Scar healing is the result of biologic wound repair and is a complex process. With the exception of minor lesions, every skin wound causes some degree of permanent scarring.
My breast reconstruction patients often ask for advice on how to improve their scars. While expecting 100% invisible scars may not be realistic, it is possible to influence the body's scar healing mechanism to improve scar appearance.
The word "scar" comes from the Greek word "eschara", meaning "place of fire." Scar tissue is different from normal skin. It is inferior both in appearance and function. For example, scars are much less resistant to the sun's ultraviolet rays and more prone to sunburn. Scars also lack a blood supply or sweat glands, and they never grow hair.
Complete scar healing can take up to 2 years. Scars continue to soften, flatten and fade during this time. Unfortunately, some scars become more problematic over time by:
1) Age - younger skin is more prone to abnormal and exaggerated scarring. This can lead to hypertrophic or keloid scars. Older skin takes longer to recover.
2) Skin type - scar healing is typically worse in people with darker skin types. African and Hispanic ancestry is associated with a higher risk of developing hypertrophic or keloid scars.
3) Genetics - abnormal scarring can be inherited.
4) Location - Movement of scars over joints can make them wider.
5) Infection - Infected wounds do not heal well. The final scar may be raised, wide, uneven and abnormally red or dark.
6) Poor nutrition - not eating healthily can deprive the body of much needed nutrients (like protein), vitamins (like vitamin C) and minerals (like copper and zinc) that are needed for optimal wound healing.
7) Smoking - components of cigarette smoke cause blood vessels to clamp down and decrease blood flow. Wounds that do not receive enough blood are more prone to poor wound healing and worse scarring.
8) Sun exposure - exposing fresh scars to the sun can cause permanent redness which makes the scar more obvious.
So what can you do to improve scar healing?
1) Keep fresh wounds clean. Don't be afraid to wash your wounds but use a skin-friendly soap like Dial. Also keep fresh wounds covered to prevent dirt and bacteria entering and increasing the risk of an infection.
2) Eat healthily.
3) Don't smoke.
4) Protect scars from the sun. Cover them with clothing initially and use sunblock as soon as the scar is healed enough.
5) Scar massage - firm massage of the scar for several minutes, multiple times a day has been shown to help soften and flatten scars.
6) Use a scientifically-proven scar treatment - there are plenty of options out there but most promise much and deliver little. Commonly recommended therapies include onion extract (like Mederma skin care) and vitamin E. Multiple clinical studies have shown that neither of these are beneficial for scar healing. Vitamin E actually causes contact dermatitis in up to 33% of users!
Scientifically proven scar treatments to look for include dimethicone silicone sheeting or gel (soften scars), topical vitamin C (lightens darks scars and promotes healthy collagen), and some (all-natural) botanicals like licorice extract (lightens dark scars) and aloe vera (anti-inflammatory). Whichever scar treatment you choose, start using it as soon as initial scar healing has taken place and continue using it until no further improvement in scar appearance is seen.
I encourage everyone to become familiar with the scientific evidence behind common scar treatments and to carefully examine product labels before buying.
Dr Chrysopoulo is a board certified plastic surgeon with a special interest in scar healing and breast cancer reconstruction. He is also Chief Science Officer of C&H Scientific, makers of the scar treatment, InviCible Scars. Join us on Twitter and Facebook for more scar treatment tips!