Scars are the visible signs of surgery and injury that remain after the wound is healed. They are the unavoidable results of wounding the skin and their development is often unpredictable.
The most common question that patients ask me is, “Will I have a scar and if so, what will it look like?” Whenever there is a cut that breaks through all layers of skin, there will be a scar. But there are some tricks that make scars less noticeable and fade faster.
The Age Factor
Scarring is highly connected to the age of the patient. Babies in the womb demonstrate scarless healing. Although it is a popular subject in wound healing laboratories, scientists have not been able to explain this phenomenon. Furthermore, children inherently heal better than adults. Although it is unclear why, the increased amount of collagen, growing tissue, structural remodeling and chemical signals which occur during growth may play a role.
Just as in real estate, location is a key factor to having a better scar. Scars in areas of looser skin heal better than in areas of tension. Scars along joints which are moving heal worse than less dynamic locations. Scars on the back or knees often heal worse than on the face. Skin thickness, color and sun exposure also affect scar healing.
The scar will enter many phases before it’s final appearance. This process takes 1.5-2 years. The scar is about 60% of its original strength at six weeks. This is why many surgeons ask you to refrain from heavy exercise for the first six weeks after a procedure. During this time the scar is building and rearranging collagen. Over the next year, the scar will flatten and become more subtle as the collagen continues to rearrange.
Tricks and Treats
- Sun protection. Scars will darken if exposed to the sun. They will not tan in the same way as your normal skin. The new color will be permanent. It is important to use sun lotion with SPF 50 rain or shine.
- Cigarette smoking impedes the body’s ability to heal normally by affecting your blood supply. I recommend not smoking for at least one month after surgery…but even better if you never smoke again.
- Silicone Therapy. The only clinically proven scar reducer is silicone. It can be applied with equal efficacy as a cream or strips. Many patients will use the strips at night and the cream during the day. The silicone helps reduce itchiness and redness, hydrate the scar, and flatten the scar. Injured skin is unable to maintain an effective barrier to the outside world and becomes dehydrated. Silicone keeps the scar moist so that healing is faster and scars are thinner, less red, and less painful.
- Many patients ask if they should apply vitamin E to their scars. The secret to using vitamin E oil is likely not the vitamin but the oil, which similar silicone keeps the wound hydrated. Large amounts of vitamin E and A can be detrimental to wound healing. On the other hand, Vitamin C and Zinc have been shown to improve wound healing.
- During the healing period, scars can appear raised while they are remodeling. It is helpful to massage the scar twice daily to break up scar tissue and smooth out the scar. In essence, you are explaining to the scar what to do, creating a smoother, flatter more regularly textured scar. Massage can also help loosen scars that are adhered to deeper tissue layers so that the scar will not pucker. Often patients use a moisturizing cream to help slide over the skin during a massage and to provide additional hydration.
Scar revision is performed to reduce the appearance of scars. The goal of scar revision is to narrow, fade or reduce the appearance of the scar. There are several techniques used for scar treatments from steroid injections, dermabrasion, laser treatments, and medical tattooing, all the way to surgical revision. Surgical techniques may include excision, skin grafts, and local or distal flaps to help minimize the scar so that it appears more consistent with the surrounding skin tone and texture. The effectiveness of scar reduction depends on a number of factors, including the nature of the injury, your body’s healing mechanism, the size and depth of the wound, the location of the wound, and the color of your skin.
If you have questions about your scars or considering having a scar revision, please call our office at (212) 600-4109 to arrange for a consultation. Our New York City practice accommodates out of town and international patients who need to travel in for surgery as well as those who are local to Manhattan.