Why do some patients have scars that fade while others last longer?

Question

I have seen some doctors patients' lose their scars within a year, and others have permanent scarring. But I have noticed those whose scars fade, have shorter incisions, it goes just above the ears along the hairline and that their results do not last past 2yrs. Those with scars, their scars run up higher along the hairline to the forehead but their results last and their facelift is more dramatic, they look younger. Why is this? Also, can laser remove all scarring? Is that always an option

Mehmet Surmeli, MD, FEBOPRAS · Answer

Hi,

Scar healing is a highly individualized process influenced by several factors. Genetics play a significant role; some people naturally produce more collagen, leading to thicker or more pronounced scars.

Skin type and color can also affect scarring—darker skin tones are usually more prone to hyperpigmentation or keloid formation.

It is also known that if the tension of the skin closure is high this may lead to worse wound healing and hence wider and more visible scars. 
Also any problem during the wound healing may lead to more visible scars. Other factors include age, ethnic background, nutritional status, and overall health. Lifestyle choices like smoking or sun exposure can impair healing and affect scar appearance as well.

Additionally, meticulous surgical technique and proper post-operative care are crucial. Following wound-care instructions can promote better healing and lead to scars that fade more effectively over time.

My comments and recommendations are solely based on your text and are subject to change. I always recommend a face-to-face consultation with a specialist to plan the treatment.

Best wishes, Dr. Surmeli.

Ajaya Kashyap, MD · Answer

Thank you for your query. You have several concerns  that I will try to address. 
Scars and their fading with time depends on the technique of surgery, post operative care as well as skin  factors including the type and genetics. The effect and longevity of facelift surgery depends on the layer that the facelift has been performed  rather than the length of the scars. Shorter incision facelifts can work just as well as longer incisions., and last just as long.  Lasers can certainly improve the scars but not remove them. The scarring is usually better when you have a more experienced surgeon working on a favourable skin type and when all postoperative precautions are taken.

Gary M. Horndeski, MD · Answer

When doing a face lift, it is important to hide the scars behind the ear or in the hairline or at the ear-face junction. This conceals the scars. Everyone responds to scars differently and there is no guarantee on scarring.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Ronald J. Edelson, MD · Answer

Patients vary in the scarring depending  on both individual scarring and the technique used by the surgeon. A good surgeon will know how to make the scarring as unnoticeable as possible

Zoran Potparic, MD · Answer

It is true that patients show lots of variety regarding the length and type of scars. Although it usually takes a year for scars to mature in the age after 40, some patients have much longer scar maturation process. Most of the scars hidden in the hair, in front and behind the ear,  are barely visible but in some patients, stretched, wide scars are reality. Unfortunately it is impossible to predict exact healing/scar making pattern in all patients. Hope this helps.

Todd Christopher Hobgood, MD · Answer

You’re right that scar healing can vary, but the main factor isn’t simply incision length. Shorter incisions often look less noticeable because they’re placed in well-hidden areas and heal under less tension. Longer incisions give surgeons more access to reposition tissues, which can create a more dramatic and longer-lasting lift. However, these incisions may be more exposed to movement, sun, or tension, which can affect scar visibility.

How scars heal also depends on factors like genetics, skin type, and recovery habits. Protecting the incisions from the sun, using scar therapies (such as silicone gel or sheets), and following your surgeon’s aftercare instructions can all improve healing.

Lasers and other treatments (like microneedling or chemical peels) can soften and blend scars so they’re much less noticeable, but they can’t remove them completely.

Selcuk Yazan, MD · Answer

Hello, 
The variability in how scars heal and fade depends on a combination of biological, lifestyle, and procedural factors. 
Genetics play a significant role in scar healing. Some individuals are predisposed to develop thicker, more visible scars, such as hypertrophic scars or keloids, due to an overproduction of collagen during the healing process.
Skin quality and type can affect your healing process too. Thicker or more elastic skin tends to heal better with less visible scarring, whereas thin, delicate skin may show scars more prominently.
Ethnicity and skin tone also influence scar appearance. For example, darker skin tones are more prone to hyperpigmentation around scars, while lighter skin tones may show redness for longer periods.
Proper hydration and a diet rich in vitamins (such as vitamin C and A) and proteins support optimal skin repair and scar maturation.
Dry or poorly moisturized skin may result in more prominent scarring, emphasizing the importance of good skincare during the healing process.
Lifestyle factors such as smoking and alcohol use can negatively impact healing. Smoking reduces oxygen delivery to the skin, impairing the healing process and increasing the risk of poor scar outcomes. Similarly, excessive alcohol consumption can hinder wound healing by disrupting immune responses and collagen formation.
The skill and approach of the surgeon are critical in minimizing scars. Procedures that place excessive tension on the skin, such as simple skin tightening techniques, are more likely to leave wide, visible scars.
Advanced techniques like deep plane facelifts allow for excess skin removal without over-tightening the superficial layers. This reduces tension on the incision site and promotes smoother healing with finer scars. 
Careful suturing in multiple layers and proper alignment of the wound edges ensure better healing and less scar visibility.
Adhering to post-operative care instructions, such as keeping the incision clean, using silicone gel or sheeting if recommended, and moisturizing the area when appropriate, can significantly improve scar healing. UV exposure can darken scars and prolong their visibility.
Everyone heals differently. Factors like age, hormone levels, and immune function influence how quickly and effectively the body repairs itself. Younger patients may heal faster but could also produce more noticeable scars due to more active collagen production.
Lasers are an existing option, but it’s best to let the body heal as much as possible on its own first. We do not recommend in our specific practice to touch the scar while it’s still healing. Please consult with your individual surgeon on which period a laser is appropriate. 
The outcome of scar healing depends on multiple factors, from genetics and lifestyle habits to the surgeon’s technique and the patient’s post-operative environment and care. Choosing an experienced surgeon, following aftercare protocols, and understanding your unique skin type and healing capacity are all essential steps in achieving the best possible scar outcome. Scar healing is life-long teamwork effort between you and your surgeon.

Pawel Szychta, MD, PhD, DSc · Answer

Scars vary due to surgical technique, genetics, skin type, and healing. Shorter incisions result in less visible scars but provide subtler, shorter-lasting results, while longer incisions allow dramatic, long-lasting outcomes but may leave more noticeable scars. Laser treatments can improve scars but rarely remove them entirely. Proper scar care and consultation with a specialist can optimize results.

William Portuese, MD · Answer

The  Fitzpatrick skin types all heal differently, but it also depends on placement of the incision, the tension on the incision, and when the sutures are removed after a facelift procedure.

Mustafa Aydinol, MD · Answer

With the advanced anatomy knowledge and surgical techniques it is possible to achieve long lasting results with good healing scars. If the results are not lasting for 2-3 years, I would say it is not a deep plane face lift. When done properly the classic face lift lasts for 10 years. The quality of the scar depends on the surgical technique, proper skin closure, gentle approach, and lastly patient genetics.

Why do some patients have scars that fade while others last longer?

Answers (11)

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