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What can I do to improve my scar?
For the first 2 weeks, follow your post-operative surgical instructions with respect to dressings and bathing. If you have steri-strips or tape, leave them in place. If you have been instructed to apply ointment, do so for the first week or until sutures are removed.
After two weeks, you can start the following:
Massage
Scar massage gently loosens tissue, desensitizes painful scars, and reduces scar tissue. After the wound is completely closed, press firmly with the pads of your fingers over the scar and rub back and forth along the direction of the scar for about 30 seconds at a time, several times per day. Focus on bumpy areas. Scar massage can be beneficial for 6 months.
Moisturize
Scars lose moisture faster than normal skin. Keeping them hydrated improves healing. Products like Aveeno, Nivea, Dove, Cetaphil, Glaxall-base, and coconut oil work well. You should not use polysporin once the wounds are closed and sutures are out - local irritation can result. Usually polysporin is only used for the first week or while wounds are open. Please avoid using vitamin E, essential oils, aloe vera, or tea tree oil for the first 4 weeks.
Taping
There is some evidence to suggest this may improve scar appearance. Body and breast scars are usually the easiest to tape. 3M Micropore or Paper Tape is preferred. Ideally the tape should stay on for 1-2 days at a time so that repeated removal does not irritate the skin. You’ll find it hard to get the tape to stick right after moisturizing so may have to find a schedule that works for you based on your daily hygiene routine. Discontinue taping if you notice irritation.
Sun Protection
Scars tan differently from the skin around them and can burn. You should protect fresh scars with occlusive clothing or SPF 50+ sunblock for the first year. Do not visit tanning booths or intentionally tan scars.
Not all bathing suits are UV protective - check their tags, otherwise, apply sunblock even to areas covered by your suit.
Silicone
Silicone gel and sheets have reasonable evidence to support their use in helping scars heal. Silicone best approximates the normal skin barrier. The gel products can be used just like moisturizer, rubbing over the scar. The sheeting can be applied and worn, usually at all times when not showering/bathing. Products include Scar Gel, Dermatix, Mepiform, and Cimeosil.
Adjuvant Therapies
After scars are fully mature, lasers can sometimes be used to reduce redness. For select problematic scars, intra-lesion steroid injections are used to soften scar tissue.
Finally, if a scar is very undesirable, sometimes it can be revised with surgery.
What is a scar?
A scar is an area of fibrous tissue that replaces normal tissue at the site of injury or surgery. A scar is the normal process of the body repairing itself.
All injuries and surgeries result in scars.
However, a hypertrophic scar or a keloid scar are not normal - these are improper scarring processes that are rare. Scars that actually get larger and more painful weeks to months after surgery may signal the start of hypertrophic or keloid scar formation. This is rare and usually related to genetics and skin type.
If you think you may be developing a hypertrophic or keloid scar, please let the office know as there may be ways to help mitigate this process.
What factors affect how my body will scar?
It’s helpful to think about factors that affect scarring as “pre-injury”, “injury”, and “post-injury”.
Pre-Injury
Injury
Post-injury
Genetics play a role - if your family members make thicker larger scars, you may also. Darker skin tones tend to make thicker, darker scars, while light skin tones make lighter scars. Also, because our skin thins as we age, older patients typically make thinner, lighter scars, while younger patients make thicker ones.
Traumatic wounds usually result in more scar tissue than careful surgical incisions, though both require scar tissue to heal. Wounds that take longer than 4 weeks to close do have a higher chance of developing bad scars - such as with burns and chronic wounds.
The main factor affecting scar appearance is time. Scars are raised, red, bumpy, and itchy for several weeks, take a few months to turn firm and purple, and a whole year to fully mature. In the post-op period, scar appearance and size can be improved.