The truth about scars
So, you’re interested in plastic surgery, but you don’t want any scars? Or, you have a bad scar and want to know what can be done?
Unfortunately, there is no way to perform surgery or recover from a cut without the body forming a scar. Surgeons who tell you they can are lying. Plastic surgeons can, however, use techniques that will make scars less noticeable. There are also things that you can do to ensure your scar heals in the best way possible.
Plastic surgeons are trained to place incisions where they will be hidden, like in the eyelid crease. When incisions can’t be hidden, they can be made as short as possible and closed as carefully as possible to minimize the risk of developing an obvious scar. I make careful cuts with the knife so the skin edges are even, and I place multiple layers of suture to make sure that tension is evenly distributed across the scar. Even when I’m repairing cuts in the emergency room, I treat every case like a cosmetic surgery.
Of course, patients can significantly affect the appearance of their scar too. During the first few days or weeks, you can avoid activities that place stress or pull at the scar, and you can take antibiotics if they are prescribed to minimize infection. Also, I often recommend that patients take Arnica Montana with Bromelain, an herbal supplement that strengthens your immune system and helps reduce swelling and bruising. This safe supplement decreases inflammation around the scar and can improve the final appearance.
So what about scars that have been there for a while?
To some degree, time alone will improve many scars. It can take the body a full year to “remodel” the healed tissue. If you don’t want to wait for nature to take its course, there are some things that will help.
When the body makes a scar, it is constantly building and removing new collagen (the protein that makes up most of the skin). This is called remodeling. Simply rubbing and massaging along the scar will help the body reorient collagen in the tissue to reduce lumpiness, firmness, and tenderness. The best thing about this technique is that it’s easy and free.
There are so many scar creams on the market that it’s hard to keep up. The best ones contain silicone. There are a lot of theories about why silicone helps scars, but the bottom line is that it does. They need to be applied regularly for 2-3 months to see results, so many patients mistakenly believe they don’t work only because they didn’t use them long enough.
Laser works by reducing the red discoloration of scars and by building up the tissue underneath scars that are flatter than the surrounding tissue. Several laser treatments may be required to see real improvement, but for some people this is a great way to improve scars without additional surgery.
Just like scar massage helps the remodeling process, so does steroid injection. It helps the body avoid building up too much collagen. This can help flatten raised scars and can improve symptoms from problem scars like itching, tightness, and pain.
When other techniques fail, cutting out the scar can help improve its appearance by starting from scratch. The scar can be reoriented so that it lies in a natural crease. If the scar is bad because there was tension or infection the first time around, the circumstances can be controlled with scar revision to avoid those problems again.
What about Vitamin E?
Vitamin E has been used for a long time, and while research shows it has no direct effect on scars, it improves the condition of the skin overall, which can improve how soft the scar feels.
Scars are actually caused by improper alignment of collagen. Normally our collagen fibers are formed in a basket weave pattern, which gives it a smooth even appearance. However, scars are formed when collagen cross links and forms a pronounced alignment in a single direction. Genetics ultimately play the largest role in how we heal, but in most scars on certain parts of the body (ears, face, nose, hands) tend to heal better than other parts (chest, stomach).
The bottom line is that most factors are out of your control. If you want dramatic results for major scaring, the collagen must be forced to reform by surgical means. Please feel free to email me a picture or description of your scar for recommendations on how to make it as invisible as possible.