Introduction
Scars are areas of abnormal skin that look different. They can happen after we cut or injure our skin, or sometimes just spontaneously. Most scars are small, but when they are big or in prominent areas, they can really bother people. The best way to deal with scars is to prevent them; however, there are also treatments to reduce how prominent they are so that they look better.
What causes scars?
The skin has an important layer in it called the ‘dermis’. The dermis has all the support structures of the skin in it; such as blood vessels, nerves and structural proteins like elastin and collagen. Elastin and collagen are what hold our skin together in one tight unit.
Scars form when the body heals a wound; this leads to new collagen and elastin being bundled abnormally in an attempt to close the gap in a wound. This results in a big hard lump. Basically, scars can form from any cut or wound; such as an accident or injury, acne scarring, a skin infection, following a cosmetic procedure or any disruption to the skin.
What to do about scars?
The best way to manage a scar is firstly to avoid it. This can be done by doing everything possible to ensure a wound:
- heals quickly and cleanly as possible,
- remains well hydrated after the early phase and
- is kept out of the sun.
It takes 2 years for a wound to fully mature to its end result. If you are unsure about the progress of your wound, seek help.
What can I do after a wound to help prevent a scar?
Short Term: <2 weeks
Goal: Make sure that your wound heals as quickly and as well as possible. This means keeping the area clean, bandaged and dry.
Anything that introduces more bacteria, dirt or disruption to a healing wound will make it take longer to heal; this means that more collagen gets made and the wound is bigger and more likely to scar:
Ensure optimal wound hydration (not too dry, not too moist)
- If the wound is wet or oozy, you can use betadine a few times per day. This is an antiseptic liquid or cream with iodine in it. You can apply 1-3 times per day until the wound is less oozy
- If the wound is medium moist, you can use antiseptic infused dressings such as jelonet
- If the wound is dry, you can use an antiseptic ointment
Many cosmetic doctors will use silicon gel sheeting to protect the wound; this has special properties to optimise the condition of the skin.
Ensure a wound is kept clean (infection prolongs healing)
- Change dressings regularly
- Use your antiseptic
- Prevent the wound getting dirty or wet
- Do not pick at the wound
Keep your general health as good as possible
- Vitamin C helps build collagen: 500mg 2-3 times per day
- Stop smoking
- Minimise alcohol
- Eat good nutritious foods
- Some doctors will inject ‘Platelet Rich Plasma’ into a wound; this is a super concentration of your own growth factors in your blood to help wound healing
Avoid compromising the wound
- Avoid swimming and water sports
- Do not lift anything more than 7kg; weight lifting can burst open a new wound due to the stretch in the skin
- Do not pick at the wound; use ointment or cool dressing if it is itchy
- Avoid heavy sport
Remember: in the first few weeks, if the wound is oozy, red, painful, itchy or not feeling right, please see your doctor early. This is the most risky time for a wound to heal and anything wrong in this phase is a much higher risk for a scar
Medium Term: >2 weeks to 6 months at least
Goal: Optimise the formation of new collagen in the wound and keep the wound out of the sun!
Ensure optimal wound hydration:
A dry wound encourages collagen synthesis resulting in more scarring
- Continue the silicone gel for 4 weeks and then switch to petrolatum (Vaseline) or moisturiser to keep it moist
- Wound areas are very prone to dark pigmentation which make the wound more obvious; people with darker skin are much more at risk of this
- You can use clothing or strong suncream or simply stay away from the strong sun
Longer term > 12 months
Goal;. Seek medical help if the scar is big, unsightly, in an awkward location or bothers you
The treatment of a scar depends on the size, location and nature of the scar as well as the patient.
- If a scar is bulky it can be cut out and the clean edges sutured together to ‘start fresh’.
- Steroid creams can be used to thin some scars .
- Steroid injections are often first line; the steroid will help dissolve some of the collagen. This technique is more powerful than a steroid cream.
- Some scars involve the skin being tethered to the structure below; like a pit. There are special cosmetic techniques that can be used to disrupt this tether so that the pit is less obvious
- Resurfacing is where the top layer of the skin is disrupted, using a chemical peel, small needles or lasers to remove the top layer of the skin and allow a new layer to grow back more smoothly
- Finally, a scar might have a different colour; lasers such as Q switch can be used to destroy pigment and even out the colour so that the scar is less prominent
Summary
Scars are best prevented by ensuring the best conditions for your wound to heal. This involves using creams, regular dressings and looking after yourself.
In the first few months, keep the wound moisturised and out of the sun.
Long term scars are best dealt with by doctors with experience. Multiple techniques can be used to either cut out the scar, shrink it, disrupt the shape or bulk and help generate a new layer of skin.
For further information, please have a look at Contour Clinics’ website on scar management. Contour Clinics are Sydney’s leading cosmetic medicine experts and have particularly strong experience in scar management: https://contourclinics.com.au/treatment/scar-removal/
