Scarring: Why It Happens and What It Means

Scarring

Scars are the skin’s natural way of healing after an injury, breakout, or surgery. While they’re common, the texture and appearance can vary—flat, raised, or indented—depending on how your skin repairs itself.

When Skin Doesn’t Heal Smoothly

Scarring is more than a mark on the surface—it’s a reminder of how the skin responded under stress. For many, scars carry frustration or self-consciousness, especially when they linger long after the wound has healed.

Notice uneven texture after acne breakouts, surgeries, or skin picking
Struggle with raised or thickened scars that don’t fade
Feel frustrated by marks—whether from acne, transition-related surgery, or medical procedures—that impact confidence in appearance

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Understanding What Causes Skin Scarring

What It Is

Scarring occurs when the body repairs damage to the skin by producing collagen fibers. Depending on how much collagen is made—and how it’s arranged—the result can be flat, raised, or indented scars.

How does the Skin Heal After Injury or Surgery?

“The wound healing process consists of 4 overlapping phases—hemostasis, inflammation, proliferation, and remodeling… The proliferative phase mainly involves keratinocyte migration, cellular proliferation, and the formation of new blood vessels… The maturational or remodeling phase starts around week 3 and can last up to 12 months. The excess collagen degrades… The maximal tensile strength of the incision wound occurs after about 11 to 14 weeks, but the ultimate scar will only have about 80% of the original strength.” – StatPearls, NIH

If collagen production is excessive or unbalanced, scarring becomes more visible.

Surgical wounds, including those from procedures like chest or gender-affirming surgery, often heal with prominent lines or raised scar tissue that can evolve differently depending on genetics, location, and aftercare.

Different Types of Scars and Their Patterns

Scars don’t all look the same:

Atrophic scars – Sunken or pitted scars, often from acne or chickenpox, caused by collagen loss. Also known as acne scars or post-acne scarring.
Hypertrophic scars – Raised, thickened scars that remain within the wound boundary.
Keloids – Overgrown scars that spread beyond the original wound site, sometimes seen after surgery or piercings.
Stretch marks – Linear scars formed when skin stretches too quickly for its elasticity.
Surgical scars – Linear scars that form after medical or elective procedures. These may flatten and fade, remain raised, or widen depending on how the skin heals.

Common Causes of Scarring

Cause	How Scars Form	Typical Scar Types
Acne breakouts	Inflammation damages follicles, leading to collagen breakdown or overproduction.	Atrophic (pitted), hypertrophic
Surgical procedures	Incisions trigger collagen repair; scar appearance varies by genetics, care, and tension on the wound.	Linear, hypertrophic, keloid
Injuries & cuts	Trauma to skin heals with new collagen fibers that may not align smoothly.	Hypertrophic, keloid, flat
Skin picking or scratching	Repeated injury disrupts healing and increases risk of noticeable marks.	Atrophic, hypertrophic
Rapid skin stretching	Skin tears at the dermis level as collagen fibers can’t keep up with tension.	Stretch marks (striae)
Burns	Heat damages multiple skin layers, producing thick, raised, or irregular scars.	Hypertrophic, keloid

Why It Matters for Skin Health

Scars are a natural part of healing but can affect self-confidence and comfort. Identifying the type of scar helps guide choices about care and whether treatment is needed for texture, appearance, or sensitivity.

Quick Summary:

Scars form through collagen response during healing.
The amount and arrangement of collagen determine scar type.
Scars can result from acne, injury, surgery, or rapid stretching.
Understanding your scar type informs long-term skin decisions and care.

Clinically Supported Skin Solutions

Why Scientific Support Matters

Scars can feel permanent, but modern research shows the skin is capable of remarkable repair. Clinical studies provide peace of mind by proving which treatments truly rebuild collagen and improve scar appearance safely.

Evidence-Based Results with Microneedling

A randomized controlled trial found that three microneedling sessions reduced the severity of acne scars by 41% on average at six months, with patients reporting smoother texture and minimal discomfort. Additional studies confirm up to 60% improvement in rolling and boxcar scars, especially when paired with combination therapy.

Backed by Laser and Energy-Based Therapies

Cold laser treatments and RF microneedling demonstrate powerful scar remodeling effects. Research highlights that laser therapy reduces scar thickness and improves pliability in keloids and surgical scars, while RF microneedling delivers superior outcomes compared to needling alone.

These findings make energy-based approaches valuable in clinical scar care.

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Scarring Questions, Answered

Finding answers about scars can feel confusing. Here, we break down common concerns in plain language so you’ll know what’s normal, what lasts, and what options exist for improvement.

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Are scars permanent?

Most scars are long-lasting, but their appearance often changes over time. Many fade, flatten, or soften naturally within months or years. Treatments like microneedling, lasers, and chemical peels can reduce visibility, though completely erasing a scar is uncommon. The goal is noticeable improvement in texture, color, and confidence.

What are the three types of scars?

Scars generally fall into three main categories: atrophic scars (depressed, often from acne or chickenpox), hypertrophic scars (raised but limited to the wound area), and keloid scars (raised and spreading beyond the original injury). Each reflects how your body produces and organizes collagen during the healing process.

Which scars never go away?

Keloids rarely resolve on their own, as they result from overactive collagen production that extends beyond the injury site. While treatments can flatten or lighten them, complete removal is challenging. Other scars, like stretch marks or deep atrophic scars, may persist but respond well to clinical therapies for visible improvement.