Acne scars are of different types, and the treatment option depends on the type of scar. Atrophic scars are classified into three types based on the depth and size of destruction.

• Icepick: These are narrow scars less than two millimeters (mm) in diameter. These are V-shaped epithelial tracts and have sharp margins that extend to the deep dermis. They are resistant to conventional skin resurfacing options due to deep involvement.

• Boxcar: These are wider, having 1.5 to 4 mm diameter, round to oval depressions with sharp vertical edges. Shallow ones can be treated by skin resurfacing, but deep ones are resistant.

• Rolling: These are the widest and can be up to five mm in diameter. Superficial shadowing and undulating appearance present.

What Are the Available Treatment Options for Facial Scars?

1. Skin Camouflage (Make-Up): Make-up can cover up facial scars when done per the skin tone. Waterproof make-up usually lasts for 2 to 3 days.

2. Silicone-Based Treatment: Silicone gel or sheet is applied over the scar so that scar becomes soft and flatter. But it should not be applied on the wound and should only be applied on the healing skin. It should be placed over the scar for 12 hours a day for three months.

3. Steroids: Corticosteroid injections are used to treat keloid and hypertrophic scars. The scar is injected multiple times to reduce swelling. Injections are given thrice at a gap of 4 to 6 weeks apart. Steroid-impregnated tape may also be used.

4. Laser Therapy: Highly powered laser beams are used to remove the top skin layer. The laser reduces the redness of scars. Laser resurfacing is used in the case of pitted scars for flattening the scars. The top layer of skin is removed by laser and it stimulates collagen production in deeper layers. There are two types; erbium laser and carbon dioxide laser resurfacing. Erbium is safest for the face, but carbon dioxide is more effective in treating scars. Laser therapy has a faster healing rate when compared to other treatment options.

5. Cryotherapy: In this technique, liquid nitrogen is used to freeze keloid scars. A disadvantage is that it can lighten the skin color in the treated area.

6. Dermal Fillers: These are costly, and the results are usually not long-lasting. Repeated treatment may be required. These are especially helpful for rolling and boxcar scars. The fillers used are collagen-based products, polymethyl methacrylate, hyaluronic acid, silicon, polyacrylamide, etc.

7. Chemical Peel: Chemicals are used to peel off damaged skin layers, thus leaving back the fresh layer underneath. Different chemical agents are used based on the severity of the scarring. The chemicals used range from mild ones like glycolic acid used in daily skin care products to phenol used for deeper peels.

8. Skin Needling: It is also called micro-needling. A small device with hundreds of tiny needles is rolled over the skin surrounding the scar tissue stimulating collagen production. Repeated treatment may be required to achieve the desired result.

9. Surgery: Plastic surgery involves an invasive procedure in which scar tissue is removed surgically and altered. This procedure is carried out by a plastic surgeon and not by a dermatologist, as for other procedures. Though the procedure has a better outcome, it may not be affordable for all and poses a risk of infection and scarring. For scar reduction surgery, always go for an experienced board-certified plastic surgeon.

10. Dermabrasion: Dermatologist uses a wire brush or a wheel to remove the top layer of skin on the face. It is one of the most effective and popular methods used. However, is not a good choice for one with sensitive skin. Complications include redness, swelling, uneven skin tone, and infection.

11. Punch Incision: This procedure is used for treating atrophic scars, mainly ice-pick scars. A needle about the scar size is used to cut the scar tissue, after which it is sutured. If scars are severe, a small skin graft is used. But the procedure may result in uneven skin pigmentation.

12. Home Remedies: These are the most affordable, but their effectiveness is questionable. Petroleum jelly due to its hydrating effects prevents scar from becoming worse. Honey may help to reduce redness and infection, but there may be a risk for allergic reactions.

Conclusion

Facial scars can be distressing for some due to their location, and in some cases even be painful or itchy. Many treatment options are available, each with its benefits and risks. An experienced dermatologist can guide one in choosing the most effective treatment for their particular condition.