Question: After my cosmetic surgery procedure, I have a nasty-looking scar that is still visible a few months after. I’d like to get rid of it, if possible. What’s available?

Answer: There is no procedure yet that will make a scar disappear completely. However, there are treatments to make a scar less noticeable. When it comes to surgical scars, the thinking is that good wound care is vital to ensure you get the best healing possible. Always follow your surgeon’s post-operative instructions. I like to tell my patients to keep the wound clean, moist and untouched for as long as possible, so i usually recommend they use a hydrocolloid type of dressing or clean vaseline over their wound.  So to get the best result from any wound healing, you need to paying attention to your wound as early as possible.

A little background: Scars form when trauma damages the collagen-clad dermis, the layer of skin directly underneath the top layer, as well as the epidermis, in which then your skin then goes through different stages of repair and what happens is your collagen begins to remodel itself as it heals. There are all kinds of scars, too. For example, during this remodeling process, your collagen may increasingly thicken itself, and if it stays within the boundary of the scar, it is called a hypertrophic scar, or a raised scar. But if the collagen exceeds the borders of the scar — a less common occurence — it’s called a keloid. Turns out, there are many variables that go into what makes you scar a certain way, for example different skin types scar differently, so it really depends on your specific skin type and genetic background.

Right after suture removal, it is important to be gentle with your scar. Your skin may look like it has healed over but we know that the tensile strength across your skin is still not at its peak yet. Try to minimize movement over the scar area and be gentle with your skin over the scar.

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My advice for patients at this stage is to keep the area hydrated and moisturized. On the body, using a thin coat of Vaseline may help. On the face, some patients find that Vaseline feels ‘icky’ and may precipitate some breakouts in some predisposed patients, so my take is to use a simple fragrance-free moisturizer such as squalane or a mederma scar cream. As soon as your scar has settled, consider using silicone gel sheets on the scar to minimize the risk of keloid formation. Researchers believe that silicone gel sheets may maintain the skin moisture levels while exerting some pressure on the skin which is beneficial to prevent keloid type scarring.

If your scar appears red, consider a pulsed dye laser like Vbeam. Studies have shown improvements in the erythematous nature of scars after the use of pulsed dye laser on red scars. There are also some studies that postulate that pulsed dye lasers may reduce the incidence of keloid formation in predisposed patients. You need to know that your chance of getting a keloidal scar may also depend on your genetics as well as location of your scar. For patients prone to keloid formation, while we cannot eliminate the risk of keloid formation, we can try to improve the appearance of the resultant scars with these measures.

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If your scar is raised, it could be the start of a hypertrophic scar or even an eventual keloid scar. It is therefore vital that you apply silicone gel sheets and use massage to institute some pressure on the area. Studies have shown both fractionated CO2 lasers and erbium yag lasers such as Fraxel to be helpful in improving the appearance of raised scars. Many sessions may be needed to help it achieve a flatter appearance.

Pressure bandages and massages as mentioned can both flatten some scars if used on a regularly for several months. The good thing is that they don’t cost a lot but the downside is that you need to be consistent with them, and patience is key. Studies have shown pressure taping with steroid impregnated steroid tape to be useful in treating keloids, but results may take months even years to surface.

Silicone-impregnated gels or silicone sheets can be used at home to remodel elevated scars. They must also be used regularly and consistently for good results.

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Cryosurgery is also a viable option. It’s technique freezes upper skin layers and causes blistering of the skin to remove the excess tissue at the scar.

Cortisone injections are also employed to shrink and flatten very firm scars. This treatment is popular for hypertrophic scars and keloids. In conjunction with cortisone, some doctors may also use interferon. This is a chemical that is injected into the scar and has been shown in some studies to improve the appearance of scars.

Finally, for very unsightly scars that have defied all methods above, you can consider surgical Scar Revision. This is a method of removing a scar and rejoining the normal skin. Wide scars can often be made thinner. Long scars can be made shorter. Using broken-line incisions can make scars harder to notice. Sometimes, a surgeon can hide a scar by redirecting it into a wrinkle or a hairline.

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