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Why Scars Blush

A red scar fades with the tincture of time

A scar is nature’s zipper. It closes up rents in the skin with a waterproof closure.

A Scar Is Born

Plastic surgeons create scars every time they do invasive surgery, though part of their art is to hide them in folds, within the hair, and along contour changes. Nonetheless they’re there. (Plastic surgeons aren’t magicians.)

When the skin is cut with a scalpel, a complex inflammatory process kicks in. Like a skilled army, specialized cells lay down clot while wound-healing chemicals flood the site. One of those chemicals is histamine.

The Itch

Histamine treats a blood vessel like a stocking, stretching it out and opening up little holes so special cells can leak out and get to work. You may be familiar with histamine.

Histamine can make scars itch.

Next specialist cells lay down collagen to knit the wound closed. That takes extra energy and extra oxygen.

Why Scars Blush (& How They Grow Out of It)

Oxygen loads up inside red blood cells like cargo, and those red cells travel like submarines inside blood vessels. But without enough blood vessels leading to the wound, not enough oxygen can get there.

So the body creates more capillaries to bring extra blood flow with lots of oxygen. The red blood flowing inside the capillaries is just below the scar’s surface. The result is sort of like a blush.

That’s why scars are pink.

In the final phase of scar-making, the disorganized young collagen reorganizes into flat, mature collagen. (It’s like seeing a teenager grow up.)

At long last the job is done. Now the unnecessary extra blood vessels disappear, slinking off without a trace.

And that’s why scars fade.

The ideal scar is thin, flat, white, and asymptomatic. Passing through the phases of scar formation takes time; the scar might not mature for up to two years. (Some scars take even longer to grow up, just like some humans.)

“Reserve One Perfect Scar, Please!”

Why aren’t all scars thin, flat, and white? Several factors that affect scarring include:

  1. Genetics: You inherit your scar-forming qualities from your parents.
  2. Tension: An incision closed under tension is more likely to be thick, raised, and wide.
  3. Location: Eyelid scars are typically better than back or chest scars.
  4. Age: Children are more likely to develop thicker scars between ages 8 to 16, while older people with thin skin are more likely to develop fine scars.
  5. Wound condition: Shredded skin edges are more likely to cause thick scars than cleanly cut ones.
  6. Proper closure. Surgical technique can impact the result, though the best technique won’t overcome other factors.
  7. Blood supply: Factors such as smoking can result in death of skin, leading to delayed healing, a wider scar, and the need for further surgery to close the wound.
  8. Infection: A wound infection can disrupt the wound and lead to a wider scar.
  9. Poor diet: Inadequate nutrition can delay healing and result in the wound opening up.
  10. Health: Medications, medical conditions, and previous radiation can affect wound healing, so share your medical history with your doctor.

And that’s the story of scar formation.

It’s really sort of magical if you think about it!


Dr. Heather Furnas

About Dr. Heather Furnas

Inspired by watching her plastic surgeon father operate in African bush hospitals, Dr. Heather Furnas followed in his footsteps, training at Stanford and serving on the Harvard clinical faculty. She and her husband, Dr. Paco Canales, practice together in Santa Rosa, California, where they raised their two children. (To learn more about their practice, visit She believes an informed patient is more likely to be a happy patient and is committed to providing that education. If you have any suggestions for topics you'd like to learn more about, she would love to hear from you!

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