How to Minimize Scar After Mole Removal?
Doctor Answers 11
How to minimize scars
Best Scar Management Practice after excision of mole from face
– Advice from Dr. Larry Nichter:
Best Scar Management is important to minimize or completely hide from view, the tell tale signs of surgery – namely, scars. Both you and your surgeon want you to have the most minimal scarring possible from your surgery. Patients with scars that are enlarged or not healing well after surgery can be from many causes. Unsightly scars are most commonly due to genetics, underlying medical conditions or improper scar/wound care. The last part is very important and patients can make a noticeable difference in their scars’ appearance by following best scar management practices. Here are some simple tips.
Scar Management tips:
1- Minimize tension on the scar – Steri Strips and/or surgical tape are often placed in non-hair bearing areas to minimize tension and keep pressure over the scar. This minimizes the stress that can pull the scar apart (dehiscence) creating a wound and delaying healing time, and can make the scar wider, or more “ropy”.
2– Keep your incision site/scar clean to prevent infection. Follow your surgeon’s wound care instructions to the letter with out modification. NEVER apply different products then recommended without first discussing them with your surgeon. This is especially important during the first few weeks. If there are any signs of infection contact your surgeon’s office immediately and/or see your doctor or his nurse immediately. Typical signs of infection may include redness outside the immediate incision site, asymmetric swelling, and drainage, of pus, fever, chills, and “feeling sick”.
3. –Protect your scars from the sun - staying out of the sun is the best advice. Minimal exposure to sunlight is prevents hyperpigmentation (permanently turning brown) and other problems that can make the scar more noticeable. Sunscreen, at least 30 SPF and an overlying make camouflage make up additionally protects the scar from the suns harmful rays. This advice is especially important the first year following your surgery. .
4. – Use specific scar maturation products recommended by your surgeon. Patients seem to have their own opinions on this touting everything from Pure Vit E, Coco butter, to Aloe Vera, etc but most have minimal benefit other than keeping the scar hydrated. Although hydration is important there are better, scientifically studied products with greater efficacy. Most of the scientific articles written about this subject indicate that topical silicone gel or silicone sheets work the best. There are a lot of products to choose from, but silicone should be one of the key ingredients. Although Mederma, an onion extract derivative active ingredient rather than mainly silicone based may help, primarily silicone based products are better and many also contain other ingredients that may be synergistic (hydrocortisone or other steroid, Vitamin E, Sunscreen,etc). At the present time I prefer BioCorneum or Kelo-Cote products and if the reader has problems obtaining these they can call my office. Patient compliance is also critical – use often and according to directions or it will not work optimally. NEVER apply products without first discussing them with your surgeon.
5. – Monitor to make sure your scar is progressing optimally. Keep your scheduled follow-up appointments with your surgeon to verify that your scars are maturing as expected. Occasionally if indicated you may need a topical or injection of a steroid preparation or even a series of injections (5-FU and/or Steroids) or laser treatments to treat or prevent scar hypertrophy or keloid formation (red raised scars), or other topical medicines to treat post inflammatory hyperpigmentation (brown scars) with prescription creams and possible laser treatments.
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Recommended method of mole removal
If the mole is small I suggest a superficial shave excision initially as this will likely give you the best result. Occasionally the result may not be optimal eg return of pigment or a small depressed or raised scar, this can then be treated by excision. You will always be left with a mark, the only advantage is that the result will in all likelihood look better than the original mole.
Minimizing scars after mole removal
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If the mole is raised, it may be just fine to have it shaved. If the pigment is deep, a complete surgical excision may be necessary. Either way, it is very important to minimize sun exposure on the area as it heals.
I almost always start with a shave removal when it comes to mole removal as it it least likely to leave a noticeable scar. You can also have it later excised with stitches if the shave scar is undesirable. Lasers can also be used to improve scarring and may be a great option. The key though is to minimize the scar in the first place so good wound care after the removal is critical.
Scar after mole removal
After removing a facial mole, it is important to close the incision using a deep layer of stitches that dissolve over time and a superficial layer to bring the skin edges together just right. The superficial stitches should be removed in 5 - 6 days. Leaving them any longer can result in Frankenstein "rail road tracks". After removal of the superficial stitches, the deep layer helps to maintain some strength of the wound so it does not break open.
I always have my patients wear tape on their scars for 3 - 12 months after surgery. The tape protects the scar from the sun (VERY IMPORTANT) and also provides a little pressure on the scar so the scar will flatten and fade ASAP.
No matter how careful the surgery and post op care is, some patients just scar a lot. It is much more about their biology than the surgeon's skill.
I always tell my patients that they will be trading their mole for a small but permanent scar. It's a trade off.
Mole removal is an individualized procedure and based on the following factors:
- Anatomic location
- Suspicion of precancerous or cancerous based on history and individual characterisitcs of the mole
- Individual threshold for a scar
Find someone who specializes in removing moles from the face and they will be able to guide you on the best way of having a mole removed.
Minimizing surgical scars with mole removal
Dr. Oppenheim is absolutely correct in his assessment of your problem. Scar excision of the chin would be preferable to shave excision transdermally. I would recommend a scar excision with multiple layers including absorbable sutures for the deep dermis and non-absorbable prolene sutures for the skin. Excision patterns should be placed along Langer's lines.
This area, I feel, does best with a double layered closure after an excision. It is generally not as amenable to the shave biopsy technique as it might be in other places. It also ensures that the whole nevus (mole) has been extirpated.
After biopsy care should include a second skin type of dressing, the choice being up to the surgeon. I like scarguard MD to diminish the scar.
Do wear a sunscreen and oral zinc and Vitamin C may help healing.
Minimizing mole removal scar
To achieve your best possible results, follow the pre and post operative instructions of your board certified facial plastic surgeon or plastic surgeon. I require that my patients stop using aspirin containing products for two weeks before and after the removal. I also have very specific post operative instructions for my patients. Check with your reputable surgeon for his/her specific instructions.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.