Wound care: How to prevent scarring

Whether it’s a sudden injury or a planned surgery, you may find yourself healing and, later, trying to minimize the scar — your skin’s reminder of what happened.

Scarring, whether on the skin or anywhere else, is a result of the body’s natural healing process following an injury or wound.

Proper wound care, like keeping the area clean and protected, can help make scars less noticeable over time.

What happens to your skin to cause scarring?

When the skin is injured, several processes begin immediately in the body, and they generally last around three days.

These include constriction of blood vessels and the formation of clots to stop bleeding as well as an inflammatory response where immune cells clean up bacteria and debris.

This is followed by a healing phase where new blood vessels form and collagen (a protein that provides structure and strength to new tissue) is built in the wound by specialized cells called fibroblasts.

This process occurs over the first three to four weeks after an injury and initially occurs in a disorganized fashion.

However, as more time passes, the wound will mature and remodel, resulting in more organization of the collagen fibers.

This corresponds to the contracting and flattening-out of scars that we see over time. The remodeling process progresses over the first year or more, depending on the nature of the wound.

How to minimize the appearance of a scar

Acting sooner, when the wound is still healing, rather than years later can help.

There are a few key things.

• Keep it clean, moist and covered. Wash with soap and water immediately following an injury, and keep the area moist with petroleum jelly.
• Avoid topical antibiotic ointments, such as bacitracin, unless there is active concern for an infection, as many people are allergic to them and they can increase inflammation in the skin.
• Protect your scar from the sun. Sun protection is important, whether that’s with a bandage at first or sunscreen later on. Sun exposure can significantly increase the odds of skin color changes along the wound that will result in the scar staying more visible over time.
• Avoid further trauma. Every time the tissue is pulled or moved, the healing process is disrupted, and a wider or thicker scar will form. Try to minimize activities that will put tension on the skin as it’s healing.
• Don’t pick at scabs. Scabs are the body’s natural bandage. Removing them will prolong the healing process, which increases the odds of developing a more prominent scar.

Factors that can determine scarring

The nature of a scar is dependent on several factors, including the depth and size of the injury and the location on the body. Even your genetics come into play.

• Depth/size of injury: Shallow wounds, such as a scrape or abrasion that doesn’t go deeper than the epidermis (the outer layer of the skin), typically heal without much or any scarring. Deeper injuries that reach the dermis (inner layer of the skin) or completely penetrate the skin will result in visible scars.
• Location on the body: Areas of the body where the skin is under more tension, such as the chest, upper back and shoulders, are more likely to form visible scars, as are areas that have thicker skin or a less robust blood supply, like the bottom of the foot. Areas with lots of skin motion can stretch scars into a wider appearance as they heal, and surgical wounds where the skin is pulled together under tension are also more likely to widen as they heal.
• Your genes: This is an area of ongoing research, but some people tend to form less prominent scars than others. Certain skin types are also more prone to forming prominent scar tissue.

Stages of healing — what you should expect

• Week 1: At first, the injury will appear red, swollen or raised for about one week as the healing progresses through the initial inflammatory phase to the cell regeneration phase.
• Weeks 2 to 4: The wound will start to contract and flatten out, and scabs will fall off.
• One month and beyond: The car will keep getting flatter and softer over time. The skin will typically become less red, though it may remain pink, purple or dark brown depending on your skin type.

The color changes will continue to fade and the tissue will continue to soften until the scar is fully matured. This maturation process generally takes about one year, though some people may see changes up to two years after an injury. Beyond six months, the scar becomes far less likely to have changes on its own.

When to act to prevent scarring

Traditionally, we waited for scars to mature fully before intervening, but trends are shifting toward earlier intervention.

Dermabrasion, microdermabrasion and certain lasers can reduce scarring for people with certain skin types and can be performed a few months following an operation or injury, though not every patient is a candidate for them.

For open wounds with scabs, try to avoid picking at the scab and keep the wound clean and moist. In cases where the scar has fully matured, you’re still potentially a candidate for one of the procedures above or a scar revision to try to resize or reorient the scar so that it’s less noticeable.

Silicone sheets can reduce the odds of prominent scarring, but they’re only helpful during the initial stages of wound healing in the first few weeks.

There isn’t any conclusive evidence to suggest that any other interventions, such as oils and creams, consistently improve scarring, though the act of applying an ointment (e.g., petroleum jelly) with gentle massage for five to 10 minutes a day can help soften scars when performed before they fully mature at around one year.

Once the scar has matured, at around one year, topical products will no longer have an effect.