A scar is an area of fibrous tissue (mostly collagen) that replaces normal tissue in reaction to an injury. Wound healing can be negatively influenced by a wide variety of factors including smoking, diabetes, vascular disease, heart disease, immunological deficiencies, use of anti-inflammatory medicines, poor nutrition, excessive alcohol consumption, disturbed sleep patterns, and stress.

Scars that markedly overproduce collagen becomes raised and are called "hypertrophic." Keloids are more serious and can progress relentlessly into shiny and/or elevated reddened growths.

A true keloid

While Asian skin is often said to scar excessively, most surgeons would dispute this, noting that while initial scarring may seem to be more vigorous and thus noticeable, the final result is generally comparable to scars in non-Asian skin.

If skin is cut, it will always heal by producing a scar. Most such normal scars are not perfectly flat, and none are invisible. All are either slightly raised, some slightly sunken, and some, like stretch marks, can be thin and discolored.

No normal scar can be obliterated by more surgery since this simply replaces one scar with another. Laser surgery may sometimes lessen some of the redness but is not very effective at flattening and is totally ineffective at eliminating depressions.

The only effective method for improving on bad, ugly abnormal scarring is careful scar revision by an expert surgeon skilled at a textbook full of advanced techniques and tricks.

Less invasive treatments have been suggested, and some may (but usually don't) help a little. Silicone sheeting placed over a true hypertrophic or keloid scar may flatten it slightly; placed over a normal or poorly sutured scar, it will accomplish next to nothing. Steroid injections may help in some people, although they can also cause thinning and lumpiness.

Other less complicated medical treatments may include dermabrasion, injecting fillers, use of low-dose radiation, and "needling" to stimulate deeper collagen production.

So what about about those expensive over-the-counter scar creams and ointments you read about in every beauty magazine?

Don't get your hopes up. Controlled medical studies have shown no improvement in still-healing scars or mature scars with heavily marketed preparations such as, for instance, Mederma or Strivectin.

Any good moisturizer will make some scars look a little better by plumping up the tissue. Vitamin E, frequently claimed to have work wonders, has not only proven ineffective in controlled research studies but in some cases can worsen the outcome.

And what about all the new and seemingly miraculous products claiming to do things like stimulating skin remodeling using fancy compounds like copper peptides and DNA regeneration compounds and nearly every vitamin and antioxidant you've ever heard of?

Most will thin your wallet more effectively than your scar. Garden-variety healing and scars that are already mature do not respond in the slightest.

Fortunately, most scars tend to improve slowly over many years, sometimes eventually becoming almost invisible. They are a normal part of healing and an expected consequence of cutting through living tissue. The only successful way to "eliminate" them fully is to cover them with makeup.

Update: Do silicone gel sheets speed healing of normal surgical scars in Asians?