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What is a scar?

The skin is the largest organ in the human body, with a number of remarkable abilities. Far from being a simple covering, our skin helps regulate our temperature and hydration levels, and protects us from harmful substances such as bacteria, chemicals, and radiation. The skin constantly produces new cells in its deep layer (the dermis), which then move up to the surface of the skin (the epidermis), before falling off. Because of this constant renewal of cells, the skin possesses the ability to quickly repair itself after an injury. When wounds affect only the epidermis (e.g. grazes or sunburn), this natural renewal process ensures that healing is quick and permanent scarring is highly unlikely.

Scars tend to occur with deeper wounds, and when the full thickness of the skin is affected, scarring is inevitable. This is because the normal skin cell renewal process is insufficient to cope with the injury, and the body reacts by laying down scar tissue. In the early days, this tissue is full of new blood vessels (which is why new scars are pink/ red in colour), and collagen. The collagen is initially a tangle of fibres running in all directions, but over time these fibres line up with eachother and reduce in overall bulk – think of tangled hair before and after it is combed! Combined with a gradual reduction in the number of blood vessels, this process explains why scars go from being lumpy and red to flat and white (the colour of collagen) as they mature. This whole process takes a year to eighteen months, and it is important to remember that scars usually look at their worst at about four to six months, before gradually improving.