Scars

First things first

This page is mostly concerned with ways to reduce or cover scars. First of all there are a few things to mention:

• Not all self-injurers have scars.

  It depends on lots of factors, not just severity of injury but also method, how it was cared for, and the individual healing pattern of your skin. And we all agree that the severity of an injury isn't necessarily linked to the degree of mental distress that caused it. So please, if you don't have scars, try to keep it that way, and don't let this page bother you.

• Not all self-injurers want to get rid of their scars.

  Scars can have many meanings and can be important to someone, perhaps as a physical memory of past pain, as a mark showing they have survived and healed, or somehow just a part of their history that they don't feel they should have to hide or be ashamed of. I understand that and have some of those feelings myself (constructed this page mostly because I'm a geek who loves gathering and categorising information!). The advice below is for those who do find their scars upsetting and would rather be without them.

• Treating your scars could make you feel worse.

  This is for two main reasons. Firstly, focusing attention on the effects of your injuries might "trigger" you to do it again. Or it might give you a sense of disgust about your body or a sense of being abnormal. Secondly, you may not be finished with self-injury yet; while there are physical reasons to start scar treatment as soon as possible, bear in mind that if you put time and money and effort into improving the look of your skin and then you go and "ruin it", you can feel very bad indeed.

OK, with those caveats, I'll continue. The information below comes partly from my own experience, but also from contributions by members of the BUS Web Board. In particular I want to credit Whoops for a long post about scar treatments, and Waterfall for her tips on cooler dressing. The personal comments about treatments are mine if in normal type, someone else's if smaller.

Scar prevention

Before the injury

• The obvious way to prevent scarring is by not self-injuring. Clearly that's hard, but if you're concerned about scarring, add it to your list of reasons not to self-injure, and try to remind yourself of it when you are feeling the urge to do something.
• Next best is to injure in a way that will scar less—and if that happens to be a way that will also hurt you less, so much the better. Something that worked for me was altering what I used to injure with, choosing an intact safety razor rather than a separate blade.
• I guess it's fairly obvious that you could consider injuring a place that's easier to conceal. I need to warn, however, that when I did this, moving to a new site that was always covered by clothes led to a big increase in my self-injury—somehow the sleeve-wearing thing had been holding me back, and removing that barrier gave it free rein. Please be careful.
• Similarly, you might injure in a way that makes the scars look accidental. But again I warn: For me, injuring in a way that forms words is a safer form of SI, because it releases a lot of self-hate with a comparatively minor injury. Yes, word scars are embarrassing. But your safety is more important, so do weigh these things up. More generally, put your efforts into finding ways to prevent self-harm rather than finding clever ways to make your injuries look accidental.
• On a more positive note, avoid areas of sensitive skin, soft tissues, and areas where the injury will be difficult to care for.

Caring for the injury

Treating an injury properly can do a lot to minimise scarring.

• If professional attention is needed, get it. Proper closure of wounds, grafting of burns, correct cleaning and dressings all help to minimise scarring.
• On the subject of cleaning, I've heard it said "Never put anything in an open wound that you wouldn't put in your eye". Presumably means avoid harsh stuff like alcohol and peroxide; I think Betadine (=povidone-iodine, comes as ointment or in a spray) is what nurses use, and I can't say I'd put that in my eye either, not least because it's yellow-brown.
• Infections worsen scarring, so keep the injury clean, and get medical attention if it seems unusually red, hot, weeping or starts to smell or if you feel unwell.
• Cuts that are just left to gape form wide, often raised, scars, so close the edges as soon as possible (after cleaning). Steri-strips can be bought easily, butterfly sutures stick better, but strips of any kind of first-aid tape will do.
• More generally, care for your wounds properly. Some cheaper bulk sources of first aid supplies are on my links page.
• There are some special dressings on sale in chemists that claim to minimise scarring, such as Elastoplast Active Plasters.
• Don't poke at or scratch healing wounds, even though they may be itchy.
• Start the scar treatments listed below as soon as possible (but check whether it's safe before using them on any wounds that aren't fully healed).

---

Before we go on to look at treatments, I should point out that nothing will make scars totally disappear. What can be done is to make them less noticeable, less red, less raised etc. And the best healer is time. The treatments below will help, but it's still slow; even if you think your scars are dreadful, in a few years (yes, years) they will be considerably improved.

Other detail: I'm in the UK, and for space reasons I've only included below things easily obtainable here. If you're in the US (and even if you're not!) I recommend Deb's site.

---

Over-the-counter scar treatments

In this section I'll put things you can buy that are specifically marketed as scar reducing products. Although they're over-the-counter, you might be able to get some (such as Cica-Care) on prescription from a sympathetic GP, and this is worth doing since they can be expensive.

• Herbal scar cream

  "This was okay, but was very rich and smelly even though it did reduce scars. Also cheap."

• I don't know what brand this was, unfortunately. Try Google or a health food shop.
• Neutrogena Healthy Skin Lotion

  "This is just a moisturising cream to make discolouration disappear. It is a light cream so I liked it better and it's helps with bruise colours, etc which I have a lot of. Also cheap."

• NeoStrata 15AHA Gel (Glycolic Formulation)

  "I recently used this to fix my skin's discolouration and it has helped A LOT. On the bottle it says it is very strong, but it hasn't irritated my skin at all. It gets rid of any black/blue discolouration or pinkishness and it makes the skin smooth although it isn't supposed to help with healing. It doesn't smell, it isn't sticky and it's a clear gel so it doesn't stain. It is a little bit expensive but a little bit goes a long way."

  As far as I can tell, this is the kind of stuff dermatologists use for chemical peel treatments. Sounds scary to me, use with caution.
• Cica-care gel pads

  I tried this. It's a rectangular sheet of clear, ridged sort of jelly stuff. You cut pieces to cover your scars, and wash and re-use them every day. I found that although it's meant to just cling to your skin it didn't actually stick very well, especially at night, so I ended up bandaging over it.

  It really did seem to be making my scars flatter and paler, but I gave up cos I was finding it a nuisance, and you need a new piece every few weeks and it's so expensive.

• Elastoplast scar reduction

  I've not tried this although I've seen it. I believe it works similarly to CicaCare but sticks on with actual adhesive rather than just clinging. Also it is white rather than clear.

  "Quite effective in making the area more easily concealable, if that counts for anything...?"

Help from your doctor for scars

• Silicone gel sheets (see above) seem to be a standard NHS treatment for scarring, although it may be hard to find a doctor willing to prescribe them for self-inflicted injuries. But they are expensive, so it's worth asking.
• Steroid injections—I don't know much about this, but I think you need to get your doctor to refer you to a dermatologist.
• Your doctor can also refer you to the Red Cross cosmetic camouflage service.
• Surgery
  • Generally, a surgeon will not consider operating until you have been free of self-injury for quite some time. The figure I have heard is two years.
  • Surgery cannot make scars disappear. After all, most operations leave scars, don't they? So do be realistic. It feels horrible to go through painful surgery and then be disappointed with the result.
  • Basically, surgery can't remove scars, but it can alter them, move them about a bit etc. Much better explained on this site by the American Society of Plastic Surgeons.
  • I've not had surgery for scars, but I have had skin grafts for burns, so I'll explain those. There are two types of skin graft: split thickness and full thickness. The latter looks better cosmetically but you then need a split thickness graft to cover the donor area for the full graft. Anyway, I had two split grafts. The effects on my scars were as follows: The burns even with their newly grafted skin were pretty spectacular scars, and still are although fading over the years. The donor sites had some existing cutting scars, and these remained and weren't transferred to the burn site. The taking of the graft itself left some very large but uniform and flat areas of scarring, although they deliberately chose my upper thigh to be easily covered. Skin grafts are painful, but it's not as bad as people say, and the pain is mostly when moving around or having dressings changed. If you can remember grazing your knee as a child, then imagine it as a large graze covering most of your thigh.
  • A friend of mine (here in the UK) had surgery for SI scars including the use of tissue expanders. From what I gather, it was a painful and lengthy process that did bring definite improvements but not as much as she had hoped.

"Alternative" treatments

This section deals with products not specifically recommended for scars.

Things rubbed into the scars

First of all, I want to point out that the surgeon who grafted my burns said to use a moisturising cream, and that it wasn't so much the substance as the action of rubbing it in that brought benefit. That said, here are the experiences of me and others:

• Sudocrem

  "Supposed to be um... a nappy rash cream? But works really well on reducing the redness of scars and healing them. i have cleared up some fairly nasty cuts on my arm with it overtime."

• Lush's "Buffy the backside slayer" (?!)

  "They class it as a skin conditioner, meaning that it moisturises and gets rid of all the wobbly dimples on your bum! Its all made of lovely ingredients like cocoa butter, shea butter, ground rice, ground almonds, aduki beans, lemon oil etc. but heres the good bit, this product really really makes scars a lot less visible. i think it may be the lemon oil in it. Because it has no chemicals I found I could use it on fairly new ones without it stinging, and it works well on old ones as well!"

• Rosa Fina Body Conditioning Lotion

  "My friend bought me this moisturiser for Christmas that she said would help my old scars, I was sceptical but i can honestly say my scars are now hardly noticeable, especially if you didn't know they were there. My mum saw the other day and was like, what did you do with the scars? Is only made with natural ingredients. Smells yummy as well."

• Vitamin E oil

  "The BEST was Vitamin E oil ... it reduced scars a lot and very quickly too—the bottle says it reduces scars by 1% a day. But start it straight away and do it for about 200 days for best effect. It is also very cheap. The problem with Vitamin E oil is it is really sticky, it's yellow and it will definitely stain your clothes unless you can wrap a bandage around your skin. I had to stop using it because my scars are on my breasts and I can't bandage that area so it was staining all my clothes really obviously. Also, my skin has become infected because of SI and the oil makes it much worse. I live in Australia so I don't know where you can buy it from ... here we buy them in Chemists or health food stores but in the US I think you call them drugstores ... don't know??"

  I tried this myself using Vitamin E oil from the Body Shop (came in a tiny pink bottle). Must be different stuff, cos I didn't find it sticky or staining! It seemed to make my skin a little itchy, so I stopped using it.
• Rosehip oil

  "Rosehip oil is very good too, not as good as Vitamin E but it isn't as sticky."

• Aloe Vera

  "Also very good, especially if you have swelling and pinkness. It doesn't reduce the scarring itself so much as the raw look of them. The scars don't disappear so much as lose their colour and inflammation. It is also cheap. The great thing about Aloe Vera is that it isn't greasy and it doesn't stain, plus it's very moisturising at the same time. And it feels great. It reduces pinkishness."

• Vitamin A cream (Retinol cream)

  "I tried a Retinol cream by L'Oreal. Didn't notice so much difference but I didn't try it for very long because it made my skin a bit flaky (maybe coz chest skin is very delicate). It's designed for wrinkles, I thought it might help anyway. It's pretty cheap too. And I was told Vitamin A is supposed to help scars."

• Tea tree cream

• "What works well on helping cuts heal is tea tree oil, or cream. helps them heal really fast, does sting a little though"

  Not clear whether it helps on old scars. And it's important not to put concentrated tea tree on your skin. More info at this site from the University of Western Australia.
• MediHoney (see also GoldenGlow, seems to be available on various UK sites.)

  "This is basically just sterilised honey. It is a new product and all the doctors are raving about it. Tests have proved very very positive. You can just use normal honey (warmed up) if you want though. It has one HUGE advantage over the other creams which is that it also is an antibacterial agent. The only thing is, it is really intended for wounds that can be dressed, because it is so sticky."

• Rosemary

  "Rosemary essential oil is also supposed to be good. Never directly on the skin and never on an open wound but added to the bath or in a moisturiser. I'd never heard of that but it does increase the circulation to the skin so there's another possibility."

Other things

• Some people have suggested that taking Vitamin E, Vitamin A or Zinc (orally) might help. Do be aware, though, that high doses (particularly of Vitamin A) can be harmful, so read the label.
• In the Burns Unit I was told to eat a high protein diet to promote healing.
• Opinion seems to be divided on whether sunlight is a good or a bad thing. In the Burns unit I was told to avoid sun for a long time, as the scar tissue would sunburn very easily. On BUS some have said that a suntan can make the scars more contrasted and therefore more noticeable.
• For information on Aromatherapy, Ayurveda, Herbal Therapy, Homoeopathy and Massage for scars, see this post by Michelle from BUS board.

Make-up to camouflage scars

I haven't found make-up terribly successful, probably partly because I'm not very good at it (!) but also because it doesn't disguise the texture of my scars, only the colour. But it's worth a try, and I do still use it on "special occasions".

• The Red Cross run a cosmetic camouflage service for anyone with a disfigurement. You need a referral from your GP.
• Dermablend seems to be the most widely known brand of camouflage make-up. I've used the Leg and Body Cover Cream although I found even the "Ivory" shade was too dark for my skin. It does last well and is waterproof. You do need to use the setting powder with it, otherwise it stays sticky and marks things. I bought it online from Escentual, but Boots stock it now and probably other places.
• Veilcover is another brand. I haven't tried it, but I've heard the range of colours is better.
• Ordinary concealer is cheaper and not bad. I sometimes use the shade they call "correcting green"—the stick does look a strange colour, but it counteracts the redness quite well.
• Some people say that self-tan helps make their scars less noticeable, others say it makes it worse.

What to wear to hide scars

Hot weather

These are the tips from Waterfall of BUS Board:

• Cotton (and linen) are cooler than blends, blends are cooler than pure artificial fabrics.
• Woven fabrics, especially loose weaves, are often cooler than knits (eg T-shirts). Loose clothes give more room for air to circulate, and are much cooler than tight ones (especially skin tight, which can really heat up the body).
• Sandals with bare feet can often make you feel a lot cooler,whatever else you are wearing.
• Long thin cotton skirts are really cool—much cooler than trousers, and possibly cooler than shorts as well.
• Slits can aid air circulation, and they never really reveal anything for long enough for a scar to be noticed. (Just make sure when you sit down it doesn't fall open over any scars.)
• A short sleeved (or sleeveless) T-shirt can be worn with a shirt unbuttoned over it. This hides your arms, and has the advantage that if you are in company whom you don't mind seeing your scars, you can just take the shirt off.
• Sleeves just below the elbow are no hotter than those above (as long as they are not tapered).
• Light colours are often (but not always) cooler than dark.

Myself, I wear sleeveless tops with very loose men's cotton shirts over the top. But even then, when I had to visit Madrid on a work conference, the heat was pretty unbearable. :(

Formal wear

I don't really do formal gear ;) but people tell me that jewellery, long gloves, sheer fabrics and strategically placed safety pins are the way to hide scars and still be the belle of the ball.

Swimming

I bought myself a swimsuit that has long arms and short legs, to cover the scars on my arms and thighs. It's great! I got mine (shown on the right, though the model's not me!) from Sunshell (Australia), although there might be nearer places now. They are marketed as "Sun protective swimwear", so try a Google search for that.

• Sungrubbies
• Sunemporium
• Sunshell

Others have suggested "rash shirts" or sarongs to cover up when swimming.

What to say when someone asks about your scars

I haven't much advice here, cos it all depends on the person and the situation and what you are comfortable with.

• Brushing it off: In response to "Eew! What happened to your arm??" say something bland, being careful not to look or sound shocked/upset by the question—boredom is best!
  • "It's a long story."
  • "Nothing interesting"
  • "It was ages ago"
  And quickly put your scars out of sight and change the subject.
• Misleading: I usually feel guilty with these, but they're useful with really nosey people whom you really don't want to tell the truth
  • It was my auntie's cat
  • It was a jaggy bush when I was helping with my granny's garden
  • I was doing the washing up and there was this sharp knife hidden under the water...
  • I had this weird accident with a cheese grater... (plausible if your scars are all parallel?)
  • It's a skin condition (eg for burn scars)
• Stating the obvious: The person will take a moment to realise that you've not quite answered the question, by which time you'll have moved on, and if nothing else they'll realise that you don't want to talk about it.
  • "That? It's a scar."
  • "I cut myself" (burnt myself, hit something etc) The tone of voice should be very casual, you're not trying to suggest you did it deliberately.
• The truth: If the person just noticed, it probably isn't appropriate to launch into a long conversation about your SI, but you can still be truthful if you want. I find it actually feels quite empowering to just state it honestly and without shame.
  • "Those are self-inflicted scars."
  • "Sometimes I find cutting myself makes me feel better."
  • "I (used to) self-injure."
  Be brief and matter-of-fact. If they ask further questions, you can continue or you can say "I'd rather not discuss it."
• Humour: There are huge lists circulating of amusing things you can say (eg here). The idea is to bamboozle the person, so that you are 5 minutes into the next topic of conversation before they remember what they asked. A few examples:
  • "What? I don't see any scars?" (give them a look as if they are mad)
  • (Look around furtively, and whisper) "The aliens did it"
  • "I had unprotected sex with a porcupine"

Sites with information about scars

If you know of a better link for this section, do let me know

• Scar Information (this site belongs to Smith and Nephew, so not entirely noncommercial!)
• Keloid and hypertrophic scars, explained by the American Osteopathic College of Dermatology (?)