The emotional and physical investment in surgery, whether aesthetic or medically required, is huge: any changes made to your body are big ones. Inevitably, that emotional and physical investment will manifest itself in a scar—even the most skilled plastic surgeon is still cutting skin, and therefore creating a scar. In other words, scars (and their treatment) is a topic that affects nearly everyone. Recently, a reader reached out wondering how best to prevent, manage, and erase her scars. Read on.
Q. Charlotte’s Book Reader:
I just found your site, and the timing could not be better. Yesterday, on my 41st birthday, I had the big unveiling of my recent skin cancer surgery. Skin cancer was no big surprise after growing up on Florida’s east coast beaches, but learning that I have a family history of skin cancer didn’t help my case. Luckily the unsightly “sun spot” turned out to be a basal cell carcinoma and not a melanoma. Whew! That was a relief.
However, after a week of wondering what was under that bandage on my left cheek, I now see that I have quite a scar, and it isn’t pretty. Is there anything I can do to make it look better?
My plastic surgeon suggested that I massage it nightly to reduce the hardness and hopefully flatten it out a bit. Also, he suggested I use a product called bioCorneum, a collagen-building serum. I was wondering if your team was familiar with this product and if they have any other suggestions for lessening the appearance of facial scars? With the incidence of skin cancer on the rise, particularly in younger patients, I bet there are quite a few readers dealing with this. It seems most articles related to skin cancer are talking about how to prevent it—I’d like to see a story that focuses on what to do after you get the diagnosis and specifically what to do post surgery.
Dear reader: we hear you, and we agree. To ask the tough questions about post-op scars, we reached out to two Charlotte’s Book doctors, a plastic surgeon and a clinical dermatologist. Sophie Bartsich, MD, is a plastic surgeon practicing in New York City and Long Island. Mitchell Kline, MD is a clinical and cosmetic dermatologist practicing in New York with an ongoing focus on melanoma detection and treatment. Their detailed, insightful answers here.
ANSWER 1 — Mitchell Kline, MD:
Your patient has the right attitude. The most important thing is to avoid scars by being pro-active about preventing future skin cancers with sunscreen, but even past sun damage can be reduced by using a potent topical niacinamide such as Heliocare, which may be purchased over-the-counter. Niacinamide pills are also an option, especially Nicomide. At least one good study reveals a dramatic reduction in the formation of basal cell and squamous cell carcinomas in patients who take this antioxidant pill; it has also been used as an anti-inflammatory for acne and rosacea.
Scars take approximately 12 months to heal, and steadily improve during that time. It’s important to have a scar reassessed any time it appears to be changing, or if it doesn’t follow the expected program of smoothing and disappearing. An expert should also take a look if the scar is raised, red, or itchy—these could be signs of keloid or hypertrophic scars.
Techniques for Minimizing Scars: What Works Best?
The use of topical silicone patches and creams, which prevent water from escaping the skin, are vital to improving scars by decreasing scar tissue formation. Overall, I prefer bioCorneum, especially with large surgical scars. Injection of cortisone into the scar, or mixing cortisone with a chemical called five fluorouracil may also help flatten a raised scar. Redness and brown staining may be reduced using various lasers and IPL therapy, and microdermabrasion, laser abrasion, and fraxel can help smooth scars. Of course, these techniques should only be performed by an expert, so make an appointment with your doctor.
When Should I Schedule These Treatments?
While scars take approximately 12 months to “mature,” there are many individuals and many studies suggesting that earlier intervention with fractional lasers, laser abrasion, and dermabrasion as well as submission or PRP and other treatments are more effective earlier in the course of scar healing. I personally prefer intervening earlier in the course, depending on where the scar is located, how wide the scar is, and how I feel the scar has healed. After diagnosis, it’s clear that particular procedures will help certain scars more.
Notes On Massage + Sun Exposure
Massage is extremely effective, but shouldn’t be initiated until healing is complete and the surgeon has confirmed it’s safe to do so. Do not expose scars to the sun: this is a major rule. Not only will discoloration occur, but scars are more prone to developing skin cancer from sunlight exposure.
ANSWER 2 — Sophie Bartsich, MD, FACS:
Any time you cut through skin, you will end up with a scar. Scars are the body’s way of gluing tissue back together. They happen to everyone, and they are there forever. Genetics, environment, and where on your body the scar is all contribute to how good or bad it will look in the end. Sometimes patients ask me if their scars can be removed down the road, if they get plastic surgery. Unfortunately, there is no magical scar eraser; there are ways to minimize scarring and end up with the best cosmetic result possible.
The Scar’s Timeline
When a cut happens, for one reason or another, it goes through many phases before it finally settles into what it will ultimately look and feel like. It takes about a year and a half to two years for a scar to be fully mature, so don’t expect to look at your scar three months after it first started and see a nearly invisible line. These things take time. Scar tissue will try to flatten and soften on its own over time, and it is during this long phase of scar maturation that you have the opportunity to intervene and maximize the scar’s potential, or make it look as good as you possibly can. And as with most things in life, an ounce of prevention is really the only way to get where you want to go.
A Treatment Plan
So you have a fresh new scar, and you’re ready to do whatever it takes to make it look as good as possible. What do you put on it? How do you protect it? There are so many lotions and potions out there, it’s hard to know what works. The short answer is: not much does. But the good news is that there are a few simple principles, and a few technologies that can make a difference in making that mark fade from view.
If your scar is the result of surgery or a cut, having it repaired properly is a key to success. Regardless of who performs your surgery, consider having the wound closed by a properly credentialed plastic surgeon. Plastic surgery principles will help line up the tissues and avoid tension on the repair, both of which are key to starting your healing off on the right foot.
Once the wound is repaired and healing, the number one factor in avoiding scar darkening is sun exposure. Over the course of its maturation, a scar will pick up sun pigment differently than normal tissue. Instead of tanning and then fading, it will pick up color slowly but continuously, in a pretty much irreversible manner. Sunblock therapy is the most important element in cosmetic scar healing, and I recommend daily sunblock for almost all healing wounds, rain or shine.
How Massage Can Help
The next key to optimizing your scar is massage. During that year and a half that the scar is maturing, it is continuously changing its structure. Routine massage can tell the scar what to do, or how to remodel itself. It can suggest “flatten” or “smooth,” leaving a much more regular texture to the scar. Massage therapy should be performed daily for several months in a row to maximize its benefit.
The last key element to scar optimization is silicone gel. It is one of the only scientifically proven materials that can help scars fade and sometimes even flatten. Silicone therapy is the basis of many well-known scar treatment creams, and the evidence is there to back it up. Biocorneum—the one your reader mentions—is a product only sold through doctors’ offices. It has the benefit of being a silicone gel and sunblock combined, and has the best chance of any product to minimize your scar in the long-run.
Whatever you decide to do for your scar, make sure you communicate with your provider. Remember that anything you put on your scar is relevant, even if it’s a homemade potion that you don’t consider to be a “medication.” I have seen patients take a beautiful wound and turn it into chopped steak by rubbing everything from calendula oil to “frog” lotion on it, because someone told them it would work. Less is more when it comes to making scars look their best. Slow, continuous pressure, and the discipline of a focused routine will help translate your expert’s recommendations into scar success.
CURIOUS ABOUT OUR EXPERTS? LEARN MORE:
Dr. Mitchell A. Kline is a board-certified clinical dermatologist with a private practice on the upper east side.
Dr. Sophie Bartsich is a board certified plastic surgeon specializing in aesthetic and reconstructive surgery.