Last week, we shared with you an evidence-based look at the cultural forces behind K-beauty, tretinoin-core, and the modern patient’s skincare identity. This week, we’re shifting focus to something every clinician encounters, across all specialties of dermatology: scars.

Scarring is not just a cosmetic outcome. It’s a biologic process, a record of inflammation, wound healing, genetics, tension, and time. Despite how common scars are, misconceptions persist about why they form, why some worsen, and why treatments work brilliantly in some patients and barely move the needle in others.

Here’s a detailed, evidence-informed look at scars from the cellular level to the clinic.

A scar is the result of imperfect regeneration. When the skin is injured deeply enough to disrupt the dermis, the body prioritizes speed over architecture.

The wound healing process unfolds in four overlapping phases:

Read more in the guide we’ve created just for you:

Scars form when this balance is disrupted. Too much fibroblast activity, prolonged inflammation, abnormal collagen deposition, or excessive mechanical tension can all tip the scale toward pathologic scarring.

What patients notice:

Time matters, but biology matters more.

Lumping all scars together leads to poor outcomes. Treatment success depends on recognizing the scar phenotype.

Atrophic scars

Hypertrophic scars

Keloids

Contracture scars

Each behaves differently. Each demands a different strategy.

When patients ask, “Why me?”, the answer is rarely just one factor.

Common contributors:

Here’s a key insight: the first 8–12 weeks after injury are critical. This is when scar biology is most modifiable. Miss that window, and treatments become corrective rather than preventive.

Read more in the guide we’ve created just for you:

Expectation management is everything.

Early scars (under 6 months):

Mature scars (over 1 year):

Atrophic scars rarely disappear completely. Raised scars can flatten dramatically but may recur. Patients who understand this trajectory are far more satisfied with their outcomes.

Topical and conservative therapies

Injectables

Energy-based devices

Surgical revision

No single modality works in isolation. The best outcomes come from layered, staged treatment plans.

Expected and temporary:

Concerning but manageable:

True treatment failure is rare. More often, the issue is insufficient duration, undertreatment, or misclassification of the scar type.

Before treatment:

During treatment:

After treatment:

Adjusting the plan:

Be cautious in patients with:

Scar treatment is as much psychological as it is physical. Listen closely.

Remember:

Scars are not failures of healing. They are adaptations. When we understand the biology behind them, we stop chasing miracles and start delivering consistent, meaningful improvement.

The most successful clinicians don’t just treat scars. They anticipate them, prevent them, and guide patients through their evolution.

We got you.

Here are some job postings you may find interesting:

Take one of our modules

Here is our featured course for today!

For a deeper appreciation of process over outcomes:
“Range” by David Epstein, a compelling look at why broad understanding and adaptability often outperform rigid specialization.

Scar management works best when it’s grounded in biology, timing, and honest communication, not hype. Improvement is incremental, cumulative, and deeply patient-specific.

Next week, we’ll talk about that thing that’s been holding you back professionally and how to fix it… curious? We’ll tell you all about it next week!

See you, DERM Community!

— The Derm for Primary Care Team