Whether it’s a small scar from acne or a larger keloid that forms after surgery, any time we have an injury to the skin, it will result in a scar. While scars are a natural part of the healing process, treating them can be difficult. Often those scars can make us feel self-conscious, particularly for individuals with darker complexions. Nevertheless, there are dermatologist-approved options available for scar revision that are effective and tailored specifically for people with more melanated skin tones.
Scars and Skin Tone
Before delving into treatment options for scar revision, it’s essential to understand how scars form and how they can affect people with darker skin tones. “Whenever we violate the skin, there’s some sort of scar,” says New York dermatologist Michelle Henry, MD. “With true scars, you should see a line or distinction in the area where the skin was cut or injured.” And not all scars are the same. “You could have standard linear scars that are flat or hypertrophic scars that become thick, just on the line of the scar.” When it comes to acne, these scars take on different shapes. “Common acne scars can include depressed atrophic scars, angular boxcar scars, rolling scars, and ice pick scars which look like an ice pick was taken to the skin.”
While scars can appear on all skin tones, individuals with more melanin are more susceptible to certain types of scars. People with darker skin are more prone to forming raised, thickened scars called keloids. “Keloids can appear anywhere from the earlobe to the chest, back, shoulders, and even the legs,” Montclair, NJ, dermatologist Jeanine Downie, MD. “These are thick scars; my patients say they look like little earthworms under the skin.” They are caused by trauma to the skin. “They may form after procedures such as C-sections, tummy tucks, and breast implants.”
Why individuals with deeper skin tones are more susceptible to developing elevated keloid scars that extend beyond the wound’s original boundaries has to do with a few factors. “Darker skin tones have more fibroblasts, which are the cells responsible for producing collagen,” says Dr. Henry. Collagen is the protein responsible for giving the skin its elasticity. “Melanin provides protection against photodamage, and collagen helps maintain the skin’s elasticity; this is why we often see that darker skin tones tend to age better.” The issue with scarring arises when fibroblasts work overtime. “A consequence of having more fibroblasts is that they can become overstimulated, leading to the formation of keloids,” explains Dr. Henry.
Treatments Options for Scar Revision
When it comes to treating scars, a variety of dermatologist-approved options are available to help revise the look of scars. However, no treatment is one-size-fits-all; the right treatment plan will be personalized for your specific needs and goals. All treatments, including in-office treatments, will require patience. “Scars can be really depressing and upsetting for anybody that has them anywhere on their face, neck, or their body,” says Dr. Downie. Some non-invasive treatments include silicone sheets, laser therapy, and topical creams. Invasive treatments include injectable treatments, microneedling, chemical peels, and surgery. Also, no matter what treatments are getting, don’t forget the importance of using sunblock to protect the skin. “Use SPF 30 daily and remember to reapply,” says Dr. Downie.
Silicone sheets help to flatten and soften the scar tissue. “While this can help after surgery to decrease possible scars, many times I recommend somebody come back post-surgery two weeks later to follow up and see if they are going to need intervention with lasers,” explains Dr. Downie.
In-office laser therapy targets the pigmented cells in the scar tissue and breaks them down. “A light pulsed dye laser helps to get rid of the red and the scar,” explains Dr. Henry. Microneedling is another effective treatment for scar revision on melanated skin tones. “This helps to stimulate collagen in atrophic scars and blur the sharp edges,” says Dr. Henry. This treatment creates micro-injuries in the skin, triggering the body’s natural healing process and promoting collagen production. In addition to using the Fraxel laser, I also use Intracel RF microneedling and chemical peels to treat acne scars,” says Dr. Downie.
“Sometimes, we use steroid injections, use varying concentrations of steroids to help the thick flat scar and keloidal scars,” explains Dr. Henry.
In some cases, more invasive treatment is necessary. “If less invasive treatments aren’t effective, sometimes we have to excise the scar.” This applies when scars are so bad they need to be surgically cut out. “After this procedure, we can start all over again. All-wound care instructions and post-laser instructions from your doctor should be followed exactly by the patient,” explains Dr. Downie.
Choosing a Qualified Dermatologist
Just like any other medical treatment, finding the right provider is key. “It is important to choose a board-certified dermatologist or a plastic surgeon with experience treating darker skin tones for scar revision,” says Dr. Downie. Before starting any treatment, consult your dermatologist about their experience working with people with your skin tone and ask to see before and after photos. “It’s absolutely critical; scar revision treatments can still be high-risk procedures even in the best hands. And so anyone with insufficient training could really make a bad situation worse,” explains Dr. Henry. By taking the time to research your choices and selecting a qualified dermatologist, you can reduce the chances of complications and regain your self-confidence.