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How to Properly Care for Your Scar

Image by Alexander Van Steenberge

Congratulations on getting through the hard part! As plastic surgeons, scars are important to us- and we know they are important to you. In many instances, surgical incisions cannot be avoided to obtain the best results. Rest assured we will do everything we can intra-operatively to minimize scarring and to hide incisions. At the end of the procedure, you will be well on your way to a great outcome. This information is designed to make sure you have the best, most scientifically accurate information on scarring at your disposal. It is important to remember that 100% of healing will occur after you leave our facility (we put things in position, your body does the healing)! Therefore, it is very important that you take care of your incision to get the best possible outcome.

 

The final outcome of a scar is related to technique, genetics, and postoperative care. I use multiple layers of suture as a technique to minimize scarring. Genetics are mostly out of our control, but please inform me if you are prone to keloids. For a recurrent keloid, alternatives to the following may be necessary such as injections or radiation therapy. Otherwise, postoperative care is a significant factor in the final outcome of a scar.

 

THE FIRST TWO WEEKS

Initially, your main goal will be to keep your incision clean. It is common to be nervous or uncomfortable with a fresh surgical wound and not clean the area around the incision- this is bad! Clean is good! Different incisions may have specific bandages on them which will require specific care. In all cases, protect your incisions from sun exposure. Take a look at your incisions, the type of closure will change the way you need to take care of your incisions:

  • Under surgical tape (steri-strips): This tape is designed to take tension off of the wound. You do not need to do anything to the incisions until the tape falls off. The tape will fall off on its own or will be pulled off in the office (or you can pull it off after 1 month). If the tape begins to raise, you can trim the edges. You may shower with soap and water.

  • Colored Sutures: Black and blue sutures are permanent and will be removed from the incision once wound healing occurs, generally 5-15 days after surgery. For the first 4 days, use peroxide on a q-tip to clean any dried blood and scab from the incisions and to clean the areas. The area should be totally clean before applying a moisturizer (we highly recommend Aquaphor, an over the counter product widely available). Apply Aquaphor (regular formula) twice daily. You may shower with soap and water.

  • Clear or Yellow Sutures: Clear or yellow sutures will absorb on their own. As they absorb, they will appear to be falling out. Sometimes, long ends are left out of the skin and will be clipped after 1-2 weeks. For the first 4 days after surgery, use peroxide on a q-tip to clean any dried blood and scab from the incisions and to clean the areas. The area should be totally clean before applying a moisturizer (we highly recommend Aquaphor, an over the counter product widely available). Apply Aquaphor (regular formula) twice daily. You may shower with soap and water.

  • Skin Glue: Skin glue appears shiny over the incision. If skin glue is placed, it forms a water-proof barrier. No specific care is necessary until the glue falls off. My preference is for the glue to stay on as long as possible, but if it is still present at 2 months call the office to have it removed.

  • Staples: Occasionally, staples are used in the hairline to reapproximate tissues. They tend to trap less hair than sutures and thus are very useful in this area. Areas within the hair are a challenge to keep clean. Use peroxide to remove dried blood and shampoo to clean the hair. Staples are removed around 7 days after the procedure.

  • Drains: empty drains as instructed. Clean the exit of the drain with a q-tip and peroxide daily, then cover with Aquaphor and fresh gauze. Drains are removed 1 day to 1 month after a procedure, depending on the output. In general, a drain must put out less than 1 ounce (30 mL or cc) over a 24 hour period to be a candidate for removal. Once removed, the drain site closes within a matter of hours and does not require any suturing. Apply Aquaphor to the site once removed and place fresh gauze.

 

 

WEEKS 2-12

The bulk of the healing occurs in the first 12 weeks. After this, the scar will remodel a bit, and the color of the scar will change, but the initial 12 weeks are the crucial ones for scar control. Our surgical technique and attention to detail give almost all of our patients a nearly invisible scar at maturation (1 year), without any extra treatments. However, we are often asked what can be done to maximize scar outcomes. Simply put, a scar will heal fastest and look the best if it is protected from the sun and given a clean barrier for protection and hydration. For this, we recommend Skinuva Scar, a growth factor infused silicone gel that has been shown clinically in a few different studies to provide greater scar control than standard silicone gel alone. This is available in our office.

 

OTHER RECOMMENDED THERAPIES

  • Scar massage has been shown to be useful, especially on raised scars. This can be safely started one month after surgery. Scars are gently massaged in circular motions with the finger tips. This can be done in conjunction with the application of biocorneum (twice daily for a few minutes), or on its own for 30 minutes 3x/week.

  • Sunscreen and sun protection are crucial for your final scar color. The incisions are more sensitive to the sun than the surrounding skin. Protect your incisions well for the first year.

  • Aquaphor or other moisturizing creams are very important for wound healing. They provide the appropriate environment for healing. Be sure to keep your incisions clean and well-moisturized.

  • Injections (steroids) may be utilized if scar tissue buildup is abnormal, or if you are prone to keloids.

  • Laser treatments can help scar color and stiffness mature faster. These are generally used 3-12 months after the surgery

  • Microneedling can be a useful adjunct for scar healing. This would occur a minimum of 3 months after surgery

 

OTHER (NOT RECOMMENDED) THERAPIES

Other scar care treatments that you may run across have not been shown as effective in blinded controlled clinical studies (the best kind). This includes Mederma (its active ingredient, interestingly, is onion extract). We are not saying you will not have a response, but there is not convincing evidence that any of these works well. Vitamin E Oil has been shown to make a difference when started in the preoperative phase, but not just postoperative.

 

 

Thanks for reading! We know this is a lot of information and are glad you want to be properly informed!

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