What is the difference between a good and bad scar?

Some people produce better scars than others, for example, ‘poor scars’ such as hypertrophic scars stay visible and cause skin irritation for a number of months after formation. When these ‘visible’ scars fade they tend to whiten, flatten but, remain visible – unlike a ‘good scar’ which will fade significantly and blend with the tone of the surrounding skin.

Clearly good scars are those that you cannot see, where all conditions for good scaring are met.

What are these conditions?

The scar must be in the right direction in the lines of skin tension. Experienced trained surgeons will choose to position scars properly as for instance transversely across the abdomen rather than vertically downwards. Lacerations are random in direction. A razor slash of the face leaves the telltale poor quality Glasgow Smile.

Scars may be in areas where it is naturally better, such as by avoiding the centre of the chest or tip of the shoulder.

Scars may be hidden below the breast, behind the ear, in the groin or in the armpit (axilla).

Surgeons can influence the result by meticulous technique and using dissolving sutures or glue and removing other stitches early enough to avoid stitch marks.

Have the right genes. Some people always tend to make bad scars. Very dark skin is more prone to make the worst ones- keloids. At the opposite extreme, Celtic skin and those with red hair are also poor scar makers.

A hypertrophic scar is one that continues to grow after healing. It is red and itchy, but after some months will mature to a scar that is pale, flat, but often slightly wider than the best scar.

A keloid is similar to a hypertrophic scar but goes on growing and spreading. It is painful as well as itchy.

Atrophic scars are those that widen after healing. Whatever the stitching, they just stretch.

Icepick scars are the pitted scars left behind on the face and back as acne heals.

Depressed scars. Some skins heal with scars below the normal skin level.

Do not despair. Maybe one cannot make scars disappear, but the can be influenced. The Cadogan scar management system has numerous treatments for all these scars. Ideally one would start treatment early as the wound heals.

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