Scarring & scar prevention

Incisions, suture lines and scars are a necessary part of surgery. These lines take many months to fully heal. There is no guarantee as to what a scar will look like once it has fully healed, however the following instructions are important to achieving optimal outcomes.

Scar massage is important to help your incision mature into soft, non-problematic scars. Massage does this by promoting collagen remodeling, increasing moisture and pliability, and decreasing itchiness. Your surgeon will let you know when it is OK to begin scar massage, but generally this will be about two weeks after your surgery.

• Apply lotion of your choice to scar
• Massage in firmly with your fingertips
• Move your fingers in circles, top-to-bottom, and side-to-side
• Repeat three times each day, 5 to 10 minutes each time

There is no reliable evidence that starting anti-scar treatments will make what would have been a normal scar “heal better.” Therefore, these treatments are recommended for patients with a history of problem scars or for those who are developing a problem. However, if you feel compelled to purchase an ‘anti-scar’ treatment, we would recommend ScarGuard® and ScarFade®.

Problem scars are either referred to as hypertrophic scars or keloids. Hypertrophic scars may be raised and red but are confined to the border of your initial incision. Keloid scars, on the other hand, are raised, itchy or even painful, and extend over the border of the original incision.

Management of problem scars is extremely difficult. Numerous treatments exist and can include adhesive paper tape, silicone gel sheeting, pressure therapy, steroid injection, laser therapy, surgery, and even radiation. Despite treatment, these scars may not improve or may recur in over 50 percent of cases. There is no good evidence that starting scar treatments will make what would have been a normal scar “heal better.” Therefore, these treatments are recommended for patients with a history of problem scars or for those who are developing a problem. However, if you wish to use a product we would recommend ScarGuard® and ScarFade®.

In general, keeping a hypertrophic or keloid scar moist will help to alleviate symptoms. Any topical moisturizer (Eucerin®, aloe vera, Vaseline®, mineral oil, etc.) applied several times each day is recommended. Also, Benadryl® or other over the counter antihistamines may improve itching and discomfort.

Of the many products available for problem scars, silicone gel sheeting is one of the most widely accepted treatments for hypertrophic and keloid scars. Although the mechanism by which silicone sheeting works is unclear, it is a standard treatment and may be recommended by your surgeon.

1. Trim sheeting to cover your scar
2. Apply as directed to cover scar, sticky side down
3. You must wear the silicone for at least 12 hours each day, more if possible

Some examples of silicone sheeting products that we recommend are the following:

• CICA-CARE (Smith & Nephew)
• SILASTIC® gel sheeting (Dow Corning)
• Mepiform® (Molnlycke Health Care)

Your surgeon may inject a steroid into your scar in the office. This is usually done every 4 - 6 weeks for several cycles. Side effects include hypopigmentation (decreased skin pigment) and thinning of the skin.