Whether the result of a surgery or a traumatic injury, a poor scar can leave patients with unsatisfactory results and psychological distress. Contrary to popular opinion, plastic surgeons do not perform “scarless” surgery. Each plastic surgery procedure trades the creation of a scar for an improvement in the shape or contour of the face or body. Plastic surgeons are trained, however, to minimize a scar’s appearance using a combination of surgical techniques and adjunct therapies.
Over-The-Counter Therapeutic Strategies:
- Moisturizer – An important piece of any skin care regimen, a moisturizer helps keep skin soft, supple, and hydrated. Once a wound has been cleansed, and there is minimal risk of infection, consistent moisturizer use will speed healing and improve long-term results. Moisturizers will also prevent wounds from scabbing, which should be avoided for the best cosmetic result. Over-the-counter ointments, such as Aquaphor and Eucerin, are excellent options, and they can be used for a variety of other skin maladies, including chapped lips, dry skin, and eczema.
- Sunblock/Sunscreen – UV radiation from the sun is one of the most underappreciated risk factors that can lead to poor wound healing and scar appearance. Regardless of an area’s climate, it is important to maintain consistent use of a sunblock on any incision for six months or more. Look for sunblocks that list titanium dioxide or zinc oxide as their active ingredients, as both act as physical barriers to all spectrums of UV radiation and require only once daily application. Sunscreens, which physically absorb UV radiation and as a result become degraded from sun exposure, necessitate repeated application during the day. When choosing a sunscreen, ensure that it has multiple active ingredients, such as avobenzone and octinoxate to cover the full UV spectrum. A sunscreen or sunblock can replace the moisturizer in your daily scar management routine and can later be used as part of an overall skin care regimen.
- Physical Barriers – If a sunblock or sunscreen is unavailable, then use of physical barriers can aid in scar prevention. To minimize an incision’s UV exposure, as well as the likelihood of scarring, patients should wear dark colored items of clothing and cover the affected area with band-aids or medical tape.
- Silicone Sheeting – We do not know how or why silicone sheets work, some believe it’s a pressure phenomenon, and others think it lowers the oxygen tension across the scar surface. Regardless of its mechanism, what we do know is that silicone sheeting is an inexpensive therapy used to soften and flatten scars. The sheets can be trimmed to the size of the incision and are reusable.
Physical Scar Manipulation Strategies:
- Scar Massage – Used in conjunction with a moisturizer, scar massage aids in softening and flattening scars that are partially healed, still maturing, and in the process of remodeling. Scar massage also helps in desensitizing scar tissue and the surrounding skin. Proper instruction by a plastic surgeon must be given to help speed healing, while minimizing the risk of a wound separation.
Physician-Directed Medical Strategies:
- Retinol/Tazorac – The same products used for skin rejuvenation will allow for quicker recovery and more rapid scar maturation and fading. When applied to incisions and wounds, these medications will help turn over your skin cells faster, accelerating the healing process.
- Bleaching Creams – Injured skin often darkens relative to the surrounding skin as a result of direct injury, as well as exposure to UV radiation. Used in conjunction with retinols, bleaching creams can help fade a scar’s appearance.
- Corticosteroid Injections – For those patients prone to hypertrophic scars and keloids, injections of cortisone into the scar can help them soften and flatten, while removing redness and any itchy sensations.
Surgical Scar Improvement Strategies:
- Subcision/Filler – Some scars become tethered to the underlying tissues of the face and body leading to contour irregularities and unattractive shadowing. Subcision involves the creation of a small puncture near the location of scarring, and a needle is used to release the tethering bands. Once the scar tissue has been released, small amounts of fillers can be placed to elevate the scar to the level of the surrounding skin.
- Surgical Revision – If a scar does not respond to more conservative treatments, and the skin has fully healed, removal of the old scar can be performed and a re-do attempted to make the new scar thinner and less noticeable.
A scar will flatten, thin, and fade in color for over a year or more from the time of injury. Though the measures discussed will not prevent the formation of, or “erase,” a scar, diligent care can lessen a scar’s appearance.
As an Emory, Harvard, and University of Pittsburgh-trained, ASPS board-certified plastic surgeon, Dr. Castillo welcomes the opportunity to discuss any skin care or scarring concerns that you may have, and he is happy to individually tailor a treatment regimen that can best address your particular concerns.
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