Plastic Surgeons are in a constant battle with scars. Most of the time we actually win. We have a lot of tricks to keep them small, hidden and (hopefully) as close to invisible as possible. But we also have some time-tested methods that our patients need to know and they need to utilize for the best results. Whether a scar is from surgery of any kind or an accident, following these tips and guidelines will tend to yield the least visible and most inconspicuous scars. Remember though, you should always discuss with your board certified plastic surgeon all specific issues regarding your individual care or scars you may have.
Scar maturation is a slow process that typically takes from 9 months to 18 months to be finalized. It is important to understand that although there may be thickening or redness associated with a scar for the first few weeks or even months, most of the time these issues substantially resolve with a much improved appearance by 12-14 months. While some scars may be objectionable early on, it is usually best to wait until this full maturation process has been completed before implementing any significant intervention. Most often, there is enough natural improvement that surgical revisions or special interventions are not even necessary.
Even if surgical improvement is ultimately needed, it is also usually far less intense than what would have been anticipated if done earlier (and prematurely). In general, as long as a scar looks slightly pink or red, it is still undergoing active maturation. In children, this maturation process may be further extended by periods of active growth, which generally results in continued improvements as well. If a scar seems to be growing in size and getting thicker as time passes rather than thinner, or is developing increasing redness rather than lightening, you should bring this to the attention of your plastic surgeon right away. This sort of behavior by a maturing scar could be indicative of an impending keloid or hypertrophic scar – conditions which usually warrant earlier intervention.
Maturing scars must be protected from tanning rays(UV radiation) for a good 6-12 month period; this includes both the sun and tanning salons. Sun exposure, whether in winter or summertime, can result in permanent, dark pigmentation spots in or around areas of scar known as “hyperpigmentation”. This is often a permanent pigmentation change in the skin which is virtually impossible to eliminate by any means. With the use of sun blockers (SPF 30 or higher, frequently and regularly applied) use of baseball-type caps or hats, umbrellas, shade seeking, and avoidance of the peak hours of sun exposure (11am – 2pm), this dreaded complication can be avoided. Once the one year period has passed, this tanning sensitivity and hyperpigmentation risk will be essentially equal to that of normal, uninjured skin. At that point, you don’t need to worry about hyperpigmentation anymore. Even so, we recommend the continued lifelong success strategy of using sun blockers and avoiding those tanning rays to decrease your risk for developing skin cancer and to prevent wrinkles and aging of the skin!
In the early phases of your recovery when the healing process has been completed, any sutures have been removed or dissolved, and you have been officially released from any/all restrictions, the massage-like application of a high quality, hypoallergenic, moisturizing agent twice a day for at least 3-6 months is of great benefit. Massaging of the general area is more important than simple application. Several minutes should be spent gently massaging the entire area surrounding and including any specific scars.
This “physical therapy” applied early and throughout the course of the maturing of a scar tends to make scars progressively flatter, softer, more supple, smoother and more regular. The moisturization aspect also helps to produce more pleasing long-term results because maturing scars and the areas surrounding them tend to dry out easily and really do need a lot of extra moisture supplied to them regularly. Stay away from any expensive perfume containing or scented products which can cause irritation problems.
Silicone containing creams and self-sticking silicone sheets represent a very successful and fairly inexpensive way of minimizing scar formation during the maturation phase as well. Believe it or not, no one has ever really figured out why or how this technique actually works – but it does! Silicone sheets are worn as close to 24 hours a day as soon as the wounds have healed. If you have had problems with poor scar formation or keloids in the past, this is definitely the way you want to go. Silicone sheeting application has even been shown to be of value in scars 2 or more years old, previously believed to be completely stable and fully matured to the point that they shouldn’t respond – yet, they often do!
Your plastic surgeon will generally ask you to follow-up with regard to your final scar appearance in about a year when the maturation process is essentially complete. This is an appropriate time to discuss any concerns you may have and review what options are available to make further improvements if desirable (and possible). Surgery, special medication injections and lasers are options that have all been proven to be of benefit in a variety of situations involving unacceptable scars.
Dr. Lyle Back is originally from New York City, receiving his medical and surgical training at Rutgers Medical School, Cooper Hospital – University Medical Center, and Ohio State. He is Board Certified in General Surgery (ABS) and Plastic Surgery (ABPS). He is a Fellow of the American College of Surgeons (ACS), the American Academy of Cosmetic Surgery (AACS), and a longstanding member of the premier American Society of Plastic Surgeons (ASPS). He served as a Professor of Plastic Surgery at Temple University and St. Christopher’s Hospital for Children and performed reconstructive surgery with “Operation Smile” in Vietnam. He specializes in the full range of the most modern and state of the art cosmetic surgery procedures for the body and non-surgical cosmetic enhancement techniques available today.
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