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What is a scar?

Scars are areas of fibrous tissue that replace normal skin after an injury (fibrosis); these result from the biological process of wound repair.
A scar is a permanent mark left on the skin after wound healing. This may be because of an injury, accident, surgery, or a burn. Scars are produced as a part of the body’s defence and healing process.

How do scars heal?

The skin is held together by a glue-like substance called fibrin; the edges of the cut and the gaps between the edges come together to form a scar. The wider the cut, the wider the scar.

Types of scars

These include:

  • Flat pale scars - these are the most common type of scar
  • Hypertrophic - red raised scars that can remain in status for several years whilst maturing
  • Keloid - caused by the production of excess scar tissue at the site of the wound; they can increase in size even after it has healed
  • Pitted scars (atrophic) - have a sunken appearance, e.g., pock marks / acne scarring
  • Contracture scars - usually caused by skin shrinking and tightening, e.g., after a burn. These can reduce function and restrict movement.
  • Unstable scars - are larger wounds that heal over creases but may take longer to heal.  These scars can be easily injured and reopen; this cycle can repeat itself several times without healing. The defect will require durable skin closure such as a skin graft or flap.

Abnormal scars – Keloid and hypertrophic scars (raised)

Keloids are large, bulky, raised scars that develop at the site of any operation or injury; they can be unsightly and grow over time. These can be present anywhere in the body, but the most common sites are ears, neck, shoulder and back.
People of Asian and African descent are more likely to develop these compared to their Caucasian counterparts. Evidence suggests this may have something to do with the increased melanin produced by darker skin. Keloid scarring can be inherited.

Factors that affect wound healing

  • smoking - non-smokers on average heal more quickly.  Smoking has been proven to affect wound healing due to the absorption of nicotine, which reduces blood flow to the area and therefore supplies less oxygen to the tissues.
  • age - younger people heal more easily than older people, however scars in older people fade more rapidly.
  • illnesses such as diabetes, high blood pressure and poor circulation can decrease the body’s ability to heal
  • nutrition - studies show that the body needs certain minerals like zinc, vitamin C, iron, protein, and adequate calories to aid effective healing
  • skin quality and blood supply to the area - for example, skin that has already been thinned and stretched increases the risk of raised, wide, or irregular scars.
  • pregnancy - imbalanced hormones may produce more scar tissue; once eostrogen levels fall after birth, the scar tissue may reduce and fade.

How long will it take my scar to heal?

Scars can take anything up to 18 months (about 1 and a half years) – 2 years to mature; they may change in colour and appearance as they heal. 

Scar treatments

  • Dressings - silicone treatments such as gels and sheets
  • Steroids - these can help soften and flatten hypertrophic and keloid scars
  • Vitamins - E and C can help fade dark scars
  • Surgery - scar revision is  usually done 12-18 months after the first injury
  • Chemical peels - these destroy the epidermal (superficial top layer of the skin).which lead to increased exfoliation (dry shedding) skin
  • Dermabrasion - removal of the surface skin with a special machine, can be deep or superficial
  • Laser treatments - this therapy smooths the epidermis (top layer of skin)
  • Radiotherapy - low dose therapies can be used to prevent recurrence of keloids

Sun and scars

  • Scars are more prone to damage from sunlight than normal skin
  • Avoid exposing your scar to direct sunlight for the first 12-18 months (about 1 and a half years)
  • Use a strong sun block, i.e., SPF 30-50, recommended by dermatologists
  • If scars are allowed to tan, they may fade to leave a mottled and patchy appearance
  • Scars often itch under sunlight

Scars and skin creams

Gently massage the dry area 2-3 times a day.
Creams suggested and used by patients to improve scars:
•    Vitamin E cream 
•    E45
•    Bio–oil
•    Any sun protection cream or oil with a high SPF barrier (30+)

Staff at your local pharmacy may be able to advise you on suitable products.

Make-up for scars

Cosmetic camouflage can help cover up scars, some waterproof make-up stays in place for 24 – 48 hours (about 2 days). Ask your GP (General Practitioner) or pharmacist for advice.

There are various charities and organizations that offer free advice. You can search for these online

For further advice, please contact the lead nurse on 0300 615 3031

Contact us

If you have any queries relating to this information, please contact the Plastic surgery service.

About this information

Service:
Plastic surgery

Reference:
T/027

Approval date:
19 February 2026

Review date:
1 February 2029

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Important note 

This page provides general information only. It is developed by clinical staff and is reviewed regularly every 3 years for accuracy. For personal advice about your health, or if you have any concerns, please speak to your doctor.