Patient's Guide to Proper Scar Care

Gary H. Manchester, MD (retired)

Article by
San Diego Plastic Surgeon

I am often asked, "How can I get a good scar?" While not obvious, the answer is quite simple. The majority of the population, about 98%, does not have a problem healing yet the majority achieve less than the optimal result following surgery. This happens for one of two reasons.

The first reason is that you need to go to a good doctor who knows how to do surgery. This would rule out the majority of dermatologists, family medicine, and internists that have had no surgical experience or training. So the first thing is to pick either a general surgeon or better still a plastic surgeon. They have been trained how to treat tissues kindly and this protects the skin edges from damage throughout healing.

Second and most important step in scar care is to keep the area clean dried blood (scabs) out of and off of the wound. "Your mother was wrong." I was always taught not to pick or touch any wound that I had while growing up. Think of skin as a semi-liquid such as concrete. If a rock was placed into concrete when it has just been poured and not removed until days later, you would have an impression of the rock cast in concrete. The same happens with skin. When you see an individual with bad acne scars, you are witnessing someone who did not remove their scabs during the break out. This is because wounds heal from the bottom up. Without a scab, the acne boil, or surgical incision has the opportunity to fill in the crater from its depth up. This enables skin to grow across the traumatized area. Without its removal, regenerating skin can only grow around the scab thus leaving a perfect cast.The easiest way of removing a scab is to soak it in hydrogen peroxide and then remove it with an equally soaked Q-tip. Hydrogen peroxide acts to dissolve blood (hemoglobin) and thus allow for proper healing.

All healing wounds are sensitive to ultraviolet light, and sunlight during the first six months after injury. If exposed, the resulting scar has a tendency to hyperpigment (where it is lighter than the person's normal skin tone). To avoid this a hat, sunscreen and avoiding sun exposure are all suggested.I hope this helps you in achieving a good scar result following injury and surgery and prevents your need for scar removal procedures in the future.

This guide was written by Dr. Gary Manchester, a Harvard-trained plastic surgeon who has over 30 years of private practice experience.