Skin Science: Post Surgical Scar Care
Skin Science: Post Surgery Scar Care
This week I want to share my knowledge on a topic that I talk to patients about every single day, post surgery scar care. As a plastic surgeon optimizing scars is a big part of my practice and I think it should be a skillset in every household. By the end of this newsletter you should know how to categorize a scar as immature or mature and also how to optimize healing. If you need supplies then click on the images of my product recommendations for an easy link to purchase on amazon!
Not all scars are made equal. There are “normal” scars, hypertrophic scars, and keloid scars. Intrinsic factors affecting scar quality include your age, genetics, melanin content, immune status, medications and likely biologic processes yet to be understood. Extrinsic factors affecting scar quality can include mechanism of injury, bacterial contamination, tension, and scar care. A scar created surgically by a plastic surgeon trained in principles of tension and wound healing should be very different from a scar created by trauma.
THE HEALING PROCESS
There are three main stages to wound healing:
Inflammatory Phase (0-5 days): characterized by the arrival of immune cells to fight infection and remove debris.
Proliferative Phase (5 days to several weeks): Fibroblasts produce collagen, which helps rebuild tissue strength. The wound bed regenerates and epithelial cells migrate to cover the wound's surface.
Remodeling Phase (several weeks to months/years): Collagen fibers reorganize and realign along tension lines, improving wound strength. The scar becomes less noticeable, and the red color fades.
For young children with robust collagen production the maturation process can take up to two years. For an elderly person with decreased collagen content and production capacity, a scar will mature quite quickly. The average adult will likely reach scar maturity by one year.
Use this is a guide to help you understand if your scar is still immature, because if it is, scar care efforts are worth your time and investment! If your scar is already mature but not ideal you may be a candidate for light/laser therapies, injections, or surgical revision. That is a whole topic for another newsletter!
TENSION AND SCARS
One of the most important principles of optimizing your scar is to minimize tension. In the operating room I practice intentional suture selection and technique to minimize tension along your incision. After that, the rest is up to you! You may have noticed that scars on your body seem to heal differently, and often this is because different areas of your body are exposed to different amounts of tension. A scar over your knee is often wide because knee movement constantly puts the scar on tension. A scar on the face is often very thin because of the lack of tension present.
As you think about keeping tension off of your scar, keep in mind that with time the strength of your scar to withstand tension is increasing as follows:
1 week - 5% normal skin strength
2 weeks - 10% normal skin strength
3 weeks - 20% normal skin strength
4 weeks - 40% normal skin strength
5 -8 weeks - 80% normal skin strength (this is about the maximum strength most scars achieve)
EFFECTIVE SCAR CARE TECHNIQUES
The part you have all been waiting for!
This is where I like to make things simple because it’s so easy to complicate it. I love to maximize education and then simplify the action piece for you. I don’t know about you but big restaurant menus and large department stores are my worst nightmare. Isn’t that why we all look to infuencers for recommendations? Tell me what works, give me 1-5 options and I’m happy. There are so many fantastic medical grade products but the truth is you can find the basic must-have items on amazon.
Avoid clothing that rubs/pulls over the scar and limit strenuous physical/sexual activity when your scars are fresh.
If the scar is thick, raised, and ropy - massage it. Massage it as often as you think about it and aim for a minimum of two focused massage sessions a day. Use oil or lotion to facilitate this. Don’t be afraid to get aggressive if the scar is 6 or more weeks old.
SCAR CARE PRODUCTS (DOING something always feels better)
For all immature scars apply a topical scar treatment to provide an ideal environment for healing
Great for scars on the face or an exposed/non-clothed body part that you don’t want a bandage on. It is also great for use during your scar massage.
Silicone Scar Tape
Great for scars under clothing or if you want extra protection from the sun to an exposed scar. I am absolutely obsessive about this - if I have a small wound or surgical scar on my face/neck/arms/legs, I keep it covered with silicone tape anytime I am outdoors.
Protecting your scar from the sun while it is immature and vulnerable to UV damage is so important. Even when covered under clothing you will notice that after a day in the sun your scars will be bright red. This is something that can surprise women with breast lift scars. They will be so happy that their scars are fading and then will spend a day at the pool and will notice their scars turn bright red. I encourage application of SPF beneath your swimsuit until that scar is fully mature.
I have a background in public health and one of my driving passions in life is wellness through lifestyle choices. There are so many things that we have so little control over. Rather than stressing about the genetics and environmental factors that we cannot control, it can only make us happier and healthier to focus on those things that we can change. Good nutrition (high protein, nutrient rich, low sugar), moderate alcohol use, avoidance of smoking/vaping, regular exercise, and proper hydration are lifestyle variables that you have the power to choose! I am always in search of the best products for nutrition that are low in sugar, don’t have fake sugars in them (I will compromise sometimes with monk fruit or stevia), and are gentle on my sensitive digestive system. I’m linking a few products that my husband and I both currently use and love.
If you are ever struggling with a stubborn scar, see a dermatologist or plastic surgeon for evaluation. Not all scars are created equal and they don’t all need the same treatment. A well-trained physician will be able to guide your scar treatment efforts and investments. If you have an old ugly scar and are not sure what options exist to make it less obvious you can read about treatment options in my newsletter next week!
Here's to choosing how we age, on our own terms!
Dr. Lindsey Tavakolian, MD