Wound healing after a minor procedure – scar or no scar?

A scar is a mark left after a wound or an injury has healed. It’s a natural part of the healing process and most will fade over time, although they don’t always completely disappear.

This is why when carrying out minor surgical procedures, we consent our patients so that they are fully informed about scarring.

To understand a little more about this, let’s delve into the stages of scar formation:

There are 4 stages:

Stage 1:

Haemostasis: looks like it is bleeding.

This occurs immediately after cutting the skin/ injury to the skin. The body responds by trying to stop the bleeding by activating platelets which are cells responsible for clotting. The blood vessels within the wound constrict to help with stopping the bleed. This takes a few minutes.

Stage 2:

Inflammation: the cut scabs over.

Once haemostasis is achieved, the wound healing process is initiated. Cells such as platelets, neutrophils and monocytes (macrophages) act together to mop up any bacteria, infections, releases growth factors to provide ultimately a clean wound bed for further repair process. This will leave the wound, although closed, a little red, inflamed and sensation of discomfort/ pain. This process takes approx. 3-4 days.

Stage 3:

Proliferation: the mark becomes bumpy, but smaller and will be less red than the previous stage.

The proliferative phase occurs between 3-21 days after injury/ surgery.  As the name implies, this stage is all about the building stage: formation of new blood vessels, granulation tissue, collagen and growth factors. The fibroblasts produce elastin and collagen which form the scaffolding support for blood vessels and granulation tissue. This granulation tissue is rich in blood supply and is essential in the wound healing process and for maturation and re-modelling.

Stage 4:

Maturation: the skin becomes pink, or paler, and flat, calm.

The final stage is the maturation stage where there is collagen cross-linking, re-modelling and wound contraction. Initially, the fibroblasts product Type III collagen which is thinner than the more mature Type I collagen, found in abundance in healthy skin. During the maturation phase, Type III collagen is replaced with Type I collagen and a scar is formed!

This switch from Type III to type I collagen increases the wound strength seen at 4-5 weeks after healing. The wound will regain 80% of its original strength 3 months after the injury/ surgery. The scar formed can be raised and red initially due to collagen deposition and also vascularity respectively.

Slowly, the scar will flatten and become paler and re-pigment 6-9 months after the injury/ operation. This whole process of the scar flattening and re-pigmentation can take up to 2 years.

Factors that affect wound healing

Age: Younger people generally heal more easily than older people. But, older people’s scars fade more quickly.

Nutrition: Eat healthily, drink fluids to keep hydrated.  As well as good caloric intake, studies have shown that you need Vitamins (A,B, C and E), minerals, Zinc and iron for effective wound healing. (NB: don’t use Vitamin A if you are pregnant).

Chronic disease: Conditions such as thyroid disease, Diabetes, circulatory problems, High BP cand effect your body’s ability to heal.

Medications: Some medications such as steroids, antibiotics, anticonvulsants can affect wound healing.

Lifestyle: Non-smokers heal more quickly than smokers. Sun exposure also affects wound healing, cause pigmentation issues, including melanoma.

Quality of skin: Thinner skin heals slower than thicker, more vascular skin.

If you would like to discuss a mole or a skin tag removal, there are many ways in which we can do it. Get in touch to find out what would be best for you.