Why haven't my scars healed after a year? (Photo)

Best Scar Management is important to minimize or completely hide from view, the telltale signs of your surgery—namely, scars. Both you and your surgeon want you to have the most minimal scarring possible. There are many possible causes for scars that are enlarged or not healing well. 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:

Minimize tension on the scar. Steri-Strips and/or surgical tape are often placed in non-hair bearing areas at the time of surgery 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”. In the first few weeks after surgery, I recommend the use of Embrace Scar Therapy which is an adherent silicone sheeting pre-stretched when applied so as to offload tension on the scar.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 right away 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”.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.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. The best product available in my opinion is the Embrace Scar Therapy System by Neodyne BioSciences, Inc. available in many surgeons’ offices. Essentially this is an adherent silicone sheeting pre-stretched when applied so as to offload tension on the scar. For areas that are not applicable for this product (e.g. smaller areas or on the face), I prefer BioCorneum or Kelo-Cote products 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).. 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.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 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.

Thanks for your question. Your scars are healed. One of them (left) appears to be what is called a 'hypertrophic' scar - or a scar that continued to stay inflamed longer than usual, resulting in a raised scar. The other other side (right) appears to be somewhat widened (because of some tension on the scar during the healing process). After a year, it's reasonable to consider a scar revision to get a better cosmetic result. This procedure entails cutting out the old scar and re-closing the skin in layers. Talk to your plastic surgeon or get a second opinion from a respected board certified plastic surgeon. Good luck. 

Thank you for your question.  It appears as though you have what we call hypertrophic scars from your breast augmentation procedure.  Seeing as though you are a year out from surgery your scars have healed.  Scars take a year to reach full maturity and while they will evolve over this period of time, after a year has passed they are considered healed.  At this point a scar revision might be the best bet in the hopes of achieving more esthetically pleasing scars.  It is important that there is no tension on the closure of your incisions and that you discuss some post-surgical scar treatments with your operating surgeon to help promote good healing.  

likely when your BA was performed, your skin was under a significant amount of tension from the newly placed implant. At 1 yr post-op, your skin should have relaxed and will heal with a better scar. Scars are a mix of little or no tension and your own bodies ability to heal. Good luck

Thank you for sharing your question and photographs. Your scars have indeed healed, but in an exuberant manner, resulting in hypertrophic scarring.  This thickening of your scar tissue occurs due to a number of reasons including stretching and tension of the skin during healing, prolonged incision healing difficulties, suture dissolving issues, and inherent genetics.  Talk to your surgeon about your concern, they should be able to discuss with you the steps needed to minimize recurrence.  Best wishes.

It looks from the pictures that you have formed a hypertrophic scar.  If you are having a scar revision done I would suggest you buy some silicone sheeting to apply after the revision. This will help to flatten the scar.  Steroid injections can help as well.  

Thank you for your question and photos.  I am sorry to hear that you are unhappy with your scars.  It appears that you have hypertrophic scars, worse on the left side.  They are not keloids which enlarge outside the scar area.  We do not always know why some patients get thicker scars but it can be related to scar tension, delayed healing, and skin type.  After your scar revision you may consider silicone scar therapy to optimize your scar healing.  In some cases, your surgeon may neeed to inject steroids into the scar while it is healing if there are signs of the scar becoming hypertrophic.  Good luck.  

Thanks for your question. You have hypertrophic scarring which has led to a thicker scar and some color changes that are negative. Tension at the incision and your genes are the most important factors leading to hypertrophic scarring. I suggest you speak with your plastic surgeon and consider a scar revision. You will have to do something to lower the tension in the scar and change the way your DNA is expressed. The only product that does that is Embrace Scar Prevention. Speak with your plastic surgeon about this approach and best wishes, Dr. ALDO :)

Your scars have healed. Your body just over heals scars. This is called a hypertrophic scar.  Try using some silicone sheets daily and scar massage to help the color fade and to soften your scar. Some surgeons have lasers that will help the color fade. Good luck!

While the exact term for how your scars have healed can be debated, the main thing for you is that they don't look good, and you want them to be improved while avoiding the chance that this will happen again.  They are now 1 year old, so they have in fact healed, and the healing is for the most part complete and mature.  I agree with your surgeon that they are not true keloids, insofar as keloid scars extend beyond the limits of the original injury.  Keloids would be huge, raised, thick, and growing onto normal skin adjacent to the actual incision site.  What you have are called "hypertrophic scars," and they also are "hyperpigmented," or darker than normal too.  This is sort of on the spectrum of wound healing, but technically and under the microscope, there is a difference between keloids and hypertrophic scars.  The significance of this for you is that people that form keloid scars get them due mostly to hereditary factors, and they are far more likely to have recurrent keloid scars with any subsequent injury, including surgical scar revision, whereas in cases of hypertrophic scarring like yours, there may be an excellent chance that it can be avoided or managed postoperatively with scar revision.  Scars can become hypertrophic for a variety of reasons, including genetic skin type or hereditary factors, sun exposure, amount of tension on the skin edges at wound closure, type of sutures used, suturing techniques used, precision with which the original incision was made and how it was placed, and postoperative forces on the healing scars.  Some of these things can be changed or managed with further treatment, and some can't. For instance, if we attempt surgical revision, we can modify our technique so that we make a properly oriented incision in the skin, close it meticulously and without too much tension, and then use things like silicone gel sheet afterwards.  We can also treat postoperatively with a special type of laser to prevent the scar from becoming hypertrophic.  This requires a very specific type of laser though, and the right expertise in using it, so not everyone has that available.  There are also some non-surgical measures that can be attempted before proceeding directly to surgical scar revision too.  There are medications including steroids and cell division inhibitors usually used to treat cancer but used in tiny doses for scars, like mitomycin C or 5 Flourouracil (5-FU), which can be injected into the scar directly, and they will often achieve very nice improvement without surgery, but again, they have to be used properly because they can cause some issues with the scars if incorrect dosing or technique are employed.  In the end, your surgeon knows what techniques were used for your first surgery, and therefore, they know where those techniques could possibly be altered this time around if surgical revision is attempted.  They will also know whether or not it is advisable to try a non-surgical option first before proceeding to surgery, as they are there to examine your scars in person.  You can discuss these things with your surgeon though so that you fully understand all of your options and where they stand on them.  Good luck.