There is no scarless surgery. When you cut the skin you will always get a scar. It may be a thin scar, a pretty scar, a faded scar, a hidden scar. But there is always a scar.
When doing elective surgery you want this scar to be as pretty as possible. So what is a normal scar? And how does it change?
COLOR:
Initially, all scars are a brighter, beefy red. As time passes, the scar turns a purple-y red (yes, I know these are technical terms). Then a dull darker purple red. And then they finally fade. This process varies from person to person, but usually takes about a year to finally fade.
- Avoid sun exposure, as this can tattoo the scar and keep it from fading well.
- If you have pigment in your skin, your scar can depigment (turn white) or hyperpigment (turn brown). You want to avoid this. There are ways to help color changes- see my other blogs or see a doctor to advise.
- Avoid irritating the scar with clothing, straps, etc.
I see many patients worried about their scar who misinterpret what they see. They see a wide red streak, and they think the final scar will be 1. wide and 2. red. There is a common blush of pinkish red in the skin surrounding a scar, which makes the scar appear larger, but it isn’t scar. It is an increased vascularity (blood vessel) blush which will go away with time.
How can you tell? If you put pressure on the skin, you can blanche this so you will get a preview of what your final scar will look like.
FEEL:
I close scars with layers under the skin to take all tension off the skin closure. This often makes the scar area elevated, like a speed bump. This elevated area is NOT scar. The actual scar on the skin is the little line in the center. When the deeper dissolving sutures finally dissolve, the whole area will flatten out. This process takes weeks to months to occur.
- Deep sutures can make the area feel bumpy and ropey. You can almost feel little pea sized lumps. These are the deep dissolving sutures.
- These improve with time as the sutures dissolve.
- This thickening is actually UNDER the skin itself.
Do not confuse normal healing with thickening IN the skin scar. This could be the beginnings of a hypertrophic or keloid scar. When this happens, you want to intervene early. How can you tell the difference? This is an area where you should see a doctor who specializes in scars and healing (dermatologist or plastic surgeon).
- Keloids and hypertrophic scars can worsen with time.
- Keloids outgrow the area of the initial scar (ie they are bigger than the scar)
So what is normal and what is not? It is hard to describe. In a normal scar the redness and feel improve with time. If a scar ever feels like it is getting worse, it is always a reason to see your doctor sooner.
If a scar is mature (years old), it is hard to make the scar better. When a scar is healing and evolving, there is a chance to improve it.
So do scar care. Do it when your scar is fresh. If you have any questions see your doctor.