How To Prevent or Minimize Surgery Scars

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How to Minimize or Prevent Scars After Surgery

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Whenever the skin sustains damage, there is the possibility of scarring. For example, as a child, skinning your knee may result in a scar. The same is true of surgery, even cosmetic surgery, regardless of the skill of your surgeon. Making an incision in the skin, which typically requires cutting through all of the layers of the skin, can result in scarring, regardless of where on the body surgery is performed or why the surgery is being done.

Of course, surgery performed by a less skilled surgeon may result in a greater degree of scarring, but many times the skill of the surgeon has no effect on the amount of scarring that takes place.

Why doesn’t the skill of the surgeon make a difference in many cases? Because your surgeon cannot control all the factors that determine how badly you will scar. While good incision care is important, there are multiple additional things you can do to prevent scarring.

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Risk Factors For Scarring You Cannot Change

Certain factors beyond your control influence your ability to heal without scarring. These risk factors cannot be changed, but help determine if you will scar badly after your procedure.

Risk Factors For Scarring:

  • Your Age: As we age, our skin becomes less elastic and becomes thinner. This is because collagen (which makes the skin elastic) changes as we age, and the fat layer under our skin becomes thinner. The result of these changes, along with sun exposure, smoking, exposure to the environment and other lifestyle issues, means that skin does not heal as well or as quickly as we age. The benefit to age is that the imperfections that occur over time, like sun damage, work to help conceal scars that might be more obvious on younger skin.
  • Your Race: Some races are more likely to scar than others. African-Americans are more likely to form hypertrophic and keloid scars, which are an overgrowth of scar tissue at the site of an injury. Fair-skinned people may find that their scars are more obvious than they would be with a darker complexion.
  • Genetic (Inherited) Tendency To Scar: If your parents or siblings tend to scar heavily, you are likely to do the same. If you have a family tendency to scar badly, you may want to discuss this with your surgeon.
  • Size and Depth of Your Incision: A large incision is much more likely to leave a scar than a small incision. The deeper and longer the incision, the longer the healing process will take and the greater the opportunity for scarring. In addition, a larger incision may be exposed to more stress as you move, which can cause slower healing.
  • How Quickly Your Skin Heals: You may be one of the genetically blessed people who seem to heal magically, quickly, and easily with minimal scarring, or you may have skin that tends to heal slowly—possibly because you have an underlying medical condition like diabetes that predisposes you to slow skin healing. How quickly you heal is a personal thing and can change with illness or injury.

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How to Prevent Scars After Surgery

Preventing scars means focusing on the factors that you can control. Some ways are simple, like following the instructions your surgeon gives you to the letter. Others are not so easy, like quitting smoking.

  • Smoking: Not only does smoking increase your risk for scars, it can also slow your healing. Smoking is such a significant risk factor that many plastic surgeons will not operate on a patient if he does not quit smoking completely for at least 2 weeks prior to surgery.
  • Drinking: Alcohol dehydrates both the body and skin, which decreases your overall state of health. While your wound is healing, avoid alcohol and focus on non-caffeinated beverages.
  • Nutrition: Eat a balanced diet with an emphasis on protein intake. Protein makes up the building blocks of healing skin, so it is essential to provide your body with adequate protein (chicken, pork, fish, seafood, beef, dairy products) to allow your skin to heal. If you do not like eating meat, soy products provide an excellent alternative as a lean protein source.
  • Hydration: Dehydration happens when you are not taking in enough fluids. In severe cases, this can cause electrolyte imbalances and heart issues. In less severe cases, you will feel thirsty and your overall health will be diminished. Stay well hydrated—you will know if you are well-hydrated because your urine will be almost colorless or light in color. 
  • Your Weight: If you are overweight, you may be at greater risk for scarring. Why? The fat under your skin can work against your surgeon's best efforts to close your incision seamlessly.
  • Prevent Infection: Good incision care, which includes preventing infection, is one of the best ways to prevent scarring after surgery.

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6 More Ways To Prevent and Minimize Scars After Surgery

  • Rest: If your doctor suggests that you rest for two weeks, don’t go back to work after one week of healing. Exhausting yourself will not help your wound heal and can actually slow healing.
  • Proper Wound Care: Taking the steps recommended by your surgeon may be the single most important thing you can do to prevent scars. Taking measures to prevent infection, refraining from using ointments and remedies that are not prescribed, and other general incision care techniques are essential to healing without scars.
  • Identify Infection Quickly: If your incision becomes infected, it is important that you can identify the signs of infection and seek help from your physician immediately. An infection can seriously impair healing and can contribute to scarring.
  • Chronic Illness: Diabetes and many other illnesses can slow healing. For the best possible outcome, your illness should be as well-controlled as possible before surgery and during your recovery. For example, for a person with diabetes, it is essential for blood glucose levels to be within normal limits as much as possible, as high levels slow healing.
  • Stress on Your Incision: Putting stress on your incision by lifting, bending or doing anything that stretches or puts tension on the incision should be avoided. This stress can pull the incision apart and delay healing, often making the wound larger than it needs to be, which increases the size of your scar.
  • Exposure to Sunlight: Avoid having the sun on your incision whenever possible. If your scar is in place that is difficult to cover, such as your face, invest in a good sunscreen. Your surgeon can tell you when it is safe to apply ointments, but it is usually safe to do so when the sutures are removed or the incision has closed completely.

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Scar Treatments From Your Surgeon

If you are seriously concerned about scarring, consider discussing the following methods of scar minimization and prevention with your surgeon. Your surgeon may be able to prescribe additional treatments that lower your chances of scarring.

  • Silicone Wound Treatment: Silicone wound dressings feel similar to a thick plastic wrap that you would use in the kitchen. Silicone, however, does not adhere to your wound, allowing it to protect your incision from stress and contamination without damaging the skin when it is removed. Studies have shown that silicone can help reduce scarring and is commonly used after plastic surgery. Discuss silicone dressings with your surgeon prior to your procedure, as the surgeon will need to apply this type of bandage.
  • Incision Placement: In some surgeries, the placement of the incision is not absolute. You may be able to talk to your surgeon about where the incision is placed to either hide or help minimize scars. For example, a Caesarean section can be performed with a vertical incision, which may be more obvious, or a horizontal incision, which may be disguised by a bikini.
  • Prescription Medications: If you have a tendency to scar badly, your surgeon may be able to prescribe cleansers, ointments or a wound care regimen to help.
  • Massage: More doctors are recommending that patients (or a licensed massage therapist) massage their scars. This should be done after the wound closes and any staples or sutures are removed. Massaging an incision and the surrounding tissue may even out any bumps or lumps that remain after the healing process. Be sure to use ample lotion, so that your fingers don’t “stick” to your skin, but slide freely.
  • Steroid Injections: If you are prone to forming keloid scars, talk to your surgeon about having a steroid injection to prevent the formation of another keloid.

Sources:

Johnson & Johnson Healthcare Systems. (October 2016).Ethicon Wound Closure Overview.

Ledon JA, Savas J, Franca K, et al. Intralesional treatment for keloids and hypertrophic scars: a review. Dermatol Surg 2013; 39:1745.

Son D, Harijan A. Overview of surgical scar prevention and management. J Korean Med Sci. 2014 Jun;29(6):751-57.

Wolfram D, Tzankov A, Pülzl P, Piza-Katzer H. Hypertrophic scars and keloids--a review of their pathophysiology, risk factors, and therapeutic management. Dermatol Surg 2009; 35:171.

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