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July 31, 2013 at 10:27 PMComments: 2 Faves: 0

Tips on Scarring

By Jeffrey VanWingen M.D. More Blogs by This Author

My kids love to hear my brother and I tell stories by looking at each others scars. A defect along the hair line tells a great one about a snowball fight that ended with a blow to the scalp with a snow shovel. (The snow turned a little red that day.)  Another defect highlights a morning before school when a few choice  words were answered with a drumstick thrown across the room. My brother got stitches, and I got spanked. 

Scars tell a story, but most people don't want such a prominent, visual reminder of a significant injury or surgery on their bodies.

Understanding the Process

The skin basically has three layers: the epidermis (most superficial), dermis (thickest and toughest), and the hypodermis (soft, fatty tissue otherwise known as subcutaneous tissue).

The first two layers are made up largely of collagen tissue. This collagen forms the scaffolding and elasticity of the skin. (I have discussed collagen in past blogs as it pertains to wrinkles and smoking.) When an injury occurs through the first skin layers and into the subcutaneous tissue, repair processes are enacted quickly. Blood hardens and plugs the gap with a scab. This sets in motion production of more collagen to create new skin, bringing things back together in a more permanent solution. While the collagen in healthy skin exists in random whorls, the repair process that makes collagen leaves a more linear, regular pattern - a scar. 

The journey from injury to the fully evolved scar takes about a year. Over the first six months, the scar tissue becomes puffy and firm.  Over the next six months, it softens and flattens. And then, as a surgeon colleague of mine says, "After a year, what you see is what you get."

Special Scars

Occasionally, this process goes awry. There are three abnormal situations in which abnormal scarring occurs.

One condition, hypertrophic scarring, occurs when an excess amount of collagen is produced. This situation is more likely to occur when an infection exists in the defect or a repair (stitches) brings the skin together under too much tension. 

There is a more serious form of this problematic process called keloid ("key-loyd") scarring. While hypertrophic scars are enlarged, puffy, and firm, keloid scars are much more exaggerated and out of control. Keloids can occur in anyone but are more common in dark-skinned individuals. They can occur with even minor injuries such as piercings. If a keloid occurs, this usually indicates a tendency that will occur with further injuries. 

The other scarring abnormality, atrophic, is quite the opposite of the other two. Atrophic scars look sunken. While they have a reasonable amount of collagen, the process causing the defect in the skin destroys a portion of the subcutaneous tissue, which gives support. Examples of this include acne, rashes like chicken pox, or boils.

Stretch marks should also be mentioned as a form of scarring even though no injury occurs through the skin.  Stretch marks form in waves on the skin when it is consistently pulled too taut as can be the case when muscle building, pregnant, or during rapid weight gain. 



I'll start by stating the obvious: The best way to prevent scaring is to prevent injury to the skin. Outside of this, keeping the skin moist (with lotion) and away from the suns' UV rays (with a bandage or sunscreen) are the best options for "typical" injuries. Preventing infection with bandages and antibiotic ointment also helps. 

Regarding vitamin E, however, most of the research regarding prevention or lessening the scarring process have come up flat. A large, well-done study in 1999 took subjects post surgery with similar scars. Participants either used moisturizer with vitamin E or moisturizer without. At the end of months of use, there was no difference in the appearance of scars. In fact, 33% of those using the vitamin E lotion developed inflammation as a result. Other similar studies have duplicated these findings. Still, vitamin E use persist as a sort of urban myth.


Dermatologists and plastic surgeons offer various options in scar treatment. Dermabrasion, chemical peels, collagen injection, and laser therapy offer improvements but fall short at perfection. Treatment involving steroid inections is similarly marginal when applied to hypertrophic and keloid scars. Decent results have been seen in injecting collagen beneath atrophic scars to flatten things out.  In general, it is questionable whether surgically removing a scar will yield benefit, especially with keloids.

When to Worry

In general, a wound through the epidermis, dermis, and into the subcutaneous tissue can cause scarring. Typically, a wound bigger than one centimeter with any significant gaping should be repaired with stitches or skin glue. This repair will reduce scaring. As far as determining which is better, stitches vs. skin glue, it depends on the location, size, and risk of infection. 

In Conclusion

Scars are an undesirable consequence of injury to the skin, but simple steps can lessen the potential for severity. Unfortunately, Vitamin E has not been shown to be one of these measures. For abnormal scarring or a desire to lesson a scar's appearance, measures can be taken which most often yield marginal success.

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  • It's too bad there isn't a better solution - but in regards to stretch marks from a baby - it's all worth it!

  • I use straight Vitamin E oil (not in a lotion formula), and it did help reduce (lighten) two of my scars. So I have to disagree with the study.

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