The Cruel Paradox of Scar Formation

The perspective we humans have on the body’s functions works is often at odds with the body’s perspective.  In many cases, our social attitudes give us a perspective that is in stark contrast to the operational bodily functions.

Consider scar formation, for example.  We humans tend to evaluate scars based upon their appearance.  We determine whether they are ugly or whether they are nearly invisible.  We praise scars when you can’t even tell there was a wound.

From the standpoint of our physiology, the scar is the final result of a process of wound healing.  Any time the body’s tissues are injured by a penetrating device, the injured area undergoes an extremely complex process to clean up any dead cells and tissues and progressively close in the resulting space as best as possible.  So there is initially an inflammatory response that consists of various types of white blood cells and antibodies that work to destroy any infectious organisms and dead tissue.  As the infectious and necrotic material is being discarded, a number of cellular and molecular processes are stimulated to heal the wound and re-establish an effective barrier to the outside world.  Fibroblast cells form collagen fibers.  Those fibers, in turn, become attached to myofibroblast cells, which are cells with contractile elements.  Those cells work to progressively pull the wound edges together so that the epithelium can resurface the wound with its impermeable barrier.

This contractile process often leaves a residual scar.  Wounds that required a great deal of contraction are much more noticeable and disfiguring than wounds that are narrower, thereby requiring less contraction.

We ideally close wounds primarily so that less scar tissue will need to be formed.  Doing so will leave a thinner and less noticeable scar, especially if the incision was made in or is parallel to the skin lines.