Making a Bad Scar Better

I know I’ve talked about scarring before, and today I’m going to talk about it again.  After all, this is a topic near and dear to the hearts of Plastic Surgeons.  On the cosmetic end of the spectrum, our ultimate goal is to make our patients look better without anyone ever knowing.  A bad scar is a dead giveaway, and can really compromise an otherwise great result.  And on the reconstructive end of the spectrum, a bad scar can actually limit function.  I’ve seen patients with severe burns that were unable to open their mouths or turn their heads because of the scarring.

I’ve previously explained how to help a wound heal and optimize the scar (see the previous post here).  But what do you do if you’ve already got a bad scar?  Is it too late?  Obviously I wouldn’t be writing a blog post if the answer was “yes, you’re gonna be stuck with that scar forever.”  So here are the options:

• You can always try scar massage and a silicone scar gel, even in a scar that is several years old.  This works best in thickened, raised scars.  I recommend massaging 4-5 times per day, at least 5 minutes each session. The massage should be firm, bordering on uncomfortable.  And as for scar cream, my favorite is Kelo-cote.  It works well, it’s non-prescription, and it’s affordable.  Put a thin layer on twice a day.  If it’s still tacky in 5 minutes, use less next time.
• Steroid injections can also help.  Again, these work best on raised, thick scars.  They will not help acne scars or chickenpox scars, as these are sunken in.
• Profractional laser treatments can help both raised, thickened scars, and depressed scars (e.g. acne scars).  This type of treatment essentially puts little holes in the scar using a laser (see an explanation here.)  The new injury to the skin causes remodeling of collagen, which is the major component of scars, and over time we see scars soften and smooth.  The treatment is done in the office, and is a little uncomfortable, but we use numbing cream and a chiller that blows super-cold air to minimize the discomfort.  Afterwards the area is red for a few days.  Several treatments are needed, but I have seen some really dramatic improvement in thick raised scars, and even scars from chickenpox and acne.  If this is something you would like to learn more about, look for a Plastic Surgeon or Dermatologist who treats scars with a profractional laser.

Do you have any topics you would like to see me address in this blog?