What You Need to Know about Treatment and Prevention.
Scar formation is the process by which all human tissue, with a few exceptions, heals. It is a staged process taking several weeks to become established and many months to complete. Patients with scars want to have the best scar in the shortest time. Unfortunately, the wound needs to heal first.
What Can Cause Poor Quality Scars
1) Suture closure still gives the best result in the majority of patients, but dressing and minimizing trauma are keys to good closure. Plastic surgeons are the experts at these techniques. If appearances matter, get one to perform the surgery.
2) Protection of the wound from tension and physical irritation is a requisite for minimizing inflammation, which is a major cause of excessive scarring. Paper tape support for six weeks is one way to achieve this. Change the dressing tape once a day. They can be non-sterile types after the first week. Contact your plastic surgeon if the tape itself causes irritation, as you may be allergic to the adhesive. Or the wound may be infected. In either case solutions exist to remedy these problems.
3) Prevent infection. Though not the most common cause of inflammation especially on the face, infection needs to be prevented. Often the source is from the sutures used to close the wound. Proper hygiene using household peroxide once or twice a day and topical antiseptics such as silver dressings will prevent infection. Once local infection is present your surgeon may prescribe antibiotics either topically or by mouth.
The scar that results at six weeks is often pink in color but minimally tender and perhaps slightly raised. If the patient wishes to continue with minimizing scar appearance they can use a mineral based cover-up. Cover FX® and Iredale® mineral make up exist for this. The best recommendation for the proper resolution of red hypervascular scars is ND YAG or pulsed dye laser treatment. However, 5-fluorouracil and/or steroids have been used for this as well. Although the injectable steroids must be used carefully as scar widening and skin atrophy can occur with stronger types. Recently, 5 fluorouracil has been used in this context as well although it is new and coverage is only partial under Medicare. The majority of patients will do well with a topical steroid and silicone-based ointment such as Cicaplast®, by La Roche Posay for an additional 6 weeks, combined perhaps with gentle massage of the area.
During the first three months it is important for the scar to be protected from sun exposure. The use of block such as SPF 40 or greater is critical to prevent darkening of the scar during the period of solar sensitivity. Bleaching the wound after the fact can be accomplished with products such as Obaji Clear® and UltraQuin cream®.
In spite of the above prevention techniques, some scars will appear unacceptably large or are symptomatic after the first year. Painful scars are best treated by a competent specialist. This may involve surgery or injection techniques. Scar revision may involve replacement or realignment of the scar. This is achieved in a number of different ways. Your surgeon can recommend simply excising the scar in a different direction, or using a Z-plasty to do this while minimizing the visibility of the resultant scar. Even skin grafts and flaps in scar contracture may be necessary.
In cosmetically sensitive areas laser resurfacing and ReCell® (currently unavailable in Canada) techniques, which rely on effecting pigmented cells in the area, may be offered. Acne scarring with is deeply pitted appearance can benefit from filler in the deep portions of the skin below the scar to raise it up. As well, new fractional laser treatments, such as Profractional® or Fraxel®, can minimize the texture and pigment changes in the scar. Cosmetic surface refinement of scars is not covered by Medicare in adults. The treatment relies on laser techniques such as resurfacing and/or vascular laser treatment. Use of surgery with injectable agents, such as 5 FU, or in some cases radiation therapy post operatively may be needed for the most difficult scars.
Ultimately, modulation of scar formation is the goal of research in this area. To date no one drug has achieved this. There are some potentially useful products about to appear on the market. Keep posted to this website for further updates.