Getting the best scar possible

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(aka: Scar Care)

Whenever an incision is made, there will be a scar. I make every effort to hide scars in unobtrusive regions, and I want them to heal as well as possible. All scars go through a normal evolution while they are healing, and there are some things we can do to help scars look as good as possible. I think it is best to understand how scars heal, so that you know what to expect.

Right after surgery, sutures are used to hold the skin edges together. Until the epidermis (top layer of skin) heals across the incision, there may be some scabs present. If your incision is covered with a steri-strip, you do not need to do anything. If it is open to air and you see scabs, I recommend using topical antibiotic creams such as polysporin or bacitracin, for the first 10 to 14 days after surgery.

Once all scabs have disappeared, the epidermal layer has healed. The scar tends to look very thin at this time. Under the skin surface, a significant amount of work is being done on the scar: your body builds up un-organized collagen around the incisional site similar to how workers bring building supplies to a construction site. This process continues for about 6 to 8 weeks after surgery, and the scar begins to feel thicker as a result. To assist with this phase of scar healing, I do recommend active scar care. Not everyone will need it, but unless you have a similar previous surgical scar, we do not know how you will heal as an individual.

The most recent advance in scar treatment is a product named Embrace. Mederma with SPF It combines the old gold standard of scar treatment (silicone sheeting) with active tension release over the scar. Please read this page to learn more about it. For high tension scars such as an abdominoplasty, I recommend that you consider this using product. If you are not going to use Embrace, then I recommend we follow my old protocol:

My old first-line choice is Mederma Advance. This is a once-per-day cream that is easy to apply, and is generally well tolerated.

ScarGuardMD (www.mederma.com)

My second recommendation is ScarGuard MD. It paints on like nail polish, and will then flake off throughout the day. I recommend this if you dislike Mederma for some reason, or if hyperpigmentation is an issue (in which case you should also use Scarlight MD in conjunction with ScarGuard.)

(www.scarguard.com)

All of these products have been shown to accelerate the resolution of the thickening of scars. The old gold standard for treating scar thickening is the use of silicone sheeting, however it is very hard to be compliant with wearing the silicone sheet (24hrs a day, 7 days a week) to receive the benefit. I like to evaluate your scars at 6 to 8 weeks so I can let you know if they are healing normally, or if I would recommend the use of silicone sheets. NewGel If you want to be as aggressive as possible and use the silicone sheets early, I recommend purchasing either ScarFx or NewGel. Both have template sheets that work well for a variety of incision types.

GelZone Wrap A patient of mine recently showed me a very nice product for use after abdominoplasty or body-lift operations. Implantech manufactures a product that combines both silicone scar therapy with gentle compression: the Gelzone Wrap. As this product has velcro tabs, it solves the problem that occurs with other silicone sheets that tend to roll over or fall off.

These scar therapies are aimed at making the scars flat. Scars will be red while they are maturing, and I discourage you from getting your scars "lasered" to get rid of the redness. The redness of immature scars is caused by the extra blood supply that your body brings to heal the scar, as well as the myofibroblast cells present in the scars. These are the cells that are responsible for making the scars contract or shrink, so if they are lasered away, you are short-changing yourself by not letting your body optimally shrink the scar. While the scar is still immature and red, I do recommend the use of sun block on the scar. If you get a tan on an immature scar, the pigment will get trapped and make the scar more visible for the rest of your life. Once the scar is mature and white, you do not need to worry about sunblock.

Scar Maturation Video

Flash video showing time lapse photos of a tummy tuck scar maturing.

These photos show the usual changes associated with tummy tuck scar maturation. The first time point is taken 2 weeks after surgery, and the scar is very visible. Suture "dents" are seen along the running suture, and scabs are still present. After 6 weeks, you can see the belly button is higher because the skin has stretched out a bit and the patient is standing straighter. The scar is a bit smoother (but still very immature). The edema (swelling) is readily apparent as her underwear left a significant impression on the abdomen. Over the next several months you see continuted improvement in the scar appearance, but different sections are maturing at different rates. (This patient utilized Scar Guard for the first 3 months). At almost a year, the scar is maturing nicely, but there is still significant hyperpigmentation in the central region.

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