Written by Sofia Kirk, M.D.
To aid our patients in reducing scars post surgery, Dr. Kirk shares these tips on successful healing. As always, any concerns you may have post-operatively can be answered by the professionals at Posh Plastic Surgery.
What is a Scar?
Scarring is the body’s natural way to heal an open wound or cut. The growth of new tissue and collagen closes and seals the wound while cleaning out dead skin and blood cells in the form of a scab. Any minor infection or debris is dealt with by the body’s immune system. An oozing of blood, pink or clear liquid is normal in the early stages of healing as the body provides a stream of protein, amino acids, white blood cells and water to rebuild the area, fight infection and keep it clean. As this oozing dries it causes a scab acting as a protective barrier which falls off when the wound is fully healed. Sometimes the scab falls off early and a newer one is produced.
In most cases a scar will be left behind. Typically it will be red or pink to begin with but will fade to a silvery/flesh color with time. How visible the scar is depends on a lot of factors such as the size of the wound, how quickly it heals, the skin type, age and health of the patient and how well they treated the wound as it was healing. There are also some steps the patients can take once the would is healed to aid the fading of their scars.
When a scar grows in height and is raised above the level of the skin it is called a hypertrophic scar. If the scar continues to grow and extends outside the bounds of the incision it is called a keloid scar. Keloids are relatively rare and treatment differs from that of hypertrophic scars. If the patient has had a sever burn over a large area then a contracture scar can cause a tightening of the area that may cause discomfort and impair movement.
The quicker and easier a scar heals the less visible it will tend to be. The longer the process goes on and the more activity there is the more of a mark it will leave. A deeper cut will leave more of a scar than a shallow one.
A good example is the difference between a paper cut and a surgery scar. A paper cut is small, clean and tidy so the two edges can join back up pretty much in place and heal quickly. A surgery incision is much deeper and often involves the removal of some skin so that the two edges being joined are new to each other, the layout of veins, nerves and blood cells is not a perfect match and a lot of reorganization needs to be done. This will lead to a longer healing time and a more visible scar.
The first and most obvious way to minimize scarring is to aid the healing process by giving it, and your immune system, as much help as possible. To do so you can follow these simple and effective guidelines.
Tips for Minimizing Scarring
1. Eat plenty of fresh fruit and vegetables, cut down on calories, fatty foods and stodgy carbs. The more nutritional and anti-oxidant value your food has the better your body can heal.
2. Drink plenty of fresh, clean water. Filtered water is best. Coffee, alcohol and soda will not help. A glass of wine is said to be good for health but only one a day. Green tea and herbal tea has a lot of beneficial health giving properties and anti-oxidants. However nothing is better than plenty of fresh, pure water.
3. Get some regular, light exercise. If you have just had surgery then ask your surgeon what you can do. Regular light exercise will get the heart pumping the blood around the body, cleaning out the old toxins and refreshing the wound site with new, fresh blood. This will bring a steady supply of nutrients and oxygen to allow for the tissue to rebuild more effectively.
4. Stop smoking. Smoking directly affects our ability to carry oxygen around the body, especially to the extremities. Tobacco smoke causes blood cells to be occupied by carbon monoxide (a deadly poison) and therefore cannot carry oxygen around the body as needed. This makes the body work much harder for less results. If you are a smoker then take your pulse before and after a cigarette and you will see that your heart rate goes up, this is partly because the body is having to work harder to process the toxins and get the oxygen around the body as needed.
5. Stop smoking. Yes, it is important to mention twice! In some cases following surgery the wound does not heal well and may open up again. Dr. Kirk has seen this happen numerous times with patients, each time the patient was a smoker. If you are serious about getting better and helping your body to heal then you will have to stop smoking several weeks before your surgery and for several months afterwards.
5. Get plenty of fresh air. You need a good steady supply of oxygen to the affected area to fight infection and to heal the wound successfully. Some sources say that up to 70% of toxins are removed from our body through the lungs. Taking this into account ensuring that you get enough oxygen into your system could well be the most important thing to do in assisting your bodies awesome healing ability.
6. Keep it hydrated, do not let it dry out or pick at the scab. The scan will stay attached to protect the healing wound until the wound closes up, at which point there will be no tissue left for the scab to attach to. The scab will fall off when it is ready, so do not pick at it and try to ‘help’ it along.
7. Gentle massage will stimulate the area to create a flow of fresh blood (and therefore nutrients and oxygen) whilst flushing away the old, toxic waste matter such as dead cells.
8. Silicone sheeting. The use of flat silicone sheeting keeps the scar from raising up (hypertrophic scarring) above the level of the skin thereby ensuring a low profile scar formation. It also protects the wound site and stops it from drying out. Posh Plastic Surgery recommends silicone sheets to help improve redness, swelling, scar thickness and itching in old and new scars.
9. Laser skin resurfacing can be a very effective way to treat scarring. Burning a grid pattern of pin-sized holes through the dermal and epidermal layers of skin stimulates healing of those layers yet is supported by the healthy surrounding tissue. Over several treatments the whole of the skin surface is treated and in the best cases complete regeneration of the surface tissue can be achieved. This treatment also works well with sun damage, wrinkles, fine lines and minor discoloration and has been known to dramatically improve the appearance of facial burn scars.
10. Hydroquinone cream acts as a mild bleaching agent which can be effective with the fading of scars, freckles, sunspots and other hyper pigmentation.
Natural Treatments to Use to Minimize Scarring
One of the most traditional methods is to apply honey to the wound. Raw honey still has all the live enzymes and is said to be a wonderful antiseptic as well as a healing agent. Honey can be used directly on the wound when it is still healing but make sure to consult your doctor before you do this. In 2006 review of over 20 clinical trials which involved over 2000 subjects showed that honey stimulated the growth of new tissue and had anti-inflammatory and anti-bacterial properties.
St. Johns Wort (Hypericum)
Commonly known for it’s antidepressant properties but also very useful when applied directly to the skin. Hypericum stimulates collagen growth and helps the scar tissue to form on the wound leading to a quick and healthy recovery. In study done with treated, placebo and untreated patients it was found that the group who were treated with St. John’s Wort within 24 hours after surgery had significantly faster healing times, less itching and discomfort, less discoloring and flatter more even scars.
Shea Butter or Cocoa Butter
Both of these are natural oils that come from the seeds of a tree. They are thick and waxy in their natural form and have been used as a skin softener, moisturizer and treatment for dry and cracked skin by indigenous people for centuries. They are available in may creams, lotions and ointments but it is recommend getting the pure form if you can and rubbing it into the newly formed scar several times a day.
Aloe Vera is a very powerful moisturizer and has anti-inflammatory properties which may help reduce the swelling and redness of the scar. It has the ability to penetrate deeply into the skin, repair damaged cells, protect newer cells and increase the amount of collagen produced. Aloe Vera has also been highly regarded as a treatment for burns.
Vitamin E has long been thought to help in the healing and reduction of scars however a recent study showed that it appears to have no effect and in up to 30% of cases causes contact dermatitis. Vitamin E is essential in the body and is a powerful anti-oxidant that can slow aging, protect the arteries, reduce bad cholesterol and helps combat heart disease. Although it has not been proven to directly reduce scarring when applied topically to the area it should certainly help the body through the healing process if taken orally as a daily supplement.
A popular ingredient in many scar treatment gels, onion extract has been shown in one study to cause no significant reduction of redness and itching in scars. An interesting finding of that study was the placebo group, who used only petroleum jelly, did have a significant decrease, perhaps due to the hydrating effects of the petroleum jelly.
This is just a rough guide to the options available should you be looking to improve the appearance of a scar following surgery, there are more options out there and a combination of several approaches will probably help. If you do decide to try any of these techniques then please discuss them with your surgeon. Although they may not agree that it will help you at all, at least get their agreement that it won’t hurt to try.
While it is possible that some scars may fade with enough time that they are no longer visible it is generally accepted in the medical field that you cannot get rid of a scar completely, the best you can do is minimize it’s appearance. However the extent to which you can minimize it depends largely upon the individual’s physiology as well as the diligence of their efforts.
Unsightly scars that are cosmetically bothersome are sometimes best improved by surgery. Scar Revision Surgery is reserved for scars that have not improved through non-surgical methods. Whether the scar is the results of trauma or previous surgery, a plastic surgeon can excise the scar and carefully close the new wound with plastic surgery techniques. Scar Revision Surgery can offer dramatic improvement.
A fear of scarring is no reason to avoid elective cosmetic surgery. Simply choosing a board-certified plastic surgeon and following the precautions and treatments outlined in this article, you can greatly reduce the risk of an unattractive scar. For more information or to schedule a consultation with Dr. Kirk, please call Posh Plastic Surgery at 904-260-2001 or fill out the convenient contact form below.