Making a scar less noticeable is one of the primary goals of plastic surgery. But to accomplish this goal, we first need to understand what makes a scar more visible in the first place. Let’s break it down:
- Color: scars optimally fade to slightly lighter than skin tone. But some scars may remain pink or red, or even darker than the surrounding skin (hyperpigmented). It can take 6-12 months for a scar to finish fading, so redness or pinkness is normal during this stage. If the pink color persists beyond this time, or if you’re just a bit impatient, laser treatments can help the pinkness fade. Hyperpigmentation in scars occurs when they are exposed to the sun. To prevent this, I recommend applying sunscreen to the scar daily over the first year. If hyperpigmentation is already present, skin lightening creams can help even out the pigmentation, as can laser treatments.
- Contour: an ideal scar is narrow and flat. But some scars may become thick and raised during the healing process, as I’ve discussed in a previous post on hypertrophic scars. This commonly occurs in scars on the chest, and some people are also just more prone to forming raised up scars. Silicone scar cream, massaging the scar, and steroid injections can all help flatten out a raised scar.
- Width: instead of becoming thicker, scars may instead widen during the healing process. This is very common on the arms, legs, and back where the skin is under more tension. I have noticed that scar widening also seems to occur more often in teenagers. Keeping a steri-strip or piece of medical tape on the incision for the first several months can help decrease tension on the incision and lower the risk of the scar widening. But widening cannot always be completely prevented.
- Blending into natural anatomic boundaries: you may have noticed that all of the above factors depend on the healing environment, i.e. how the wound is taken care of, and intrinsic healing factors that vary from person to person. But how the wound is closed also impacts how a scar develops. Wounds under significant tension are more likely to widen or raise up, so minimizing this tension through different closure techniques is an important part of plastic surgery. In addition, a good scar will blend into natural anatomic boundaries. This isn’t always an option in a scar resulting from trauma, e.g. after a dog bite. But if I am taking a skin cancer off the nose, for example, I can design the incision in a way that makes it less noticeable. Facelift incisions are another great example. Even though the incision is right on the face, placing on the natural boundary between the ear and the cheek makes a good facelift scar nearly invisible.
Do you have any questions about scars? I would love to hear them in the comments section.