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Lotions, Potions, And A Hat: A Plastic Surgeon's Scar Management Plan
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. 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, but there are ways to minimize scarring, and end up with the best cosmetic result possible.
Scars And Aging — Factors Beyond Our Control
A big part of how your scar will turn out depends on age. As you can imagine, younger people will heal wounds better than older ones. Babies in the womb actually demonstrate scarless healing, by mechanisms we don’t completely understand. As a general rule, the same injury in a small child as compared with an adult will have a very different outcome. Part of this may be due to the impact that growing tissues have on wound healing, and all the chemical signals and structural remodeling that go along with it. The rest of it remains a mystery, but a very real phenomenon.
Another important element of scarring is where on the body the scar is located. The same skin on the same person will behave very differently depending on whether it is part of the face or on the back. Skin thickness, color, and sun exposure all come into play. As a general rule, a scar on your back will rarely ever look as good as a scar on your face. The good news is that the face gives us the most leeway; and face scars usually heal very well in the long-run.
But an even greater factor in wound healing is your genetic makeup. If you are someone who heals wounds well, then this will always serve in your favor. That being said, there are many things that could happen to a wound that would give you a less than ideal result, but your body’s natural ability to smooth things out is a huge player in the scar-care game.
Routine Healing — A Longterm Process
With the exception of problem healing like keloids or hypertrophy, most wounds go through the same long process in order to form a scar. 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. That is another reason why it is usually not a great idea to revise, or re-do, a scar very early on in the healing process. You may have ended up with a great-looking scar if you had waited a bit longer, and repeating the cut just starts you back at square one. Ultimately, scar tissue will try to flatten and soften on its own over time, and it will usually regain most of its original strength as well. 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 much as with most things in life, an ounce of prevention is really the only way to get where you want to go.
S-c-a-r-s Therapy — A Helpful Acronym
So you have a fresh new scar, and you are 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.
“S”un. The number one factor in 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. The color will be different than a regular tan, and its lasting power will overcome most other efforts to minimize the scar. In other words, even if you do everything else that you can to overpower it, a scar will usually be much more obvious in the long run if it was exposed to the sun in its early phases. Sunblock therapy is the most important element in cosmetic scar healing, and I recommend daily sunblock for almost all healing wounds, rain or shine.
“C” There is a lot of speculation and some science around vitamin therapy for wound healing. Most people believe that vitamin E holds the answer, and the more you smother on your scar the better it will be. This is a huge scar management myth. The truth is that, in large amounts, vitamin E actually hurts wound healing. Vitamin C, on the other hand, has some anti-oxidant properties that can help with wound management and even anti-aging. It has a mild effect on reversing sun damage, and is a key element to anyone’s diet. I usually recommend vitamin C creams in the later phases of scar management, or as a treatment for the after-effects.
“A”cupressure, or targeted massage, is a key element in scar management. Unsightly scars usually have either a pigment problem or a texture problem. Massage is the trick for the texture part of the issue. 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 can also help loosen scars that are stuck down to deeper layers, or those that won’t allow the skin to move the way it should. Massage therapy should be performed daily for several months in a row to maximize its benefit. Using a lotion or cream is optimal to help slide over the skin and hydrate the tissues below.
“R”epair. If your scar is the result of surgery or a cut, having it repaired properly is a key to success. The layers of the skin must be lined up in the just the right way, with no tension and using the right materials, to start you off on the right foot. Many emergency room physicians can perform a straightforward laceration repair, but a properly credentialed plastic surgeon is your best bet for short and long-term management toward the best-looking scar you can get.
“S”ilicone. One of the only scientifically proven materials that can help scars fade is silicone gel. Silicone gel contains properties that help the skin fibers lay down straighter so that the scar looks more uniform. This translates into a smoother and less visible mark. Silicone therapy is the basis of many well-known scar treatment creams, and the evidence is there to back it up. Many scar creams also contain other components like vitamin E and aloe, fillers than can ultimately interfere with the main ingredient. You generally should look for a product that is basically just the silicone gel, without all the noise around it.
My Preferred Scar Treatment Recipe
When I tell my patients that they will have a scar, they sometimes ask me why. “Isn’t this plastic surgery?” they ask. While scars are unavoidable, it is often possible to make them fade so much that they can barely get noticed. A good repair followed by the right bandage is the first step. Good nutrition is also important, and stopping smoking is required. After the first few weeks, the recipe is simple: sunblock in the morning and silicone gel at night every day for 10-12 weeks, followed by daily sunblock therapy for the rest of the year. Long-term darkening can be treated with skin bleaching creams (although they have some known toxicity) or lasers, but the best treatment is to prevent that pigment from getting in there in the first place. If you weren’t able to follow through with these recommendations or you did but the scar still looks bad after your year and half of maturation, there are rare cases where cutting it out and starting all over can be the answer.
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.
Photo: The one and only Padma Lakshmi, who makes scars look gorgeous.
For each scar, a different approach: here's a look at treating acne scars. Dr. Sophie Bartsich also wrote about why there's no such thing as the standard "B" cup, and what subtle adjustments your modern, rugged man might get.
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