August 15, 2018

Ask The Doctor > Plastic Surgery > How Do You Manage Scars Post Surgery?

How Do You Manage Scars Post Surgery?

 

If you’re turning to plastic surgery to look younger and prettier, you might be disappointed to learn that your facelift, breast augmentation, or tummy tuck is likely to leave a scar. Many patients don’t realize this because they are less inclined to think of cosmetic surgery as true surgery. However, depending on the procedure in question, your surgery may be rather invasive and it may scar.

 

 

Lucky for you, there are things that you can do to minimize your scarring after surgery. Of course, let’s be clear on a few points. None of the techniques described in this article are guarantees. Not everybody is going to respond the same way to every technique. What’s more, there is no tried and true method for making a scar disappear completely. These techniques are for reducing scars; they aren’t magic tricks that will send your scars up in a puff of smoke.

 

 

Scars and Why We Get Them

First of all, a scar is nothing to be afraid of. Scars happen naturally when fibrous tissues bind an open wound together. Sometimes they fade and disappear, particularly when the wound is small or some efforts are made to help it heal (more on this later), but sometimes a wound is just too large and the scar inevitably sticks around.

Scars are also more likely to remain apparent if the deeper layers of the skin are damaged, making surgical scars more common (and sometimes more unsightly).

The Surgeon’s Role in Scar Prevention and Reduction

In truth, even the best surgeons can’t prevent scarring altogether. However, more skilled surgeons will create cleaner incisions that more easily heal, making any potential scarring less noticeable.

Plastic surgeons in particular are adept at hiding the location of scars so that small incision scars are virtually invisible. For example, breast augmentation incisions are often hidden beneath the fold of the breast, while facelift incisions tend to follow the hairline. In both cases the scar can only be spotted if you’re actively looking for it.

Being well versed in facial anatomy and understanding the emotional toll of facial scars, facial plastic surgeons will also conform incisions to the natural lines and creases on the face. If you’re interested in plastic surgery, rest assured that they have strategies in place to prevent any egregious scarring.

Complications From Surgical Scarring

Whether you get a scar from surgery or from crashing your bike, there is some potential for complications. Scars don’t always heal properly and when this happens, the results can be painful and embarrassing.

Painful scars occur when the incident that caused the scar damaged a skin nerve or when the nerve was pinched and damaged by the scar tissue itself. If your scar becomes painful, you should see a doctor for scar treatment options. There are no over-the-counter solutions that will eliminate scar pain, no matter what some products may promise.

Keloid and hypertrophic scars both occur during healing when the body overproduces collagen, causing the scars to “over heal” in a manner of speaking. Although they are very similar, keloid scars tend to be more extreme than hypertrophic scars, often resulting in bulbous raised tissue where a scar might have been. In some cases, they may only be a slight embarrassment. However, keloid scars in particular may sometimes become so bulbous as to be disfiguring.

Sometimes scars just may not heal well. If you’re inclined to pick at your scabs or your wound gets infected, you may find the resulting scar is puffy or obvious. Proper wound care may not be able to stop pain or overproduction of collagen, but it can go a long way toward keeping normally forming scars inconspicuous.

Scarring Risk Factors

Genetics plays a significant factor in how your scars form. Certain races are more likely to suffer from scarring complications. For example, dark-skinned people, particularly African Americans, are at a higher risk of hypertrophic and keloid scars. Of course, skin tone is not the only determining factor. You may also find yourself at a greater risk of scarring complications if one or both of your parents suffers from one of these types of scarring.

Age is another significant factor when it comes to whether or not an individual will scar. With age comes less elastic and thinner skin. Add to this exposure to the environment compiled over decades and the skin just does not heal the way it used to. In short, smaller wounds that would disappear on the skin of a younger person will be more likely to leave scars.

If you think you’re a risk factor for excessive scarring or scarring complications, talk to your surgeon about these concerns during your initial consultation. It’s likely he or she will be able to put your fears to rest.

At Home Treatment for Surgical Incisions

After having a procedure done, it’s up to you to follow your surgeon’s orders and properly care for your body as it heals. Doing this is the first step in preventing unsightly scars. If scarring is a particular concern for you, you should mention that to your surgeon and see what else he or she suggests.

In the meantime, follow these general tips for caring for healing wounds that are likely to scar.

  • Keep the wound clean and well-dressed. Your surgeon will tell you when it’s OK to remove certain bandages and will likely tell you how to clean the area. Never remove surgical dressings before your surgeon tells you it is OK.
  • Don’t mess with it. In other words, no picking or scratching at scabs. The more you interfere with your body’s healing, the greater the risk for infection or complications.
  • Use surgeon approved antibiotic creams. Note the words “surgeon approved.” Never use an antibiotic cream on a bleeding wound. After a wound has closed, consult your doctor before using a cream. If the doctor says no cream, then no cream.
    Doing all of the above and following your surgeon’s other care recommendations will increase the chance that the scar heals well and, therefore, is less visible.

Once a wound has healed completely, there will likely be a scar where the incision once was. If the scar is more visible than you’d hoped it would be, there are some things you can try to reduce the size and visibility of the scar. Remember that no treatment is guaranteed and there is no proven way to make a scar completely disappear.

  • Use sunscreen. Sun protection is just a good idea for your skin in general, as sun exposure can cause numerous skin complications. However, sunscreen can also help keep your scar less visible. To be honest, it does nothing to take a scar and make it smaller or smoother. It simply prevents the hyperpigmentation that comes along with tans and burns and can make a scar more visible.
  • Moisturize. The role of moisturizer in scar reduction has been up for debate. However, a 2012 study in the International Journal for Cosmetic Science examined the role moisturizers play in the reduction of keloid scars and determined that it had a positive effect. In either case, your skin will thank you for a little moisturizer.
  • Try silicone gel sheeting. Also called “silicone scar sheets” or “silicon gel pads,” these gooey adhesives are credited with reduction in hypertrophic and keloid scarring. Just apply the silicone sheeting to the affected area and let them work.
  • Massage your scar. Massage is credited with softening and flattening keloid scars. Massage is also often used to help manage pain and itching as scars are healing. It’s important to note that massage will not help with pain caused by scarring complications as mentioned above. It’s also important to consult your doctor before massaging a surgical scar. If you are still early in the healing process, massage may cause further damage to the area.

It’s important to note that the above treatments are typically most effective for new scars. Old scars tend to respond less to at home strategies. If the above strategies don’t work for you, don’t lose heart. There are other options for reducing the appearance of scars.

Medical Options for Scars That Won’t Quit

So you’ve followed all of the directions and tried everything you could, but that ugly scar seems to be sticking around for good. Don’t lose heart; your doctor may be able to help you where at home treatments could not. Consider the following options, and consult your doctor about what he or she thinks is best.

  • Laser resurfacing. This technique, which involves removing layers of skin in targeted areas via lasers, is often used to treat scarring from acne or stretch marks. However, laser resurfacing, also known as laser scar removal, has been shown to be effective against more established scars, like keloids.
  • Dermabrasion. This technique uses a revolving tool to brush away the top layers of your skin and, in doing so, removes scar tissue. If this sounds too intense, you could opt for the lighter option, microdermabrasion, that only acts on dead skin. However the later will not be nearly as effective against substantial scars.
  • Cortisone injections. A cortisone injection is a steroid injection that softens skin and helps hard scars (like keloids and hypertrophic scars) to shrink. Understand that steroid injections may need to be done in stages.
  • Scar removal surgery. This must sound ironic given that surgery is what caused your scar in the first place. Surgical scar removal involves removing the scar and reattaching the skin. It would basically be a do-over for the healing process and should only be considered if there was a complication from scarring. If your scar is reasonably well healed and you just wish it was less visible, this option would only take away one scar to replace it with another.
  • Scar revision surgery. Surgical scar revision is a less intense form of surgery that doesn’t involve removing the scar completely. Instead, it adjusts the scar to reduce its visibility by making it blend in more with your skin.

The options listed above are among the most common strategies for dealing with scars. They are not, however, the only ones. Your doctor may also talk to you about techniques like punch grafts and cryotherapy. Certain other techniques, like skin grafts, are more suitable for other types of scarring.

Don’t Be Fooled By False Promises

If you’re looking to reduce an existing scar, you’ve probably already started the internet hunt. In fact, that’s likely what landed you here. It’s probably safe to assume that you’ve come across promises that creams containing Vitamin E or cocoa butter will reduce the visibility of your scar within days if not whisk it away altogether.

Let us reiterate that there is no cream in any store that will make your scar disappear. What’s more, there is no scientific support suggesting that either Vitamin E or cocoa butter are effective against scars.

You may have also noticed several scar reduction strategies that we didn’t mention here. For example, bleaching creams can help lighten the appearance of certain types of scars. They are particularly effective against severe acne scars or strongly discolored scars. However, they are not typically effective for scars as substantial as those caused by surgery.

When considering at home treatments, remember that there are numerous types of scars (from burn scars to stretch marks). The treatments we’ve shared with you are the ones most effective for surgical scars and complications that could arise from them.

Be patient!

It can take up to twelve months for surgical scars to completely heal. If your scar is extremely noticeable a week after your procedure, give it time and wait for the swelling to go down before you panic.

What’s more, no scar reduction strategy will work overnight, so stay committed. For example, if you massage your keloid scar and don’t see results in a few days, don’t sweat it. It could take weeks or longer, and the results will be extremely gradual. Even medical solutions, like dermabrasion, will take time. The surgical procedure itself may happen in a day but it will come with its own recovery time.

Patience and persistence are your best allies in the fight for better looking and healthy skin.

 


Ask The Doctor
    Ask The Doctor

Dr. Kunaal Jindal

Dr. Kunaal Jindal received his medical degree from the University of Manitoba and completed his residency in Plastic Surgery at the University of Toronto. His education and training has been further enhanced by an Oculoplastic and Aesthetic Surgery fellowship in Atlanta, Georgia and a Hand & Wrist Surgery fellowship at Toronto Western Hospital.

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