You can get rid of scars! Here, doctors reveal the treatments that really work - and the ones that don't
Giving a rare insight into her personal life last week, Princess Eugenie opened up on social media about her experience with scoliosis and why she was 'proud' of the scar she acquired after surgery to treat the condition, which causes the spine to twist and curve to one side.
In a post to mark International Scoliosis Day, she wrote: 'My mum caught my scoliosis early and I was lucky enough to get the help I needed at 12 years old.
'I thank her so much for that, and also thank her for the confidence to be proud of my scar.'
More than 20 million people in the UK have a scar — and nearly a quarter of people living with scars said they have caused emotional or physical problems, according to The Scar Free Foundation.
Scars are formed when the deeper layer of skin, known as the dermis, is damaged — the dermis contains collagen, a protein, and connective tissue. The dermis activates a repair response that leads to collagen being produced. (Shallow nicks don't scar because the top layer of skin, the epidermis, doesn't contain collagen.)
Princess Eugenie thanked her mother Sarah Ferguson 'for the confidence to be proud of my scar'
Normally, collagen fibres are laid down in a neat, criss-cross pattern, but sometimes the repair process goes haywire, producing too much collagen, which leads to big bundles of the protein being laid down incorrectly, causing scars.
The two most common types of scar are hypertrophic and keloid.
Hypertrophic scars — common after surgery, acne or burns — stay within the confines of the wound site, but can also be slightly raised, hard and red.
Keloid scars develop when collagen spills out beyond the injury site, creating large, lumpy scars that can grow. They're more common in darker skin, and tend to form on the chest, shoulder and back. As well as looking unsightly, they can cause discomfort or pain if surrounding tissue cannot flex.
Paul Martin, a professor of cell biology at Bristol University, says: 'A scar happens wherever tissue is damaged and where the missing tissue is replaced via the process of the wound healing.
'We think an excessive immune system and inflammatory response are involved, too.
'These are activated after the skin's barrier layer has been breached by a wound — and this leads to vast numbers of white blood cells coming into the wound to kill off any bugs that might have found their way into the body.
'As part of this process, signals are sent to other cells known as wound fibroblasts, which lay down too much collagen.'
This partly explains why the older we get, the less we scar — because our immune system response is dampened down as we age.
Keloid scars in particular form when excess collagen is produced. 'Another driver of scarring is what we call mechanical tension, where the edges of the wound tend to be dragged apart.
'This mechanical tension differs according to the depth of the wound and where it is on the body,' adds Professor Martin. 'For example, if you have a surgical incision extending the length of your chest, the scar will be thickest in those regions of the wound where the tension is greatest, so about level with the breastbone.'
The Scar Free Foundation Programme of Wound Healing Research, based at Bristol University and led by Professor Martin, is investigating the reasons why we all scar differently.
Their research could in future help doctors identify those people at risk of serious scarring, using blood tests to look for specific genes, for example, as well as to develop better treatments to make scars disappear.
The standard treatment in clinics includes silicone gel, which is thought to help the skin retain moisture and boost healing. Another option is steroid creams or injections, which break down the collagen bundles. Lasers are widely used, too.
There are also at-home products that promise to heal scars. We asked experts to examine five of the newest on the market — which we then rated.
SCAR SERUM
Boots Scar Reduction Serum, 50ml, £8.30, boots.com
This serum 'is only likely to help with the darkening of the skin due to the overproduction of melanin, rather than other aspects of scarring'
CLAIM: The maker says this serum, containing the antioxidant sodium ascorbyl phosphate, is suitable for all scars and has been 'tested extensively'.
It reduces the appearance of scars in 12 weeks. Massage a small amount into the area twice daily.
EXPERT VERDICT: Scars can vary in appearance, from atrophic (sunken), pitted, raised or hypertrophic scars to keloid ones, says Dr Archana Rao, a consultant dermatologist at Kingston Hospital NHS Trust in Surrey. 'I'm doubtful that a single serum can help with all scar types. Sodium ascobyl phosphate is a form of vitamin C and works by inhibiting an enzyme called tyrosinase, which is essential for the production of melanin [pigment] in our bodies.
'So this serum is only likely to help with hyperpigmentation [the darkening of the skin due to the overproduction of melanin] rather than other aspects of scarring,' she adds.
'For a thick scar, I'm not sure it would do anything really.' 3/10
SILICONE STRIPS
Scar Erase, three 15cm strips, £28, amazon.co.uk
The strips work by 'creating a protective barrier over the scarred area' to keep it hydrated
They can then be peeled off to leave a less visible scar, say the makers
CLAIM: These reusable silicone scar strips are 'recommended by surgeons' to treat hypertrophic, keloid, old and new scars, says the maker, including 'those caused by surgery, injury, acne or any other skin trauma'.
They work by 'creating a protective barrier over the scarred area' to keep it hydrated. Wear for 12 hours a day for 12 weeks on a fresh scar; four months or longer for an existing scar.
EXPERT VERDICT: 'Silicone is thought to create a protective layer on the surface of a scar, preventing moisture loss,' says Dr Hazim Sadideen, a consultant plastic surgeon at the Cadogan Clinic in London.
'This helps modulate the collagen and prevent the accumulation of haphazard collagen, so making the scar flatter and less visible. It can be effective at preventing scarring — but to get the most benefit, you'd need to apply them for 23 hours a day. Studies show silicone is less effective in flattening keloid or long-established hypertrophic scars — where other treatments may also be needed.' 8/10
MASSAGER
ScarGone Massager, £24.99, stress-nomore.co.uk
Massaging a scar with products such as ScarGone is thought to increase blood flow and make the scar more pliable
CLAIM: This battery-powered, handheld device — the size of a roll-on deodorant — claims to help improve the colour and texture of scars. It works by massaging the affected area at 5,500 vibrating cycles per minute to help 'restore motion, strength and mobility to injured tissue', while 'diminishing the texture and tone of both new and old scars'.
EXPERT VERDICT: 'Massaging a scar is thought to increase blood flow and make the scar more pliable — but the evidence for its efficacy is more anecdotal than actually seen in clinical studies,' says Dr Rao.
'Certainly, how and where you massage is important: you should only start once the wound has completely healed. If you do it too early there's a chance the wound can split open, which could lead to infection.
'There's a theoretical concern that a massage tool may be too aggressive, so we need to study this device more. Personally, I'd tell my patients to gently massage a scar with their fingers and a simple moisturiser, for ten minutes twice a day, instead.' 5/10
GEL SPRAY
Kelo-Cote Gel Spray, 100ml, £50.59, amazon.co.uk
A study by the maker showed the spray improves the appearance of existing hypertrophic and keloid scars in 82 per cent of patients, it claims
CLAIM: Spray this silicone-based product over a scar and within five minutes it forms a hard, clear waterproof layer that lasts 12 hours. Its maker says it can treat 'large, hard to reach or sensitive to touch scars'. Use for 60 to 90 days, or longer for older scars. A study by the maker showed the spray improves the appearance of existing hypertrophic and keloid scars in 82 per cent of patients, it claims.
EXPERT VERDICT: 'This silicone spray should theoretically work in the same way as gels or sheets — but could cover a larger area,' says Dr Rao. 'I see the appeal of using it for hard to reach scars — but personally I'd still use sheets where possible, because they also provide pressure to the scar which can help flatten it. There has not been proper scientific study with the spray yet.' 7/10
ROSEHIP OIL
Balmonds Rosehip Scar Oil, 50ml, £18.99, balmonds.co.uk
'Moisturisation is key to any scar healing as it helps improve the skin barrier and stops dryness which can lead to inflammation,' says Dr Sadideen
CLAIM: Rich in vitamins A and C and rosehip oil, this is said to 'improve the appearance of scars, stretch marks and uneven skin tone'. Gently rub a few drops into the affected area, morning and night, for six weeks once scabs have healed, or on older scars.
EXPERT VERDICT: 'Moisturisation is key to any scar healing as it helps improve the skin barrier and stops dryness which can lead to inflammation,' says Dr Sadideen. 'There have been a few small studies into rosehip oil for scars — one in particular suggested it might reduce skin redness and decolourisation, but it only examined 108 patients.
'We need more data on how effective it is, particularly for more complex or older scars, but it seems safe and should do no harm. It could be worth trying as a general moisturiser to massage into a scar.' 5/10
