What's the Best Thing to Do Fade my Scars?

Question

My plastic surgeon has instructed me to use a silicone mixed scar cream to massage into my incisions. What's the best thing to do for scar care? I love my results and want to heal as fast as possible.

Naveen Setty, MD · Answer

There are many scar creams on the market today and most have no data backing their effectiveness. However, silicone based gels/creams/sheets do have some data supporting their use in improving scars. Follow the recommendations of your surgeon as he/she knows your history the best. Good luck!

Lewis Albert Andres, MD · Answer

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!

Raffy Karamanoukian, MD, FACS · Answer

After mommy makeover, I would use a combination of pulsed dye laser and Melarase creams to lighten the scars. Raffy Karamanoukian Los Angeles

David Stoker, MD · Answer

Silicone based gels and tapes are very helpful at optimizing scars following a tummy tuck.  Steroid injections may also be helpful for thicker scars.

Ronald Levine, MD · Answer

Silicone sheeting is great for scars, as is silicone creams. But the best thing to do is to keep your scars out of the sun for at least the first year to avoid hyperpigmentation.

Pablo Prichard, MD · Answer

Thank you for your post. In tummy tuck and other lift/tightening surgeries, tension is the enemy. The scar is healing gradually over 12 weeks or so, and until it is strong, it is the weakest link. As there is a great deal of tension in tummy tucks, body lifts, breast lifts, etc., the scar is at high risk of 'stretching' or widening. Silicone sheeting, although having the ability to make a scar flat, does nothing to prevent stretching of the scar. Creams or steroids or lasers also do not have the ability to prevent stretching of the scar. Those are used if scar is thick or dark, but not to reduce the wideness of the scar, which is the main problem. Massage also does not help keep the scar thin, and can actually worsen the scar in the first 12 weeks because you are actually adding tension to the scar. Massage is for softening a hard or thick scar, but if used early, will hasten the scar widening. Only tension reduction has the ability to keep the scar as thin as possible. You may notice in a lot of tummy tuck scars that the center portion of the scar is the widest with the sides toward the hips being the thinnest. This is because the maximum tension is at the center, and least amount on the sides. Embrace removes a lot of the tension by putting more tension on the skin on either side of the incision and drawing the incision together. It is expensive though at about $100 per week for 12 weeks. When patients do not want to spend the money for embrace, I tape the incision trying to remove as much tension as possible for 12 weeks and recommend no stretching back and to sit most of the time, keeping tension off the scar.Best wishes,Pablo Prichard, MD

William Aiello, MD · Answer

This answer depends on exactly what you are trying to achieve and at what stage (time period) we are referring to in your healing process.  If your scar is the result of a trauma or  an elective surgical procedure may also influence the process as well as the location of the scar.  If the area is exposed to the sun then avoidance of sun and sun blockers are indicated. If the area in question is under stretch then taping it or splinting it or compressing it in a manner that minimizes the stretch or expansion in the early phase of healing is a good idea. If the area is in a place that gets rubbed and irritated (bra line, belt line) then padding that area will minimize irritation and if you decorate the area (earlobe repair) leaving out the jewelry for 2-3 months will improve your results.  If trauma is the cause of the scar with road tattoo in the wound then an early dermabrasion to remove the foreign dirt would be indicated. A keloid or hypertrophic scar already established would require anything from silicone sheeting to steroid injections to radiation treatments. Finally if the scar looks good but is pink it may require some bleaching cream such as hydroquinones or a combination with silicone, retin A and hydrocortisone.   In the end most scars will heal well if they have been closed appropriately by a plastic surgeon without the need of any of these.  

	 

	William Aiello, M.D.   Newport Beach CA

Paul Gill, MD · Answer

I agree with your plastic surgeons recommendation of scar massage and silicone based creams or sheets.    With time and diligent scar care, you will be amazed at how quickly your scar heals and improves.   Congrats on a great result.

	Dr. Gill

Sugene Kim, MD, FACS · Answer

I would normally wait 3-4 weeks after surgery before using silicone sheets or scar cream. However, you should follow your plastic surgeon's postoperative scar management. As you can see, we tend to differ slightly on timing.

C. Bob Basu, MD, MPH, FACS · Answer

I generally recommend starting scar massage therapy approximately 4-6 weeks after your surgery.  There is published evidence supporting the report of Silicone topical therapy to help soften and fade scars.   However, we still don't know exactly why silicone helps.  There are ample theories.  I really believe its the mechanical massaging motion that really helps with scars.   Remember, it can take 6-12 months for your scars to mature and fade.  Glad to hear you love your results already!  It will only get better.

	Best wishes,

	Dr. Basu

	Houston, TX

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