Improving Scars -
Whenever there is an incision in the skin, a scar will result. The scar may be very good—a fine line—or it can be red, widened, or bumpy. As plastic surgeons, we try to minimize scarring by hiding the incisions in the hair or along a natural skin crease, doing a several layer closure, and avoiding tension, but truthfully, the way an individual heals will be the most important factor in determining scar quality. If you are a great healer, you will probably get a fine line no matter how you treat your wound. If your incision is not showing any redness and is nice and soft, there is nothing you can do to make it better. If your incision is red, bumpy, and angry, there are some things that might help.
Despite what you might have heard, very few topical agents have been proven to improve wound healing. Since most scars improve over time, it is hard to judge whether something put on your scar is really effecting the change. Seldom will you see a sudden change in a scar for the better.
There are some general principles about managing your incisions and scars:
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It will not hurt your incision if you wash it or get it wet – cleaning your wound is good for it
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It is OK to leave the wound uncovered or to cover it
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Mederma, Scar Guard, Vitamin E, and Cortisone cream all may help scars a little bit
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Incisions on the central chest, back, and shoulders tend not to heal as well as other areas
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Incisions closed with dissolving sutures stay redder longer than those closed with removable sutures
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The four most effective means of treating red, bumpy scars are pressure and massage, cortisone injections, x-ray treatments and silicone sheeting
Pressure and massage are always the way to start. If that fails, injections of steroids into the scar are the next step. It will usually help quite quickly. X-ray treatments are reserved for only the most difficult cases (there are long-term draw backs). Silicone gel sheeting can be bought at a drug store and takes a few months to work.
Scars that have widened cannot be improved with any method except surgery. The scar needs to be excised and the defect closed with plastic surgery techniques. Slightly raised or uneven scars can be improved with laser resurfacing or dermabrasion. This is an in-office procedure that takes only a few minutes, but there are some open areas that take 7-8 days to heal.
There are some lasers that will help reduce the redness in some scars. This is a relatively simple process, but does not work every time and several treatments are required. Deeply indented scars also cannot be greatly improved without surgery. These scars are best excised and resutured.
Each scar may be assessed individually to determine how much it can be improved with surgery. One scar might have a 90% chance of 50% improvement, while another scar might have a 10% chance of 90% improvement. Unfortunately, there is never a guarantee about the final result. We like to wait at least 6 months before revising scars, since often they improve for some time. Scar revision surgery is not covered by your insurance unless the scar is causing a medical problem, was caused by a car wreck, or resulted from work.
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