A healed bullet wound is a permanent mark left after the body completes its repair process, replacing damaged tissue with dense, fibrous collagen. “Healed” signifies that the acute inflammatory phase is over and the wound has matured into a stable scar, a process that can take months or even years. The final visual presentation of this scar is highly variable, depending on ballistic factors, medical management, and individual biological response. This article describes the typical aesthetics of these matured wounds for descriptive purposes only.
The Distinctive Appearance of Entry and Exit Scars
The visual signature of a healed bullet wound often allows for a distinction between where the projectile entered and where it may have exited the body. Entry wounds typically result in scars that are smaller than the bullet’s actual caliber, appearing circular or oval. The skin’s natural elasticity causes the tissue defect to contract and sometimes results in a depressed or sunken appearance known as an atrophic scar.
If the firearm was discharged at close range, a phenomenon called “tattooing” or stippling may be visible around the healed entry scar. This discoloration is caused by unburned gunpowder particles and hot gases embedding into the skin, and these specks of foreign material can persist indefinitely. The color of the scar tissue itself often settles into a tone that is either lighter (hypopigmented) or darker (hyperpigmented) than the surrounding uninjured skin.
In contrast, exit scars are generally larger and significantly more irregular in shape and size than their entry counterparts. As the projectile slows down and tumbles, it transfers more energy to the surrounding tissue, pushing and tearing the skin outward as it leaves the body. This outward force often creates a stellate, or star-shaped, pattern, or a large, irregularly outlined slit in the healed tissue.
Exit scars typically show more noticeable tissue loss and irregularity, reflecting the greater physical disruption caused by the bullet’s deceleration and potential deformation. These scars lack the tell-tale signs of close-range entry wounds, such as gunpowder tattooing or a muzzle imprint. Because of the magnitude of tissue damage, these scars frequently require extensive medical intervention, resulting in a more complex and irregular healed appearance.
Factors Influencing the Scar’s Final Shape and Size
The characteristics of the projectile are a major factor influencing the size and shape of the healed scar. High-velocity rounds impart significantly more energy, causing greater temporary and permanent tissue cavitation than low-velocity rounds, which leads to larger, more disruptive scars. Furthermore, a bullet that fragments or deforms upon impact, such as a hollow-point, creates a much wider track of destroyed tissue, resulting in a larger healed mark.
The anatomical location of the injury plays a substantial role because areas of the body subject to high tension or frequent movement, such as joints or the chest, tend to heal with more pronounced scarring. Movement continuously pulls at the healing wound edges, which can promote the formation of a raised, thickened scar known as a hypertrophic scar. Individual biological factors also dictate the healing outcome, particularly a person’s genetic predisposition toward developing keloids, which are raised scars that grow beyond the original boundary of the wound.
The quality of immediate medical intervention is another defining variable for the final scar aesthetic. If a projectile is retained, a surgical incision must be made, often transforming a small entry defect into a longer, linear surgical scar. Conversely, prompt and meticulous wound debridement and closure can minimize tissue tension and improve the final appearance. Complications, such as a wound infection during the early healing phase, will result in a more prominent scar.
Long-Term Skin Changes and Tissue Distortion
Beyond the visible line of the scar itself, the underlying damage caused by the bullet track contributes to long-term changes in the skin’s contour. The projectile’s path leaves a “permanent cavity” of crushed and destroyed subcutaneous tissue and muscle beneath the skin’s surface. The subsequent healing of this deeper damage with dense internal scar tissue can cause the overlying skin to pull inward, creating a visible sunken or indented appearance.
This internal scarring can also lead to the tethering of the scar to underlying fascia or muscle layers, restricting the skin’s natural movement and flexibility. When the skin is pulled taut over the deep scar tissue, the resulting contracture may look tight or puckered. Even years after the injury, the scar tissue may retain a persistent reddish or purplish hue because of small, newly formed blood vessels that did not recede after the initial healing was complete.
Furthermore, the trauma to the deep tissues can damage or disrupt local nerves, resulting in areas of localized numbness or hypersensitivity around the healed wound. This nerve involvement can contribute to chronic pain or itchiness, which may affect the long-term appearance by prompting repetitive scratching. The combination of surface discoloration, deep indentation, and altered texture defines the final, aged appearance of a healed bullet wound.