Every patient wants to know how to treat their scars after surgery to obtain the best result. A few facts should be kept in mind:
– Scars improve with the passage of time. It takes a full year for a scar to reach maturity, and during that year the scar is usually pink, then purplish, perhaps a bit brown, and then the final color. Scars may also be a bit thickened at first, a reflection of the increased collagen that the body initially makes in a scar. With the passage of time, the body then remodels that collagen and absorbs some of it, giving the final scar.
– Many products and treatments are said to improve scars. The vast majority of them do not offer any benefit when scientific studies are done. The reality is that almost any treatment that is performed for a period of time will be accompanied by an improvement in the scar, but the same improvement occurs in untreated scars as noted above.
That being said, what do I recommend to my patients after their stitches are removed (if they have any that need removal) ?
– Wear a sun screen on the scar until its color reaches the non-pink, non-purple stage. Ultraviolet light can darken a scar in its early stages.
– Try to avoid stretching a scar for the first year. Stretching stimulates scar thickening by complex processes that are now being explored in laboratory studies. For that reason I will often suggest applying paper tape or silicone tape to a scar since it limits the amount of stretching that occurs. Not that the tape is that strong, but it pulls on the skin when it is stretched and this is perceived by your body as somewhat irritating. As a result, you tend to reduce the amount of stretching that you’re doing.
A recent article in the Annals of Surgery (ASJ 254:2, 217-225) looked at this topic in detail. Patients underwent tummy tucks and then a stress-shielding polymer (a sheet of sticky plastic!) was applied to ½ of the scar after 1 week for 8-12 weeks. The other half of the scar was untreated, and after 6-12 months, the scars compared. The treated ½ of the scar was rated better than the untreated side in 95% of cases, and was never rated as worse. This stress-shielding polymer is currently being marketed under the name Embrace Scar Therapy and information is available at embracescartherapy.com.
The essence of the polymer is that it is stretchable. It is stretched out and then applied to the skin where it sticks and then contracts to its normal size. Any attempt at stretching the scar is opposed by the polymer, thus minimizing the stimulus to scar tissue formation.
– If a scar thicken and shows no signs of thinning out, consideration is given to
steroid injections. Steroids will break down scar tissue and a series of these injections spaced by one month intervals is usually effective. Alternatively some patients choose to wear a paper tape impregnated with steroids. These steroids generally do not have any effect other than on the scar. Care is taken to inject the smallest amount that is effective so as to minimize side effects such as excessive thinning of the skin, prominence of the blood vessels, and other issues.
– Laser therapy may be used instead of steroid injections.
Occasionally a patient may develop a thickened scar that requires more sophisticated treatment. Should you have questions about this or other topics discussed in this blog, please contact my office.
Comments are welcome!
George Sanders, M.D.