Post Mommy Makeover Scar Treatment

This is what I recommend. Other surgeons will have different opinions.


1. Keep the incision taped for 3 weeks. Steri-strips or other medical tapes are both fine.


2. Start scar massage at 3 weeks. Work that scar as often as you can.


3. Do not tan!!!


4. Use some for of silicone-based scar treatment for the first 3 months. It can be silicone sheeting, ScarGuard, or ProSil. They all work about the same.


5. Vitamin E and Mederma are not as effective as the silicone products.


6. If the scars are hypertrophic, consider Kenalog injections.


7. If the scars are very red in color, consider IPL treatments.8.  There is a newer post-op dressing, called "Embrace".  It's very good, but must be worn for 8 weeks after initial healing.  Although it's not cheap, for people who want the best possible scar, this product has a lot of good scientific research behind it.


All the best,

SCAR MANAGEMENT
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:
1 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.
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 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”.
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. 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.
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 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.

Your #healing will continue for 2-3 months following the procedure(s) as the #scars will be evolving. If my patients have concerns that something is unusual about their healing process, it is important for them to call the office and discuss these concerns or come in to be examined. Also some severe scars can be treated with re-excision, laser, kenalog/5-FU injections, creams, silicone strips and other methods to reduce and improve healing. Additionally, scar therapy with scar maturation products (e.g. BioCorneum or Embrace) are suggested for managing scars. However, we recommend you wait to use scar improving products until a few weeks following your surgery.If you have concerns about your #healing, or pain that you question to be unusual, it is important to call your plastic surgeon to discuss these further asked to be examined.

Hello! Thank you for the question! It is common for scars to fully mature for up to a year. In the meantime, there are a few things that may help to ameliorate your incision/scar. The most proven (as well as cheapest) modality is simple scar massage. Applying pressure and massaging the well-healed scar has been shown to improve the appearance as it breaks up the scar tissue, hopefully producing the finest scar as possible. Other things that have been shown to add some benefit, albeit controversial, are silicone sheets, hydration, and topical steroids. I typically allow after 4-6 weeks postop and once fully healed. In addition, avoidance of direct sunlight to the incision will significantly help the appearance as they tend to discolor with UV light during the healing process. If unsightly scars are still present after approximately a year's time, other things that your surgeon may consider are intralesional steroid injections, laser, or just surgical revision of the scar itself. Lasers may also be an option for the appearance of your scars. If still no result, consideration for lasers, steroids, or scar revision may be entertained. Best wishes!

I am a big proponent of the silicone based Embrace scar system and silicone gel sheeting in general.  It should be started 2 weeks after surgery and continued for 8-16 weeks minimum.

While there are many options out there to treat scars, I believe less is better. Many of the "treatments" are proven only anecdotally. Silicone is the only thing "proven" to work on scars. Other treatments can help but can also cause a localized reaction, making the scar worse. At my practice, I encourage the use of a silicone based gel that also contains an 30 SPF sunscreen. Sun exposure can cause the scars to appear red for a longer period of time. We start massaging this gel into the incision sites at 3 weeks post-operatively to allow the scar to soften over time. The scar matures over the first year, so be patient and use daily.

            A
large variety of agents are currently available for the treatment of
scarring.  At this point in time,
there certainly doesn’t seem to be a consensus amongst plastic surgeons
regarding their effectiveness. Nevertheless, their use appears to be increasing
amongst cosmetic surgery patients.

            These
agents include a variety of topical agents and silastic sheeting. We generally
recommend starting them 2 to 3 weeks following surgery as long as no open areas
or scabbing is present. 

           It’
s important to discuss scar treatment with your plastic surgeon. Your surgeon
should be able to make an appropriate recommendation. 

Cosmetic surgery procedures require a disciplined approach to scars, whether or not the incisions are placed on the face or body. In our Los Angeles plastic surgery clinic, we recommend that patients follow basic wound healing guidelines followed by the application of Plato’s Scar Serum twice daily once the skin is healed. If the incisions are prone to pigmentation, addition of Melarase PM is required. After a few weeks, the skin heals over and laser therapy is initiated to further improve scarring.

Best,
Dr. Karamanoukian
Realself100 Surgeon

I treat postoperative incisions with paper tape or steri-strips for 3-4 weeks.  Silicone sheeting or a product such as scar guard is used following removal of the tape.  Scar massage also helps.

Mederma and massage for surgical scars is great to maximize healing and to good results.  However, everyone is unique and it's important to allow your plastic surgeon to monitor your scar healing and to provide you with specific advice.

There are many different ways to help minimize scarring.  Avoid tension/stress on the wound, massage, bio-oil, silicone, avoidance of UV radiation have all been shown to be helpful.  Unfortunately there is no one foolproof protocol to minimize scarring.  If your scars from the previous surgery healed nicely, then repeating what you did in the past is likely to work again.  

Sincerely,

Martin Jugenburg, MD