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How to Prevent Scarring (health.clevelandclinic.org)

From kitchen mishaps to skinned knees to surgical incisions, we all have scars with stories behind them — but most of us would rather our wounds heal without reminders of misfortunes past.

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We talked to dermatologist Shilpi Khetarpal, MD, to find out what causes scarring and how to prevent a cut from turning into a scar.

What is a scar?

Scars come from the tearing of the dermis, our lower level of skin, which is rich in collagen — the elastic fibers that keep our skin springy (among other bodily benefits). Scarring can happen after any injury to the dermis.

“Think of our normal collagen like a basket weave, very nice and even,” Dr. Khetarpal explains. “When we get a scar or injury to our skin, it triggers a wound-healing response that can create just enough collagen, not quite enough, or a little bit extra. It’s always going to be different than the initial skin you had in that area.”

Our bodies lose collagen as we age, which means elderly people are more prone to scarring than children. And whether a wound is likely to scar may depend on what part of your body you’ve injured — and how much blood is circulating to it.

“Your face and scalp tend to heal the fastest because we have the most circulation there,” Dr. Khetarpal says, “but a cut on your foot, where circulation isn’t as good, could take weeks to heal.”

Types of scars

Ideal scarring is minimal and light, but scars can take a variety of forms:

  • Atrophic scars: These indented scars, as from acne or chickenpox, happen when the skin can’t regenerate enough collagen to replace the original tissue.
  • Hypertrophic scars: These scars are thick, raised and often reddish, appearing within the bounds of the original injury.
  • Keloid scars: Keloid scars are thick, raised scars that extend beyond the original injury; they’re created when the skin makes too much collagen in trying to repair itself. Some people are genetically predisposed to keloid scars, and they’re more common among Black people than other populations.

The best way to prevent scarring

You’ve cut yourself. Now what? “We want to minimize inflammation or further trauma to the skin,” Dr. Khetarpal says. Here’s how to lessen your chances of scarring:

  • Clean the wound. As soon as you’re injured, clean the affected area with soap and water to get rid of any bacteria and prevent infection.
  • Keep it moist and covered. You might’ve grown up learning to keep cuts dry, but the opposite is true. “Keeping it moist is best to prevent a scar,” Dr. Khetarpal says. Use petroleum jelly on your wound, and bandage it up to let it heal.
  • Avoid bacitracin. Resist the temptation to apply topical ointment, as 8% of people are actually allergic to it — which can further inflame the area and increase the likelihood of scarring.
  • Minimize movement. “Every time the scar moves, it’s going to alter the formation for a wider or thicker scar,” Dr. Khetarapal says. Give your wound time to heal by not overexerting the injured area.
  • Leave those scabs alone: Scabs are our skin’s natural bandages, so keep your fingers off of them and let them do their thing. Picking will only prolong your injury and keep it from healing. Think you’re picking at scabs in your sleep? Purchase a pair of cotton gloves to wear to bed.

In summary, Dr. Khetarapal says, “The bottom line is don’t let it crust up, keep it moist, keep it clean, keep it covered, and minimize tension.”

Do scar prevention creams work?

Silicone scar sheets might help improve prevent new scars, but only if you use them in the first few weeks after an injury. And there’s no need to apply special, designated creams to your scars, either, Dr. Khetarpal says.

Instead, it’s the act of massaging that cream — or any simple, bland moisturizer — into a scarred area that can have the most impact on healing.

“In the first year, it’s important and has been shown to be helpful to do a gentle massage on your scar for a few minutes a day,” she says. “It helps break up any scar tissue for ones that are getting thick.”  

The full scar remodeling process takes a year, during which time your scar may go through different phases of appearance: redder or darker, thicker or more textured. But once you hit the one-year mark, your scar is unlikely to change much on its own. 

“After you’re beyond the one-year phase, topical medicines aren’t going to do anything,” Dr. Khetarpal warns.

Seek early intervention

In the past, you might’ve been told to let a wound heal for a year and then seek medical intervention if you’re not happy with the result. But Dr. Khetarapal says that guidance has changed; now, doctors can influence a scar’s healing by getting involved sooner rather than later.

“If someone is concerned with a scar — say, they’ve had surgery or a major trauma — the earlier we intervene, the better,” she says. “We can actually influence how a scar heals versus waiting for it to heal and then trying to make it better.”

You can explore scar-minimization options as early as a week after your injury (or as soon as your stitches are removed, if you have them). In-office procedures such as lasering and microneedling — which trigger a controlled wound response — can reduce the appearance of scars by 50-60%.

“We can’t erase it, but we can improve it,” Dr. Khetarpal says.

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