They say every scar tells a story, but who says you have to share that story with the world? Most scars (triggered when the body's repair system produces too much of the skin tissue collagen at the wound site) will improve on their own over time, becoming lighter and more pliable. But some scars remain lifelong reminders of surgery, a bagel-slicing slip-up or, worse yet, a painful life event. "No one knows why some healing goes bad," says Tina S. Alster, M.D., a scar expert and director of the Washington Institute of Dermatologic Laser Surgery. The good news, however, is that there are an increasing number of options for diminishing the look of a scar. Here's what you need to know.
1. You don't have to live with pockmarks anymore.
Fat or collagen injections can raise these scars instantly, but the effects last only about four months (average cost: $250 per injection). For deeper indentations, the Nd:Yag laser seems to help by stimulating the formation of collagen beneath the skin, which can smooth out scars. Four to six of these treatments followed by microdermabrasion ($400-$600 for the combined treatment) are very effective, says Robert W. Weiss, M.D., professor of dermatology at Johns Hopkins University School of Medicine in Baltimore.
Dermabrasion, an older method in which skin is "sanded" down with wire brushes, is still effective, particularly on new scars (four to eight weeks old), says John Marion Yarborough Jr., M.D., a New Orleans dermatologist. But the treatment is painful, and recovery from it can take anywhere from two weeks to one month.
2. You can flatten raised scars.
Silicone sheeting and scar-reducing polyurethane dressings have been shown in studies to help prevent raised scars from forming and to flatten them once they've set in (cost: $17-$105). While these products produce the best results on newer scars, older scars also show improvement.
Experts aren't sure exactly how silicone sheeting works, but the prevailing theory is that it applies pressure to the scar, which may suppress excess collagen formation, says David Leffell, M.D., professor of dermatology at Yale University School of Medicine and author of Total Skin (Hyperion, 2000). The dressings can be used as soon as the scab falls off a wound and should be worn every day for two to four months. Want a faster fix? Try the gentle pulse-dye laser, which can flatten a raised scar in just one session (cost: from $400).
Products to try: Biodermis Epi-Derm Silicone Gel Sheeting ($28-$135; 800-EPI-DERM), Curad Scar Therapy Cosmetic Pads ($17; at drugstores), DDF Scar Management Patches ($30-$105, depending on size; ddfskin.com) or ReJuveness Pure silicone sheeting (from $20, depending on size, for one reusable sheet; 800-588-7455).
Mederma gel ($30; at drugstores) also may help reduce the appearance of raised scars. Its patented onion extract has been shown in manufacturer studies to help reduce the formation of part of the scar tissue, which is why it is most effective when used on new scars.
3. A combination of therapies works best on keloids.
There has been success in flattening keloids (knobby growths of scar tissue most common in people of Mediterranean or African descent) by first having the keloid sliced or frozen off, followed by a series of steroid injections -- one right after surgery then three follow-up shots over the next three months (cost: de-pending on the extent of the scar, $1,000-$5,000 to excise it and $250 per injection). "This combination works in 70-80 percent of patients,"says Steven G. Wallach, M.D., assistant clinical professor of plastic and reconstructive surgery at Albert Einstein College of Medicine in New York City.
4. C-section scars can be minimized.
The incision for a Cesarean section (or appendectomy) goes so deep that as it heals, scar tissue affixes directly to underlying muscle, which pulls the scar down. The fix includes snipping underneath the skin to sever the connective tissue, causing the scar to spring up. Next, fat is injected to fill the gap that results and to prevent the skin from reattaching to the muscle (cost: $600-$1,000).
5. Pigmented scars can be lightened successfully.
Applying a prescription hydroquinone-based bleaching cream once the wound has healed may work, but it can cause redness, itching, stinging and even sun sensitivity if you have skin that's easily irritated. You can also try more gentle over-the-counter lighteners like MD Formulations Vit-A-Plus Illuminating Serum ($65; mdformulations.com) with vitamin C and licorice extract, a botanical that has been proven in studies to be an effective skin lightener.
A new in-office procedure may also help. In it, tiny pieces of healthy skin are transplanted into the darkened area. The transplanted cells multiply, spreading normal pigment to the area after a few weeks, explains Leffell, who pioneered the procedure, called flip-top pigment transplantation. Talk to your dermatologist for more information.
6. You can effectively conceal a scar.
A dry concealer clings better to skin than a creamy one, says Los Angeles-based makeup pro Collier Strong. Try stick or pot formulas like L'Oréal Cover Expert Concealer ($10; at drugstores) for the face and set with a powder like Neutrogena Healthy Defense Protective Powder SPF 30 ($12; at drugstores). For large scars on the body, opt for corrective foundation like CoverBlend By Exuviance Corrective Leg & Body Makeup ($16; 800-225-9411) or Dermablend Leg and Body Cover Crème ($16.50; 877-900-6700).