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Advice on the care of scars

Posted by Dr James Burt on 12 June 2016

All surgical wounds leave a scar however fine.

All scars pass through obligatory phases of wound healing.  After the initial healing phase, sutures are removed.  The wound although now healed is in an extremely active phase as your body strengthens and remodels the scar.

For this reason there is much activity in the wound in the early months after healing.  This makes your scar:
  • Red (high blood flow associated with activity)
  • Lumpy (lots of new cells entering and leaving the scar contributing to the strengthening and remodelling process)
  • Swollen (increased fluid in the tissues surrounding the wound)
  • Itchy (often due to numbness in the area of the wound whilst waiting for local sensation to recover)

As time passes the redness resolves and ultimately scars are usually paler than the surrounding skin because scar tissue lacks pigment cells (melanocytes).  As activity within the wound recedes, lumpiness, swelling and itch also slowly improve.

Simple steps to optimise your wounds appearance:

  • Commencing one week following suture removal you may choose to use silicone gel for six weeks.  This helps flatten the wound, holds moisture content around the wound and there is some scientific evidence of this helping overall scar appearance in the long term.  The silicon gel is expensive and requires sustained patient effort over six weeks to derive the desired benefit.  Most people are not sufficiently troubled by their scars to pursue this option.
  • Massage your wounds twice daily with moisturising cream (you may use Vitamin E cream if you so wish but this is not essential).  This helps to soften fade and flatten scars diminishing the lumpy phase and relieving itch if this has been troubling.
  • Protect your scars from sun exposure.  This is extremely important.  Scars do not have pigment cells and therefore are very susceptible to sunburn even in situations where you would normally not expect sunburn to be an issue.  High SPF sunscreen is mandatory.  Camouflage make up may be used if you choose.
  • Ultimately scar behaviour depends on a large number of variables most of which are beyond the surgeon's and the patient's control.  Some people have an innate tendency to form bad scars.  If you have previously made an unsatisfactory scar without an obvious reason (infection, delayed healing) be very careful about proceeding with any non essential surgery.  Overactive (keloid and hypertrophic) scars sometimes occur if this occurs treatment with taping, pressure and injections are available and may be of some benefit.  If you have concerns about the appearance of a scar you should contact us so that you can be considered for these options.
Dr James BurtAuthor: Dr James Burt
About: Dr Jamie Burt was born and educated in Melbourne, attending the University of Melbourne and graduating with MBBS in 1998. He is a member of the Senior Medical Staff at St. Vincent’s Hospital, Melbourne, and was Head of Reconstructive and Plastic Surgery at the Peter MacCallum Cancer Institute until 2004. Known for his respectful, informative, and caring approach, Jamie has been caring for patients for over 15 years.
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Tags: Scars

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