Scar Revision

Unfortunately, there is nothing that will eliminate scars, and when a scar has occurred, the goal is to try to minimize its appearance and any interference with function caused by the scar.  There are a great number of interventions that may be appropriate for a given scar.

For example, we can remove the scar with surgical excision, and then close the resulting wound, with the hope that the new scar will be better than the old scar.  This is more likely to be successful when something about the closure is different the second time, such as more careful technique (especially if a plastic surgeon did not do the initial closure), or less tension the second time (because the skin has relaxed somewhat since the first closure.

A variation of scar excision and closure is a modification in the design of the scar with one of a wide variety of techniques.  One of these is the "Z-Plasty," which allows us to break up a tight scar, but there are many more revision designs available.

Other treatments of an existing scar can include injections, such as steroid injections, which can make a thick scar less thick, but which can result in a somewhat wider scar.  Laser treatments have been used, which can reduce the redness of a scar somewhat more quickly (although the redness tends to fade on its own over time anyway).  Microneedling is another treatment that has been used for scars.

Treatments you can do yourself include massage and silicone sheeting. 

Massage is often done with a lubricant, such as Mederma or Vitamin E oil (cut open a Vitamin E capsule to get the oil).  For this to work, the massage should be fairly firm, and preferably for fifteen minutes three times daily.  This is more likely to be effective in the weeks and months following healing, but can be tried with scars of any age.

Silicone sheeting can also be effective, by applying continuous pressure.  This sheeting is available at drug stores or online, and ideally is left on for 23 hours a day (i.e., except when you are taking a shower).

A preventive measure that can be used in the first few months following healing is a specialized silicone sheet with two lines of adhesive, designed to take tension off of the scar as it is healing, since we know that scars that heal under less tension tend to heal with less thickness and width.  An example of this is the Embrace® dressing, which is available online in different sizes.  This works best when started about four weeks after surgery, and kept on for about 60 days.  Each dressing can generally be left on for 10 days before being changed.  The dressing is applied with a special applicator so that the sheet is under tension when the adhesive is applied, and then pulls the two sides closer, so that they are under less tenion.