According to an article published in the British Medical Journal in 2003, every year 100 million people in the “developed” world acquire a scar. So they’re not uncommon; yet in pop culture, scars are often used to signal that a character is a villain (see Scar in The Lion King) or someone to be pitied, or even both, in the case of Dr. Maru in 2017’s Wonder Woman, and the Phantom in Phantom of the Opera. Scars are not innately villainous or ugly: They’re the result of your clever body trying to heal itself. Here’s what’s really going on with scars, and how to love yours.
What causes a scar?
When you get a cut, your body first releases platelets that bond together to form a clot that seals the wound. Below that, fibroblast cells produce collagen: This is the same protein that’s in the rest of your skin, where it’s laid out in a random, overlapping pattern, but in a scar, the collagen is aligned in the same direction. Dr. Inessa Fishman, MD, a facial plastic surgeon who runs Aviva Plastic Surgery & Aesthetics in Atlanta, GA, explains, “Any time there is an injury deep enough to reach the dermis (the deeper, collagen-containing underlayer of the skin), this will likely result in a scar. Injury can involve traumatic or surgical situations; bites; infections; or chronic inflammatory processes, such as cystic acne.”
Where the cut is and how you treat it can determine whether it turns into a permanent or long-term scar, adds Dr. Ross C. Radusky, MD, a dermatologist at SoHo Skin & Laser Dermatology, PC, in New York. “Our skin is designed to withstand very high tension in certain parts of the body — such as over joints and over the large muscles of the sternum, arms, and legs. A skin injury in these areas is going to require a certain strategy to bring the wound edges together, such as with stitches, so that the skin can heal properly before subjecting itself to the stretch it needs. For a cut on the chest, for example, every time you get dressed, open the door, and wave hello, you stretch the skin, and that can make wound healing more difficult and [more likely to] lead to a scar.”
Some of us are more prone to scarring than others. Dr. Radusky specifically points to people “on certain medications, such as steroids; nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen; blood thinners; and chemotherapies. Individuals with medical conditions such as diabetes and cardiovascular disease are more likely to have poor wound healing and therefore scar more often. Smoking also impairs the body’s natural ability to heal itself.”
What is a keloid scar?
Not all scars look the same. Many heal flat, while some end up more pronounced. “A scar requires the body to lay down collagen to properly repair itself,” Dr. Radusky explains. “The amount of collagen varies based on location. For example, a cut on the finger is going to require a lot less collagen to heal than a large cut across the chest. When the body lays down too much collagen in the scar itself, it becomes thickened, and is called a hypertrophic scar. When the collagen extends beyond the scar, and into surrounding normal tissue, we call it a keloid.” Dr. Radusky adds that people who are prone to keloid scars (that’s key-loyd, in case you ever need to say it out loud) can get them from even minor skin traumas, such as ear piercings and even plucking hairs. He also explains that you’re more likely to get keloids if you have a family history of them and/or have dark skin (apparently scientists still aren’t sure why this is).
Like any scars, keloid scars are a result of your body trying to heal itself, just in a way that’s different from how other people’s bodies do it. Unlike other scars, they can continue to grow for a while, and can be painful and itchy. If that’s the case, Dr. Fishman advises, “Keloids are usually treated with surgical excision, injections of steroids, and sometimes low-dose radiation therapy.”
How can you treat scars?
For people who want to reduce the appearance of their scars, Dr. Radusky recommends both preventative and aftercare procedures. For starters, he says, “Use Vaseline or Aquaphor to cover the skin, minimizing the risk for infection.” After the cut has healed and any stitches are out, he goes on, keep the scarred area moisturized and out of the sun for a year, either under clothes or with a thick layer of sunblock. Again, he emphasizes that you should avoid stretching the skin when it’s healing, since this encourages more collagen to flood the area (which leads to those hypertrophic scars); Botox injections can help with this too. If you already have a scar formed with excess collagen, “a steroid injection placed directly into the scar can help flatten its appearance,” Dr. Radusky explains. “Resurfacing lasers can also obliterate too much collagen, giving the skin a second chance at healing.”
Learning to accept and love your scars
Intellectually, we know that scars are a sign that your body has done its job and healed from a wound. But coming to terms with a scar, particularly one that you got as the result of something traumatic, or one that drastically changed your appearance, can be very hard psychologically.
Michelle Elman is a body confidence coach from the UK, author of Am I Ugly?, and the person behind Instagram account @scarrednotscared. By age 11, she’d had 13 surgeries, which left her with scars across her body, especially her stomach. She told us by email, “The adjustment to the scar is harder than the scar itself. The thing you will be struggling with is the change and the new stares and inquisitive questions about it. That adjustment will take time, so allow yourself to grieve your old face or body and just accept this as a change you are processing.” For Elman, loving her body the way it is came from realizing she didn’t want to undergo more surgery to remove or alter her scars, and learning to talk about both the scars themselves and the surgeries that caused them. “The more I spoke about both, the more I realized that it wasn’t as big a deal as I had made it out to be in my head.” Finding that confidence helped her deal with other people’s reactions: “Once I was okay with my own scars, those questions and stares hurt a lot less.”
Another person trying to inspire people to love their scars is Phyllida Swift, Campaign Manager at UK charity Changing Faces, which recently launched the campaign I Am Not Your Villain, calling for filmmakers to stop portraying villains with facial scars, burns, and marks. While traveling in Ghana aged 22, Swift was involved in an accident that ultimately left her with a large facial scar. Coming to terms with how her appearance had changed was far from easy, but Swift says she tried to focus on what makes her who she is beyond her appearance.
She worked hard on her course at university, downloaded Tinder, and hung out with people who didn’t make a big deal about her scars. “As soon as I started to value all of the other aspects of my identity that made me who I was, I was able to harness the strength that surviving an accident and having the battle scars to show it gave me,” she said. “I was able to see them as an asset that made me who I now was.” It’s not always easy, thanks mainly to other people’s reactions, she adds. “But the majority of the time, I know that I have so much more to give than what I look like, and if I go out there with a smile on my face and the refusal to let my scar define me, then that’s what the world will see.” Learning to love your scars after something traumatic is hard, no doubt. But your scars are your body’s stories: Don’t let people who don’t understand stop you from sharing them.
How did you get your scars, and how do you feel about them? Tell us your story @BritandCo.
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