Scars are the body’s natural mechanism to repair full thickness damage to the skin. All scars have the same natural course in their healing. They all start out tender, thick, inflamed and red. As time passes the tenderness resolves, the inflammation settles down and the thickness subsides. Scars tend to remain red for a long period of time during healing. They can change color to purple and sometimes remain that color for many months while they mature. The overall scar maturation process takes about a year.
Plastic surgery requires the placement of incisions in the skin. It is, however, the way in which the scars are managed after surgery that can have a profound effect upon the quality and aesthetic appearance of the scar. A significant factor in wound healing and scar appearance is the technique used to close the incision. This process is determined by the plastic surgeon and the patient has little influence on this portion of the healing process.
After surgery the patient will have the biggest influence on the way the incision heals and the scar develops. Here are 4 things that you can do to minimize the appearance of the scar.
- Keep the Incision Clean. Your surgeon will have given you instructions on how to care for your incision. Follow those instructions carefully but be sure to always keep the incision as clean as possible. A wound infection will have the greatest influence on a poor scar. Always wash your hands before touching the incision or the dressings. Keep the wound covered and protected from bacteria and put antibiotic ointment on any small open areas. Larger open areas, if they occur, will need specific instructions from your surgeon to manage. Notify your surgeon if anything about the incision looks questionable.
- Protect the Scars from UV Radiation. Damaging UV radiation from sunlight or tanning booths not only causes premature aging of the skin and increases the risk of developing skin cancer but it also has a detrimental effect on healing and maturing of scars. Scars subjected to UV radiation will be thicker, redder and more noticeable. If your scar is going to be exposed to sunlight, protect it with plenty of sunblock or be sure that it is covered.
- Apply a Silicone Scar Treatment. There are a number of scar treatments available. The ones that work best are all silicone-based. They come in either silicone gel sheeting that is applied over the scar or as a silicone gel ointment. The silicone ointment that we’ve had the best experience with is made by BioCorneum. It has a secondary advantage in that it already has a sunblock in it. For either the silicone sheets or the gel to work effectively, they must be used as much as possible for several months starting as soon as the incisions are healed after surgery.
- Minimize the Tension on the Scar. Scars respond to stress on the incision. Scars that heal under tension generally are wider, thicker and more noticeable. Anything that can be done to decrease the tension across the incision will allow it to heal in a thinner, less visible fashion. While facelift incisions usually have very little tension on them, other scars such as breast lift scars and tummy tuck scars tend to have much higher forces across them. For breast lifts/reductions we recommend wearing a bra that supports the breasts and takes the weight off the incisions during the healing process (8-10 weeks). Tummy tuck incisions are more difficult to support. There is a relatively new product available that seems promising called Embrace Scar therapy. It consists of a wound dressing that pulls the skin edges closer together taking tension off the incision/scar and allowing it to heal with lower forces across the incision.
Finally, if you have older scars that have healed poorly, there is always the option of having a scar revision performed. These can usually be done in the office under local anesthesia. Always follow the directions of your plastic surgeon and you can have the best looking scars possible.