A man with a scar

Skin lesions leave behind traces, sometimes very visible. A dozen or so years ago, scars had to be a souvenir for a lifetime, today medicine offers more and more methods of their treatment.

I asked a few friends if they knew what scars their loved ones had and under what circumstances they arose. It turned out that everyone had a lot to say about it! Mira’s husband has a vertical scar on his right eyebrow. In high school, he hit a burner on a table in a chemistry room. He wanted to explain something to his colleagues, nodded his head down and the cut was ready. Agata’s husband has a scar under his left knee. As a child, he wanted to impress his little sister by jumping from a tree. He fell on the broken glass and passed out. And my sister, after an unsuccessful attempt to drag him home, instead of running for help, sat with him faithfully, because she thought that otherwise her brother would “bleed out” alone, which her parents would never forgive her. Ark’s wife has a horizontal scar on her belly after a caesarean section. Arek perfectly remembers the circumstances of the scar, because it was one of the most important nights in his life. Besides, the wife has a scar on the inside of her left hand. She cut her arm, slapping it against the mirror after drinking a whole bottle of wine for the first time in her life as a sign of mourning for her lost boyfriend.

When someone asks us to describe our loved ones, scars do not even fall into the top XNUMX traits we try to characterize someone with. Nevertheless, we know the map of the injuries of the people we love. Mothers in particular remember exactly when and under what circumstances their children contracted scarring injuries, as these events were always accompanied by strong emotions. Scars set us apart from others. Some very clearly.

The secret life of the wound

When the continuity of the skin is damaged, i.e. wounded, the body begins activities that involve hundreds of chemical processes and physical phenomena until it heals. If you looked under a scab under a healing wound with a microscope, you would see how hard work is needed to repair the damage.

First, a clot is formed to act as a dressing, preventing microbes from entering and preventing fluid loss. The wound begins to clear. Neutrophils, a type of lymphocytes, monocytes (food cells that will absorb the “garbage”) and fibroblasts around the wound, are “called” to the site. The inflammatory process begins. If the wound is clean and the injured person does not suffer from diseases that could slow down the healing process, this phase should be relatively quick. The wound may be slightly red and painful to touch at this time. In clean wounds, healing occurs by the edges of the wound fusing together, which doctors call rapid growth.

Dirty wounds heal differently. Inflammation lasts longer, exudation appears. Doctors know cases of this type of wound that, without medical care, fester for months. The wound gradually fills with young connective tissue, i.e. granulation tissue.

The cleaning phase is followed by the recovery phase. The deeper layers of skin contract and the wound surface shrinks, sometimes very quickly. The granulation gradually shrinks and becomes fibrotic. It is the contraction process that causes the skin to be deformed after healing in deep or extensive wounds.

The body is able to rebuild all layers of the skin if the wound is small. After deep, extensive and contaminated wounds, visible scars appear. Their appearance and shape depends on many factors, including the type of wound, wound healing time, but also the patient’s age, genetic predisposition and the location of the scar. With time, the initially pink scars fade and take on a pearly color, because the rebuilt skin no longer contains the same amount of dye as its predecessor.

How Basia stopped smoking

In many North and South American Indian cultures, scars have been the subject of glory. The more a warrior had, the more respect he enjoyed. The remnants of wounds told the story of the warriors. It was also important whether you could interpret these silent stories. It was necessary to know whether the scar on the body was the work of a bear’s claws, a mark after an arrow or knife, or a souvenir from a fall from a horse. This made it possible to distinguish the hero from the “stupid Johnny”.

Barbara Mielcarek knows these stories because as a girl she liked to read novels about the Wild West. She wondered how anyone could find a scar beautiful. She could not get used to her own many years.

When she was 9, she and her sister decided to do something forbidden in the attic. They stole two cigarettes from my father, and from my grandfather, they stole matches and hid them behind a basket of linen. The cigarettes tasted terrible, but the adventure is fantastic. At one point they thought someone was entering the attic, so they tried to put out their cigarettes on the chipped floor. They hid by the chimney and decided to wait there so that none of the adults could smell the smoke from them. The shavings must have caught fire from the cigarette butt, then the pile of newspapers, dried bean pods, and then the linen. Instead of rushing for the adults, the girls tried to put out the fire themselves at all costs. Basia didn’t squeal even when she burned her hands. She only started screaming out loud when her clothes caught fire. The sister ran for help. Much later, Basia’s dad told her that when he took her out from under the blanket he was using to put her out, his legs buckled with horror, it looked so bad.

Barbara remembers almost nothing about her stay at the hospital. Only it hurt and she got a doll. She had second and third degree burns, almost 15% of her body in total. The worst was on the left shoulder and arms, neckline, part of the neck. She recalls that back then, as a child, she regretted her hair the most. Long curls partially burned, the rest were trimmed in the hospital. She began to worry about the scars over time.

Will it heal until the wedding?

Burn wounds are one of the most difficult to heal. It is also difficult to regenerate those with bacterial infection and ulcers. The healing process is longer in the elderly and those suffering from certain chronic diseases, such as diabetes. The quality of medical care is also important, as a badly sutured wound may heal incorrectly. Thorough cleaning, maintaining a moist wound environment and protecting it against infection promote rapid healing.

Doctors call wounds that heal within 8 weeks acute. Those that take longer to heal are called chronic. They leave visible scars, often wide, misshapen and pulled up. When treating them, a comprehensive procedure is used, affecting both the wound and the entire body, which for some reason cannot return to balance. Despite the doctors’ efforts, the wound can still leave an ugly scar.

Doctors divide scars after injuries into atrophic, i.e. soft, elastic, not protruding above the skin, and hypertrophic, i.e. thick, unsightly and growing in height. – We do not know the exact etiology of the hypertrophic scars – says Dr. Małgorzata Kot, MD, a plastic surgeon from the Nefretete Aesthetic Medicine Clinic in Łódź. – Such scars are common in children, especially after burns. Genetic factors are also involved, and there is a tendency in some families to develop this type of scarring after an injury. Most often, hypertrophic scars are formed around the collarbone, sternum and auricles.

According to Dr. Kot, the scars after the same procedure performed by the same surgeon may be very different in two patients. A person whose appendectomy has been excised may have a ‘memento’ in the form of a faint line, as long as they were operated on with mild inflammation and the wound healed within 10 days. A person operated on in an advanced disease state may have an ugly, visible scar because their wound took 2-3 months to heal.

Love the sixth finger

The burn scars were left by Barbara Mielcarek on the neckline, shoulder, neck, and a little on the left hand. In some places whitish, in others darker than her skin color, wrinkled, oversized. She remembers that her parents rubbed them with various ointments, which was supposed to improve the appearance and condition of the skin. She herself didn’t feel like it, she preferred to pretend they weren’t there. She didn’t like seeing herself in the mirror. The real emotional problem arose when she started looking for boys. Everyone in her town knew about the burn and the boys seemed to avoid her. In high school, she avoided them so as not to hear the taunts. She learned to dress in such a way as to cover scars effectively.

She met her true love, Rafał at work. She explained shyness in physical contact with deep faith. “I was ashamed to admit my scars, avoided the subject,” she recalls. – I preferred to lie that I do not agree to caresses as a believer. Rafał seemed to accept it, but I knew that my otherness cannot be hidden forever. When I told him about the scars after a dozen or so weeks, he responded with a smile. I wanted to run away then.

It turned out that Barbara’s fears turned out to be unnecessary. The boy was smiling because it was difficult for him to understand why she attached so much importance to physical imperfections. “He asked me if I would love him if he had three kidneys,” says Barbara. – Would I leave him knowing he has 6 toes? I understood where it was going. He was interested in me, not the map of my burns. Despite the acceptance, it still took me a long time to show myself without a blouse without shame.

As an adult, Barbara learned that scars could be made less visible. She wondered if this was the solution for her.

With a scar to the surgeon or beautician

A scar does not have to be a memento for life. While there is no effective method to completely remove scars so far, it can be made less visible. The younger she gets, the easier her appearance will improve. – Scars that are several years old, especially hypertrophic ones, are the most difficult to heal – says Dr. Małgorzata Kot. – It is also more difficult to heal a scar that has been neglected by the patient. Scars do not have sebaceous and sweat glands, so they are dry and flaky. The basic care is greasing throughout life, you can use ordinary ointments containing vitamins A and E. The best treatment results are obtained in the case of young scars, ie not more than 6 months.

Trauma residues can be treated with a number of methods. The most common types of treatment are: surgical treatment, laser therapy, cryotherapy, injections of medicaments, scrubs, microdermabrasion, as well as conservative treatment: ointments, massages, rehabilitation. All of them should be prescribed and guided by a doctor.

• Cryotherapy: deep freezing of the scar, most often with the use of liquid nitrogen. Temperature from -85 to -190oC destroys blood vessels, causing hypoxia and ischemia of the scar tissues. The freezing process, which lasts several seconds, must be carried out in several rounds. The improvement in the appearance of the scar is noted in about 60% of patients. Side effects include long healing, the possibility of discoloration and pain. It is used to treat small scars.

• Pressotherapy: the application of chronic and local pressure on the scar, which causes tissue hypoxia, slows down metabolism and reduces collagen production. For several months, the patient wears compression clothes or accessories for several hours a day. In this way, hypertrophic scars and keloids are mainly treated.

• Radiotherapy: a method rarely used in Poland and considered controversial by doctors. It consists in irradiating the scar with rays, often carried out in conjunction with surgical treatment. Irradiation damages the fibroblasts and is expected to break down collagen better. Opponents of this method indicate that it may increase the risk of skin cancer, and advocates recommend it for the treatment of scars that have not been improved by other methods.

• Laser therapy: according to some doctors, the method with the greatest future in the treatment of scars. It has been experimented with for over 20 years, and newer and newer types have been used for treatment. Using a laser can reduce the scar and improve its elasticity. However, some publications question the effectiveness of the method and emphasize that it still requires a lot of testing.

• Steroid therapy: used for 50 years and pharmacological method still being modernized. It consists in local administration of the drug by injection. This makes the scar softer, more flexible and less visible as it “falls” to the level of the skin. Compared to others, it is very effective, but like any other method, it has possible and quite frequent side effects. These include, among others: local atrophy or weakening of the skin, discoloration, growth of blood vessels and a reduction in the rate of wound healing. Risk of scar recurrence? 10% to 50%. Results are generally better when used in conjunction with other approaches, such as surgery or cryotherapy.

• Surgical treatment: consists of excising the lesion. The effectiveness, especially without combination with other methods, is considered to be negligible and with a high risk of scar recurrence.

Treatment of scars resulting from accidents and surgery is reimbursed by the National Health Fund, but not all methods. We will have to pay from our own pocket, for example, for laser therapy, microdermabrasion or peels. Early surgical treatment is always used when, as a result of injuries, scar contractures are formed that cover not only the skin, but also the adjacent muscles and tendons. This can restrict movement in the joints, and sometimes lead to soreness and cracking of the epidermis, so treatment is started quickly enough to restore normal body functions as fully as possible.

According to doctors, it is enough to lubricate the atrophic scars for medical reasons. For the sake of aesthetics, you can try cosmetic treatments. This is what 22-year-old Daniel from Elbląg did. He prefers not to reveal his name, because although he is pleased with the effect, he believes that a visit to a beauty salon is not something a guy should brag about.

Treatments for him

Daniel has had acne problems for several years. Whoever missed it, this may underestimate the problem, but for a boy entering life, a face strewn with pimples may equal civil death, he says. With time, the skin became healthier and prettier (the boy probably tried all the products available on the market), but the acne left ugly marks on the face. His sister, who knows all the news in this matter, persuaded him to visit a beautician. So that no one would see him, he decided to have a salon in a neighboring town.

In total, he underwent eight diamond dermabrasion treatments. It is a method of mechanical exfoliation of the epidermis, which stimulates the production of collagen and elastin. There were two-week breaks between treatments, so the whole process took several months, but Daniel thinks it was worth being patient. The acne scars aren’t gone for good, but they’re less visible. “I recommend it to those who are wondering if rubbing will do anything,” he wrote on the forum for those who want to improve their beauty. – The treatment brings the same results for men and women. Gentlemen, you don’t have to look like Tommy Lee Jones! Scars do not add charm to everyone, so ask your girlfriends or sisters what they recommend to you. “

On the forum, Daniel openly admitted to fighting scars in a beauty salon, because he did not have to reveal his identity on the Internet. He tells his colleagues from work that his skin “itself” has looked prettier. She explains that “in our culture, a man who attaches importance to beauty may encounter unpleasant comments.” He urges you to be open on this issue, but would like someone else to start a discussion on this issue.

Balm for… a scar

It is not easy to find publications on the old methods of scar treatment. This is due to the fact that several dozen (let alone a few hundred!) Years ago, the belief that saving a patient’s life or health would be enough was dominant. Scars were treated as a necessary evil to which the patient had to get used to. The only reports of treating scars from more than half a century ago relate to topical plant extracts. Applying ointments and mash is one of the oldest methods of improving the appearance and condition of scars. In the past, “healing” of souvenirs after injuries was the domain of witches and herbalists. Currently, pharmacies offer many creams, ointments and gels prepared using natural and synthetic ingredients. They may include, among others:

• onion extract, chamomile or calendula accelerating granulation and having an anti-inflammatory effect;

• allantoin that accelerates the healing and regeneration of the skin. Additionally, this substance has an astringent and anti-inflammatory effect;

• heparin with an anticoagulant effect. The substance also improves skin hydration and relaxes the collagen structures;

• arnica having anti-edema, anticoagulant, and additionally bactericidal and fungicidal properties. The active substances of the mountain arnica strengthen the capillaries and accelerate the reabsorption of the exudate fluid;

• phytoestrogens that stimulate the skin’s ability to regenerate and improve the tone of collagen fibers.

The combination of the action of various ingredients can make the scar more elastic, flattened or make it pale, but it must be remembered that sometimes this effect is visible only during the use of the preparation and disappears over time after its discontinuation. The prices of cosmetics useful in the treatment of scars range from a dozen to even several hundred zlotys. From time to time, new products appear on the market. These can be ointments or creams containing, for example, snail mucus, mother-of-pearl or Asian plant extract. Before buying (especially expensive), it makes sense to consult your doctor or, if possible, ask for a free sample first.

Most preparations should be used for at least several months. They have not been reported to be effective in the treatment of keloids. It is worth remembering that a preparation recommended by someone as effective may turn out to be useless for us. Ask an expert with the question about the most effective drug and be prepared for the fact that it may take time to find a specific product suitable for your type of scar and skin. Doctors emphasize that there is no miracle ointment that will make scars completely invisible. If someone tempts us with a preparation designed to “remove” the trace of the injury, it is a sign that we are dealing with an unreliable offer.

The soul heals

In the case of Barbara Mielcarek, scar removal turned out to be problematic. In the plastic surgery office, she was offered several methods, but it was warned that the effects would not be visible and might not satisfy her. She resigned. “I realized it wasn’t that important,” he explains. – The most important thing is that the soul has healed. My daughter doesn’t care if my cleavage is ugly. Why should I care? If something cannot be changed, you have to accept it. A scar is not a shame, even if it was just a lack of reason that caused the injury. Sometimes wanting to remove it is like wanting to go back in time. It takes maturity to realize that this is impossible. Even its elimination would not have erased the accident from memory. And if unpleasant memories have already faded away, it makes no sense to undergo arduous treatments – comments Barbara.

Doctors, however, persuade patients with ugly scars to treat them. Scars are not only an aesthetic and emotional problem, medical considerations are often at stake as well. The consequence of tissue scarring may be, depending on the site, e.g. intestinal obstruction, erectile dysfunction, infertility and pain. All inconveniences related to the healing of the wound and the resulting scar should be reported to the doctor. Due to the advancement of medicine, doctors can propose a method for almost every scar. Hypertrophic scars can be reduced, e.g. by using a compression method, others can be made more flexible by injecting steroids into them. In some cases, it may be effective to remove the unsightly scar so that proper stitching and treatment create a new, less visible one. Skin grafts are also used. However, decisions about surgical intervention must always be discussed with the doctor so that the patient is aware of the advantages and disadvantages of such a solution.

If the scar is small and not a medical problem, caring for it can not only improve the appearance but also help you accept it. The worst thing you can do is pretend the scar is gone. You lose then not only a fascinating story to tell your loved ones.

Do you know that

A handsome man with a scar

If French football star Franck Ribéry ever met one of the best snooker players in the world, Ken Doherty, from Ireland, they would probably find a common topic to talk to. In childhood, they both had accidents – a Frenchman fell through the windshield of a car in a collision, and the Irishman fell from the roof onto a metal garbage can. For both, it ended up with serious facial injuries and visible scars. Both the footballer and the snooker today can afford visits to the best private plastic surgery clinics where they could get rid of scars, but neither has the slightest intention of changing anything in their appearance. They both say that they cannot imagine their faces without scars, and they do not consider skin imperfections as a disgraceful or disfiguring thing. The French even stated in one of the interviews that the scar makes him extremely interesting for women and that he owes her many pleasant moments in the company of women.

This is interesting

A scar like jewelry

Black people are ten times more likely to develop overgrown scars than white people. Some African communities have made this an advantage. These scars testify to their status, age and experience. Patterns are made of scars, forming intricate ornaments. However, to get “nice” scars, you need to inflict a deep wound. In 2000, the American Museum of Natural History hosted an exhibition on ancient and modern methods of invasive scarring of the body. When asked why people are ready to inflict pain on themselves, the curator replied: “To be human. For beauty, as a sign of change, rebellion or belonging to a group, to emphasize the importance of your gender or a deeper connection with your ancestors. “

Important discovery

When the wound does not scar

There are more and more surgeries around the world on patients who are… not yet born. Such treatments very rarely leave traces in the form of scars. By 24 weeks of fetal life, wounds heal without scarring. We do not know the exact mechanisms behind this phenomenon, but scientists around the world are closely watching it, looking for more effective methods of treating wounds in adults. It is suspected that the loose structure of the fetal extracellular substance, which allows free migration of cells to the wound environment, plays a significant role. According to scientists, the human fetus not so much repairs a wounded area as can rebuild it. We just don’t know why it loses this ability with the passage of time, because it would be useful to all of us.

Text: Sylwia Skorstad, Let’s Live Longer