The best way to fix a scar is to never have one! Although that sounds a bit silly, it does underscore the fact that certain types of scars tend to be a problem and if there is a choice, those scars should be avoided. For instance, if you or a family member has a history of bad scarring, beware of surgery that tends to produce problematic scarring. Certain areas like the center of the chest, the back and the outside of the upper arm are prone to poor scarring. If you have a mole in the center of your chest, beware of removing it since the scar that results is apt to be a poor one.
Why do people scar in the first place? A scar is simply the way the body heals itself in most instances. A cut through the skin will heal with a scar – it’s unavoidable. In plastic surgery, the trick is to get the scar to heal so that its appearance is acceptable.
What are some of the tricks that I use?
• Avoid tension on the skin edges to the greatest degree possible. The more tension, the worse the scar. Not only does it stretch in width, but it also tends to thicken. I decrease tension by using internal sutures that last for up to 6 weeks. These hold the skin together during the early phases of healing so as to minimize widening of the scar.
• Have the patient wear silicone or paper tape on the scar for the first 3 months. Although the exact mechanism of how this works is unclear, it probably decreases the tension on the skin edges which results in a lesser scar.
• If the scar begins to thicken in spite of the above, consider treatment with a laser that targets the skin. If this is not successful, think about steroid injection into the scar. Steroids will cause the breakdown of the scar tissue. Although a series of injections at monthly intervals is often necessary, it is usually successful in decreasing the thickness of the scar.
• Vitamin E, Mederma, Aloe, and other such creams have never been demonstrated to be successful in scientific studies.
• As a last resort, consider revising the scar. I would wait at least one year in most cases since scars improve on their own for one year. If the scar becomes very thick and extends beyond the edge of the original scar, it may be a keloid. Keloids are more difficult to treat than the average scar. Injection with more powerful scar-reducing drugs may be appropriate and radiation therapy in combination with scar excision may be considered.
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