Ah. The classic question. “Hey doc. Can you look at this scar? I got it from an accident/ knee surgery/ my C section. Should I use this scar treatment on it? Can I make it better?” So to figure out if you can make it better, you need to do a little analysis of the scar. For some scars, you need to cut them out and try again. For other scars, they just aren’t going to get better. So what do you look at?
5 THINGS TO ANALYZE YOUR SCAR
- What is the issue with the scar? Is it wide? indented? red? elevated? pigmented?
- How old is it? Is there still any redness in the scar, where it blanches when you put pressure on it?
- Where is it on the body? Certain areas are notorious for bad scars- knees, shoulders, backs, the midline of the body.
- What was the mechanism of injury? Was it an accident? Infected? Filled with gravel? A sharp surgical cut?
- How was it treated the first time? Did you do scar care? wear sunscreen? Were deep sutured placed? Who sewed it up? Was it sewed up?
Generally, if you have an old mature scar, topicals won’t make it better. Topical treatments don’t fix things like wide or indented scars. But will a topical work on some scars?
I received literature recently from Biocorneum (liquid silicone gel- it is Kelo-cote with sunscreen in it), stating it has been shown to improve existing scars. I thought that was interesting. I know treating a new scar (under 3 months old) is efficacious. What surprised me was their claim, “Efficacy of silicone gel was high in mature scars (>2 years), immature scars (< 2 years), hypertrophic scars, minor and major keloids.” The revelation to me was its efficacy in mature scars. They cite a study from the Dermatology Journal in 2004. So I did what all good docs should do and looked up the original study.
- 111 patients, 25% mature scars / 75% scars were immature.
- Kelo-cote was applied for 2.3 months.
- For the mature scar, 60% of patients thought the improvement was good, and 30% thought it was very good improvement
- This is the patient evaluation of the scar.
So?
I traditionally look at scars to figure out if they are done evolving. If the scar is red, itchy, or symptomatic, then I think it isn’t a fully cooked scar yet, and things may be done topically to improve it. Generally if a scar is older than one year, there is likely to be little further change. Time is a funny thing with scars though- you can’t make a general rule of when a scar is done changing, as people are different. If the scar looks like it hasn’t fully matured, then scar treatments may be good.
Before you throw tons of money at products, get an evaluation by a plastic surgeon to make sure a topical treatment is the right path for you. As I stated before, indented, widened, and other issues won’t fix with topical treatments.