Scarring from Lipoma Removal?

Presently our therapeutic optioins for treating scars is limited.

Silicone gel sheeting seems to be helpful for preventing hypertrophic scars ( normal scar tissue but heaped up) and keloids ( abnormal scar tissue which is also piled up), but not very helpful to minimize normal scars. We are not sure why silicone gel works. It was once felt to be the occlusive effect, but current research indicates it is more related to the silicone gel-skin interface. The gel sheeting that most of us, including myself, recommends is Scar Guard MD but gels may do well such as Neosporin's ( does not contain Neomycin), Curad's, and Cica Care.

For those who want to go more organic, Mederma, is derived from an onion extract. A funny thing occurrred in one of our magazines, Skin and Allergy News, a few years ago. Merz, the company that makes Mederma ran a large ad proclaiming the benefits of their prodcut in reducing scars. Juxtapoised to the ad, Skin and Allergy News, ran a study showing how Mederma was useless in preventing excessive scars! I never knew how they worked that our, although I applaud SAN editorial intergirity. Subsequently, there was a study that did show Mederma to be helpful in diminishing scar formatioin.

I would recommend Vitamin C ( 1 gram a day), Vitamin E (orally. 200 I. U. a day) and Zinc (25 mg. a day). All three of these help in wound repair.

If you tend to hyperpigment, a sunscreen should be applied, especially if a mole was removed.

The issue of Vitamin E helping in wound formation is an example of a medical perception becoming popular among laymen way before their was scientific validation. A number of studies had shown that Vitamin E was not superior to placebo. Not that placebo did not help. Vasoline was often used as the placebo. When a good lubricating substance was placed over a wound it helps healing. Any oily surface, not necessarily Vitamin E. Finally, a few years ago Bill Eaglestein, the noted dermatlogist, and chairman of the dermatology department at Miami, showed that Vitamin E in itself was modestly helpful in reducing scar formation. However, occasionally, we see an allergic reaction to topical Vitamin E so watch for, and discontinue, with the onset of any redness or irritation.

Most of the present research in wound repair involves Epidermal Growth Factors and Vascular Endothelial Growth Factor. A paper in Laboratory Investigation ( April 2008) showed that the latter not only is responsible for angiogenesis ( the development of blood vessels which is oligatory to feed the new wound), but also mediation in the quality and quantity of scar tissue.

Even more interesting is a drug , Juvista, (avotermin) which seems to improve the healing of scars. This is an epidermal growth factor ( Human Recombinant TGFa3---Transforming Growth Factor a3).

Recentt studies published in Lancet ( April 9, 2009) led to great optimisim that this would work as envisioned. Volunteers had wounds inflicted before and after receiving injections of Juvista. There were controls who received normal wound care ( tough being a control). The Juvista side scored 5 points higher ( on a visual 100 point scale) after six months and 8 points higher after a year.

Another study, also published in Lancet, demonstrated that higher doses of Juvista led to even more significant imporvement. Further, the collagen was laid down in a more proper manner (25 less abnormal orientation versus 33% abnormal orientation in controls). This, to me, seems like it might help greatly in preventing keloid formation, besides helping diminish scars in general.

So for now, the best medicine has to offer would be silicone gel sheeting, maybe a little topcial Vitamin E, oral zinc and Vitamins C and E. If your scar heaps up, a visit to the performing surgeon for intralesional corticosteroid injections or pulsed dye laser would be in order,.

However, I can see the day when someting like Juvista will be injected nto wounds prior and following surgery.

Scarring can be reduced by using massage, vitamin E application and sun protection. If your scar is raised then you can get steroid injections in the scar to flatten it. Along with that you can use over the counter product called Scarguard MD every day for 3 months.

In some cases it can be excised and sutured with fine sutures to give a better scar. Make sure you go to a Plastic Surgeon for that procedure and ask him if he has done scar excisions and repairs.

Regards