How can different scar types be recognised ?
Relief is one of the first criteria for identifying a scar.
A scar may be :
• Flat, approximately level with the skin.
• Atrophic, forming a depression.
• Hypertrophic, thick and raised but within the original wound boundaries.
• Keloid, forming raised tissue extending beyond the original wound.
Its colour, suppleness, width and evolution should then be observed.
A scar should therefore not simply be considered “nice” or “bad”. Analysing its characteristics allows precise classification and guides treatment choice.
What is a flat or normal scar ?
A mature, ‘normal’ scar is generally flat, supple and relatively close in colour to surrounding skin.
However, a recent scar may be pink or red and slightly firm. These characteristics can gradually diminish during maturation.
Its width depends particularly on the original wound, location and skin tension during healing.
A flat scar may nevertheless remain visible because of different colour or texture.
A scar therefore need not be raised or depressed to be noticeable.
What is an atrophic scar ?
An atrophic scar is depressed, below surrounding skin level.
It forms when skin repair does not fully reconstruct tissue destroyed by the original lesion. Volume loss then persists, causing the scar's depressed appearance.
Atrophic scars are particularly common after inflammatory acne, but can also appear after other skin lesions.
Their appearance varies according to shape and depth. These characteristics matter for treatment choice : a narrow, deep scar requires a different approach from a broad, superficial one.
What are the different types of depressed acne scars ?
Atrophic acne scars are mainly classified into three forms : ice pick, boxcar and rolling scars.
• Ice pick scars are narrow and deep, resembling a small opening extending into the skin.
• Boxcar scars are broader, with relatively defined edges and a depressed base.
• Rolling scars are broader and less clearly defined. They give skin an undulating or irregular appearance.
Several types may coexist on one face.
Acne scar treatment depends on shape and depth : ice pick, boxcar and rolling scars need different or sometimes combined techniques.
What is a hypertrophic scar ?
A hypertrophic scar is thick and raised, remaining limited to the original injury area.
It may be red, firm and sometimes tender or itchy. It appears when scar tissue production is excessive during skin repair.
It may develop after surgery, a burn or a wound subjected to substantial tension.
Over time, some hypertrophic scars may flatten and soften.
Remaining within the original wound boundaries particularly distinguishes it from a keloid.
What is a keloid scar ?
A keloid is a raised scar whose tissue extends beyond the initial injury boundaries.
It may continue increasing in volume after wound healing. It is sometimes firm, painful or itchy.
Keloids may appear after surgery, a burn, piercing, an acne lesion or other skin trauma.
Certain locations are particularly affected, notably the shoulders, upper chest and earlobes.
Individual predisposition also exists.
Does a red scar constitute a scar type ?
A red scar is defined by colour rather than relief. It often corresponds to a recent scar with substantial remaining vascularisation.
During maturation, red or pink colour may gradually fade. A red scar can be flat, but a hypertrophic scar can also be red.
Colour and relief must therefore be assessed separately. Persistent redness needs treatment mainly targeting the vascular component, while a depressed or raised scar needs treatment correcting texture and promoting skin remodelling.
What is a hyperpigmented scar ?
A hyperpigmented scar appears darker than surrounding skin.
This colour may reflect post-inflammatory hyperpigmentation after the lesion and healing.
It is more common and sometimes more persistent in darker phototypes.
A pigmentation change may persist even with a perfectly flat skin surface.
What is a hypopigmented or white scar ?
A hypopigmented scar is lighter than surrounding skin and may sometimes appear white.
This colour difference reflects reduced or absent pigmentation in scar tissue.
It may be particularly visible when surrounding skin is pigmented or tanned.
A white scar is not treated like a red or hyperpigmented scar.
How can you know which treatment suits each scar type ?
Scar treatment depends on its characteristics : relief, colour, depth and age must be assessed before choosing an appropriate technique.
A depressed scar mainly needs treatment improving relief and stimulating skin remodelling. A red scar requires targeting its vascular component, while a pigmented scar needs management of colour changes.
Fractional lasers can improve certain scar textures and stimulate skin remodelling. Other techniques may be necessary according to scar type and the characteristic to correct : subcision releases adhesions maintaining certain depressed acne scars ; TCA CROSS can treat narrow, deep scars, particularly ice pick types ; peels may improve certain superficial texture or pigmentation irregularities.
Keloid and certain hypertrophic scars require specific dermatological care.
Clinical examination therefore identifies scar type and what makes it visible. Treatment is then selected according to the characteristic genuinely targeted for improvement.
Article written by Dr Valeria Romano
Dr Valeria Romano supports each patient with a comprehensive approach to the aesthetics of the face, body and intimate areas, and to skin and hair quality. Every treatment is based on a personalised medical assessment.
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