How To Treat Every Scar, With Tips From Dermatologists

Photographed by Ashley Armitage
Scarring is never just skin deep – this is something I can vouch for. A bad fall in childhood meant having a skin graft on my knee, which ended up resembling a sewn-on patch that was a source of both fascination and disgust among my classmates. I was tasked with applying good old E45 Moisturising Cream to it every night, and over time, as I religiously massaged in that white ointment with its distinct scent until it disappeared like magic, it became a rather pleasant self-care ritual.
Over the years, my scar has minimised in appearance and the redness diminished, along with the residual shame I felt at being less than perfect. But if writing this piece has taught me anything, it's that I'm not alone. "Our initial emotional reactions towards a scar are often related to shock," notes Dr Andrew Thompson, reader in clinical psychology at the University of Sheffield and British Skin Foundation spokesperson. "There also may be feelings of anxiety associated with thoughts of what the eventual scarring might look like. In addition, scarring can be associated with feelings linked to the event that caused the injury, such as anxiety, anger and even shame. However, most emotional reactions should settle relatively quickly."
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According to the experts, learning how to manage a scar is key to reducing its emotional repercussions. With that in mind, I asked some of the best dermatologists and aestheticians in the business for advice on how to treat the most common types of scarring.

Elevated scars

"Hypertrophic and keloid scars are two types of elevated (or raised) scars," explains Dr Anjali Mahto, consultant dermatologist and author of The Skincare Bible: Your No-Nonsense Guide To Great Skin. "Both types occur due to overgrowth of dense, fibrous tissue after healing of a skin injury." However, there is some difference between them. "Generally speaking, hypertrophic scars are the same size as the wound that caused them," – this could be as a result of piercings, burns and cuts, for example. "Keloid scars extend beyond the limits of the injury," Dr Mahto adds. "This type of scarring is more common in pigmented skin. They usually do not diminish by themselves and often require intervention to soften or flatten the areas."
Professional procedures are something ZO Skin Health dermatologist Dr Rick Woodin seconds. "Treatment can include medicinal corticosteroid injections, freezing, surgical removal, laser therapy, creams, gels or pressure dressings. Your dermatologist will advise on which is best for you." If you do choose to visit a dermatologist, it pays to check that they are properly qualified by searching their name on the General Medical Council register.

Superficial scars

"Superficial scars are those pesky red blotches you can get post-acne, that don't seem to let up," Dr Mahto explains. "Retinol (another name for vitamin A in its purest form) is great for all skin types and works especially well for those who suffer from this sort of scarring." Try SkinSense Retinol Serum, £39, which has an active concentration of 0.03% of pure retinol or SkinCeuticals Retinol 0.3, £65, recommended by dermatologists. If you’ve been advised to avoid retinol, for example if you’re pregnant or your skin is prone to chronic sensitivity, The Inkey List’s new Bakuchiol, £9.99, positions bakuchiol, a potent antioxidant, as a natural alternative ingredient for exfoliating and speeding up cell turnover.
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Ice pick scars

According to Dr Woodin, as the name suggests, these are small, deep holes caused by acne that look as though the skin has been punctured with an ice pick. Sadly, when it comes to treating them, there is no miracle product that you can pick off the shelves, as Dr Mahto explains. "I would wholeheartedly recommend against throwing your money at creams, lotions, potions, and popular oils. Despite what the packaging may claim, they will simply not be as effective against such scarring. Skincare in this context would be a false economy." The NHS suggests 'punch excision' or 'punch grafting' as possible treatments, but it is best to discuss your options with a professional, as Dr Mahto emphasises. "Your money really would be better spent getting an expert opinion from a dermatologist."

Boxcar scars

These are broad depressions with sharply defined edges, several millimetres wide and can result in a 'crater' appearance of the skin. "Treatments such as dermal rolling and laser will stimulate collagen type III to plump out the skin and smooth the acne depressions," notes Dija Ayodele, aesthetician and founder of Black Skin Directory. "The earlier this is done the better, as it’s much more challenging to treat old scars."

Rolling scars

Similar to boxcar scars, rolling scars have a deep crater-like appearance but with more sloped edges. When treating them, the above advice holds, but in more extreme cases, cosmetic treatment is another option. Aesthetic doctor Sophie Shotter offers different treatments, such as filler, at her Kent clinic, Illuminate. "I would always recommend filler used in combination with other procedures and I’m a big fan of stimulating collagen to treat scarring," she says. "I use a resurfacing technique with a system called Venus Viva, which uses nanofractional radio frequency." This is said to heat tissue and encourage collagen production.
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Laser expert Debbie Thomas adds: "Deeper scarring can potentially be improved over a longer period of time, but often, a number of different treatments may be needed. Lasers like the Erbium:YAG (Er:YAG) physically remove layers of skin. The idea behind this is that by forming a wound and removing said layers, it forces the skin to regenerate at a much more optimum level. Light to moderate peels are best, as your skin is a living organ and can only take so much trauma."

Post-inflammatory hyperpigmentation

"This is quite a common side-effect of acne," says Dija. "Appearance-wise, they can appear quite flat but leave dark marks in patches or dots on the skin." Treatment options for this type of skin staining vary. "It can be treated topically using products that fade the dark patches, such as hydroquinone prescribed under medical supervision. You should also look for ingredients that inhibit and quell excess melanin pigment, such as liquorice extract, vitamin C, niacinamide, bakuchiol and retinol. Applying a broad spectrum sunscreen daily is also a must to prevent it getting any worse."
Dr Dennis Gross' Dark Spot Sun Defense Broad Spectrum SPF 50, £44, is a clever multitasker and contains three forms of vitamin C to even out pigmentation, while blocking UVA and UVB rays. R29 also rates Soleil Toujours Extrème UV Mineral Sunscreen SPF 45, £45, and
Piz Buin Allergy Sun Sensitive Face Cream SPF 30, £7, as they are both effective and travel-friendly.
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A few things to remember...

When it comes to minimising the impact of scars, one vital piece of advice comes from Dr Thivi Maruthappu, consultant dermatologist and British Skin Foundation spokesperson. "As tempting as it may be, it’s so important not to pick or squeeze a spot, as the pressure can drive inflammation and infection deeper into the skin. The same is true of picking at scabs, which can increase the chances of scarring, including hypertrophic scarring." And for those finding things particularly challenging, extra support is at hand. "Help in managing scars is increasingly available through both specialist medical services and mainstream mental health services," Dr Thompson explains. "A number of free self-help resources are also available on websites such as Skin Support and Changing Faces."
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