What are the best products for good scars after plastic surgery: the do’s and don’ts

Our clinicians see hundreds of scars every month, and while genetics, suture choice and incision position all influence scarring, there is a visible difference in scar outcomes between patients who do three key things for their scars during the early healing phase:

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Create a daily scar care routine utilising at-home products and massage

In this article Nurse Brittany Brown specifically looks at the care routine and products that can assist with optimal scarring – and what not to do, if you want the best possible scarring.

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Scarring is one of the most common aspects of surgery that cause concern preoperatively. And while any surgical procedure will leave some degree of scarring, it is important to know that the healing process of a scar can take a full two years, at which point the overwhelming majority of patients are comfortable and pleased with their scar appearance. Proactive scar care and patience is key.

Scars go through three core stages of healing, these being the inflammatory stage, the proliferative stage and remodeling stage.

The inflammatory stage begins immediately post-surgery and lasts a few days. During this time, bleeding or oozing stops and white blood cells come to the incision to ward off any signs of infection. At this stage the incision can look red and swollen.

Then comes the proliferative stage, which occurs over several weeks. It is here that fibroblasts (skin -forming cells that produce collagen) gather at the site of the incision and begin strengthening the skin, pulling wound edges closer together and forming new blood vessels to aid in healing. At this time the scar can appear thicker, raised, red and stiff making the scar more obvious. This often can be a cause of concern for patients during the first 6 months however it is important to remember that this is only stage 2; the best is yet to come!

Stage three of scar healing sees the remodeling stage take place which takes up to two years. This stage is what changes a red and raised scar to a flatter, thinner scar which over time will usually fade and become unnoticeable.

The saying ‘time heals all’ is fitting for surgical recovery and scar healing, however there are several modalities that can be incorporated into your post operative journey to ensure your scars heal as smoothly as possible.

WHAT TO USE FOR SCAR OPTIMISATION: BODY INCISIONS

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Following body procedures such as abdominoplasty, breast surgery, lesion removal or arm lift, surgical tape will remain on the incisions for 3 weeks for support.

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At 3 weeks post op, if the incisions have healed into scars and don’t have any broken skin or scabs remaining, silicone scar tape is recommended for a further 12 weeks.
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Silicone tape is applied every 4-7 days over the healed areas of the incision.
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Not only does the tape provide support to the incision as well as protection from irritation, the 24-hour delivery of silicone directly to the scar encourages healing within those early months following your operation.
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Silicone increases hydration to the outer layer of the scar, facilitates in the production of fibroblasts as well as restructures collagen to encourage a flat scar line.
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After 3 months, it is recommended to either continue with the silicone tape, or swap to massaging in a silicone scar gel daily for the first 1-2 years after surgery.
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WHAT TO USE FOR SCAR OPTIMISATION: FACE INCISIONS

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Following most facial surgery procedures, such as facelift, blepharoplasty and lesion removal, there will not be any tape covering the incisions.

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During the first few weeks, you will be asked to apply a topical antibiotic ointment onto the incisions, as demonstrated here. This reduces the risk of the incision becoming infected.

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Once your incision has healed into a scar, the best ongoing scar management for facial incisions is daily massage with a silicone scar gel. A tube is included in your postoperative recovery gift bag.
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Doing this for as long as possible for the first 2 years after surgery will ensure scars heal as flat and soft as possible, eventually fading to be very discrete.
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From 6 weeks post-surgery, you may wish to explore Fraxel laser scar reduction therapy with our skin clinician. Multiple sessions of Fraxel laser improves the texture and appearance of a scar as it heals within the first two years after surgery.

scar healing products Dr David Sharp

What if I am allergic or sensitive to silicone-based products?

Occasionally patients can find their skin becomes irritated from silicone-based products or they may have a pre-existing intolerance/allergy to certain creams or tapes. In this case it is recommended a simple application of Glory Oil or Bio-Oil – if well tolerated – with daily scar massage to manage scar healing.

I want the best-looking scar possible. Is there a specific type of scar gel I can use?

All silicone over the counter scar gels are good; we include a complimentary tube in your postoperative bag. If you want something a little more powerful than over the counter scar gels, our compounded scar gel contains an ingredient called Pracasil, which encourages the accelerated healing of scars. We can arrange to have this compounded for you, at your one week post operative review appointment if it is something you wish to try. We have lots of information about this gel in our clinics, so please ask about its benefits at your next post operative review.

What NOT to put on your scar

Scars are sensitive in the early stages of recovery and applying anything too stimulatory or irritating can significantly impact the long term appearance of your scar. The following products should NOT be applied to a scar during the 3 abovementioned healing stages:

  • EEssential oils – these can irritate or burn skin, worsening scarring
  • EBleaching or skin lightening agents – these can cause patchy hyper/hypopigmentation, delayed wound healing, skin breakdown, allergic reactions and dermatitis.
  • EHomemade body oils – certain ingredients may cause skin to become sensitive to the sun and induce burning and blistering to the skin
  • EHeavily fragranced products – these can cause rashes and scar irritations, exacerbating scarring
All of the above can severely impair wound healing in its early stages and may lead to unsatisfactory surgical results.

As a part of your holistic healing process, it is important to also consider how you can reduce the risk factors for poor scar healing, such as:

  • EHealth conditions such as diabetes, high blood pressure and poor circulation
  • EPoor nutrition and lack of essential vitamins, minerals and nutrients. Fresh, unprocessed foods, vegetables and fruit – as well as adequate vitamin C, zinc, iron, B12, DHA/EHA and protein all improve healing quality.
  • ESmoking has been proven to negatively impact the healing process
  • EPoor skin integrity and/or blood supply can affect how a scar heals. For example, skin that has been stretched through excess body weight or pregnancy can be at risk for raised or widened scars.
  • EStretching the scars. This can include doing everyday activities such as reaching up to hang up washing and exercises that pull or place tension on the scar area etc. Repeatedly small movements can even widen scars.
  • EStress and anxiety is common after surgery and due to the negative impact it has on healing and wound recovery, we recommend seeking the guidance of your trusted GP or psychologist if you experience this postoperatively. Positive thinking has powerful healing benefits; we see this time and time again for patients who have a patient, calm approach to their healing journey.
To discuss which scar management option may be right for you, book a review with Nurse Brittany or Nurse Deborah in our Brisbane or Ipswich clinics.

This article does not constitute medical advice. If you have questions or concerns regarding scarring please consult your treating clinician. 

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