The time to address scarring is when it is new.
When you have a scar, you need to try to decrease inflammation. When scars are mad, they can elevate, pigment, break open, and heal poorly.
Basic scar care: (and this is not medical advice. Talk with your doctor about your particular case)
- Keep it clean. Wash with soap and water (not alcohol or hydrogen peroxide).
- If it has scabs or muck on it, clean that off. Yes, you actually have to touch your scar.
- A little bit of bleeding isn’t scary. But if your scar has an area that looks irritated or open a little, clean it, use polysporin/neosporin/bacitracin in a thin layer, and then pad it.
- I don’t like bandaids all the time. They are really occlusive, so they can trap moisture.
- If you are spitting a stitch (see my blog), clip the whisker.
- Watch out for things that are rubbing on your scar- clothing, belts, bras. Pad your scar so it isn’t being irritated.
- Don’t stress your scar until its ready. That is part of why I don’t like exercise until 3-4 weeks. You have to let your scar heal.
- No sun. Wear SPF and cover your scars until they are mature. Sun exposure can “tattoo” the scar to being red.
I use kelocote, a liquid silicone, for my patients. (actually I give my patients Biocorneum as it has sunscreen in it as well). For many, I also recommend double coverage with silicone tape on top. I do this because of a study with histologic biopsies which showed it was better than Mederma and Vitamin E. It was also recommended in an Asian scar summit for avoiding keloids.
If it is starting to pigment (particularly for those with more melanin in their skin like Indian, Asian, LatinX, and Black patients), jump on it early. Make sure the scar isn’t being irritated. Clean it, scar treatments, pad it. You can use hydroquinone topically. I am not a huge fan of lasers for pigment, as I have had patients who tried it and ended up with worse pigmentation. I am sure it works for some, but I steer clear.
Keloids and hypertrophic scars (where the scars elevate) doesn’t happen usually until months in. If it is starting, see your doctor. There are some new modalities which may help scarring- microneedling, BOTOX® Cosmetic, and others. But all of these things need to be done early. There are some areas of the body- midline, hair bearing areas, over joints/ high motion areas- that tend to scar more. See my blogs HERE.
If you have an old scar (ie more than a year out), it is likely mature. At that point, most topical treatments won’t have much effect. Prevention truly is key. Cutting out the scar and rolling the dice again may help. Many times with a big surgery your body is diverting its resources to many areas. When you do a scar revision (which is typically under local anesthesia in the office), your body and you can concentrate on one area.
Even with all of this, some people are just genetically prone to bad scars. If your family has a history of pigmentation, keloids, and elevated scars, you are at higher risk. So you can do everything right, and it still may happen.