“So will I have a scar doc?”
You may have heard of some plastic surgeons offering “scarless breast surgery”. Unfortunately, I am unable to cut into the skin without causing a scar (I promise we aren’t all wankers).
Patients undergoing skin cancer surgery focus on two things. They want to remove the cancer, and they worry about the scar. Here are the three things that I tell my patients to help them improve the appearance of their scars:
1. Sun protection/avoidance
It surprises me how many patients get a skin cancer, and one of their first questions is about when they can go back in the sun! My answer – ideally, never. But, if it is unavoidable, they should aim to cover the scar with a physical barrier like clothing or zinc. Direct sunlight can darken scars and make them more noticeable.
2. Massage
The body lays down collagen randomly to form scars. Massaging the scar makes the collagen fibres align more parallel. This leads to a flatter scar. I encourage my patients to massage their scars from the two-week mark. Five minutes a day with something slippery on their finger, like Vaseline. I ask them to start with gentle pressure at first and to increase it over time. When massaging, you can’t press too hard. If you press softly, you might as well not be doing anything.
3. Silicone
Silicone is the only product that I know of that has been shown to improve the appearance of scars. There are plenty of theories of why this works (e.g. increased tissue hydration) but nothing is set in stone. For scars below the neck, I recommend a silicone sheet like Cica-care. For facial scars, I recommend a silicone gel like Strataderm. Silicone needs to be on the scar for at least twelve hours a day to have any benefit.
Scars show improvement up to the two-year mark. Most of the improvement occurs during the first year. Will patients continue their scar management for that long? Unlikely. So I encourage them to be diligent with it for at least three months.
How much of a difference do these three factors make? I’m honestly not sure. Every time I see a barely noticeable total knee replacement scar, I question whether it’s even worth it! This was closed with staples, by an Orthopod (insert bonehead joke here), and likely had no scar management.
One thing that will definitely improve the appearance of their scar – time. A young patient of mine sent me these photos after having a BCC removed from below her bottom lip. She was very diligent with her scar management, but I would love to know what it would have looked like if she did nothing.
Until next time,
NS
