Does youth play a role in better scar healing? Who is at a higher risk of developing hypertrophic or keloid scars? Do genetics play a role in how your scar heals? The answers may surprise you.
Scar healing is the result of biologic wound repair and is a complex process. With the exception of minor lesions, every skin wound causes some degree of permanent scarring.
Inflammatory Phase: Dilation of blood vessels causes leakage of fluid that contains enzymes, growth factors and cytokines (inflammation cells). The wound uses this fluid to break down the collagen damaged by the injury. Unfortunately, the skin is not efficient at controlling the amount of these healing factors. This causes an “over-breakdown” of collagen and contributes to a larger, less cosmetic scar. We have found that certain scar treatments work together to decrease this excess breakdown of collagen at the wound area. These include stable forms of vitamin C, dimethicone silicone gel and certain botanicals (natural plant extracts) like licorice, aloe vera and oils rich in n3 and n6 essential fatty acids (like sunflower and safflower seed oils). Any vitamin C skin care product that becomes discolored over time (typically turning brown on repeat exposure to air) contains unstable forms vitamin c which have become oxidized and are no longer effective.
Proliferation Phase: After the inflammation, the body replaces the damaged tissue with new collagen. The skin builds this new collagen very quickly and may produce abnormal collagen. The build-up of abnormal collagen can lead to hypertrophic scarring and even keloid scars. Stable vitamin C complexes and dimethicone encourage production of normal, “healthy” collagen while also limiting production of abnormal collagen.
Epithelization Phase: The top layer of skin conserves water and serves as an infection barrier. Skin injury severely disrupts this function. The next phase of healing is formation of new top skin (epidermis). Replenishing water content of the skin is essential during this phase. Essential fatty acids restore the lipid biolayer and provide moisture to the developing epidermis. Dimethicone also traps water. The resulting increased moisture encourages faster and improved scar healing. Scar treatments containing alcohol should be avoided. Alcohol can dry the skin which worsens scar healing.
Maturation Phase: The newly formed scar now starts to mature. This final scar healing phase can last for 2 years. Collagen fibers reorganize for a stronger and durable scar. This can cause scar hardening and loss of elasticity. The scar may also become red, which can take up to several years to improve. Stable forms of L-Ascorbic acid (vitamin C) and certain vitamin C esters aid in decreasing scar pigmentation by over 80%. Botanicals like licorice extract also helps decrease hyper-pigmentation. Essential fatty acids are vital for restoring normal skin elasticity during this phase.
- Age – younger skin is more prone to abnormal and exaggerated healing. This can lead to hypertrophic or keloid scars. Older skin takes longer to recover.
- Skin type – scar healing is typically worse in people with darker skin types. African and Hispanic ancestry is associated with a higher risk of developing hypertrophic or keloid scars.
- Genetics – abnormal scarring can be inherited.
- Location – Movement of scars over joints can make them wider.
- Infection – Infected wounds do not heal well. The final scar may be raised, wide, uneven and abnormally red or dark.
- Poor nutrition – Not eating healthily deprives the body of nutrients (like protein), vitamins (like vitamin C) and minerals (like copper and zinc) that are needed for optimal wound healing.
- Smoking – Cigarette smoke causes blood vessels to clamp down and decrease blood flow. Wounds that do not receive enough blood are more prone to poor wound healing and worse scarring.
- Sun exposure – Exposing fresh scars to the sun causes permanent redness.
Complete scar healing can take up to 2 years. Because of this, we recommend you continue to use your scar treatment of choice until you stop seeing an improvement in the appearance of your scar. In addition to applying a scar cream daily, proper nutrition, exercise and good lifestyle habits are also essential.
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