For scars, what is the best way to minimize them?

Most of us have an accident in our lives resulting in a scar.  I still remember when my then 2 y.o. old daughter suddenly climbed up on the couch, and then promptly fell off hitting the coffee table leaving her with a scar in just about the same place.  I felt awful, and couldn’t sprint across the room in time.

The body location matters.  For example, a scar under the brow will generally heal much better than a scar on the chest, which is especially prone to difficult scars.

Some things to remember about scars:

• Wound healing is a fascinating and complex process that our bodies do miraculously well.
• It can take a full YEAR for scar tissue remodeling to be completed under the surface of the skin, where you can’t see it.
• Most scars will fade on their own with time and be barely visible.
• If a scar starts to “lump up,” or get raised or hard, it’s a sign there’s a problem.
• Starting treatment for a scar problem is much easier earlier.  The longer you wait, the harder it will be to fix the problem.
• Expect scars to be purplish, then fade to red, and then pink.
• Sometimes the buried stitches (you can’t see them), which are under the skin, don’t dissolve.  They will create a “stitch abscess” instead.  Your doctor can remove them for you.

Treatments for scars and scar problems:

Lasers, especially the carbon dioxide laser (CO2) can make scars almost invisible. There is a LOT of science on this. The earlier the CO2 treatments are started, the better the outcome.  Experts, like a board-certified dermatologist, only for this.  It’s harder, but not impossible,  to blend a scar when it’s been present a long time.  Expect 3-10 treatments depending on the size, location, and cause of the scar.

Talk to your surgeon or dermatologist (we treat a lot of scars) about:

1. Can you use scar cream/gel on it?  These are usually silicone-based and really help?
2. Can you massage it?  Many scars benefit from massage, but you need to check with your surgeon about when to start that.  Too early could do the opposite.
3. Injections with a steroid (anti-inflammatory) solution or 5-fluorouracil.  These can be very helpful in a certain stage of scar development if the scar is raised or hard.
4. Lasers – especially the CO2 (see above).
5. Subcision.  This is helpful sometimes if the scar is indented or “bound down.”
6. Fillers.  These sometimes can be used to allow a scar to heal in a more neutral position.  Experts only, please.
7. Botox.  I know …weird!  But Botox/Dysport can be used sometimes to relax a muscle that is pulling a scar out of position.