What Should I Use when I Massage Upper Eyelid Scars Scars?

Question

Hi, I had upper eyelid surgery 3 weeks ago. My doctor told me to massage the scars twice a day with Tobradex ointment or vitamin E as he said that I had some irregularity in the stitches on one eyelid that should eventually flatten out. Which is the best stuff to massage the scars with? Can I use kelo-cote to massage the scars instead of vitamin E or Tobradex? Thanks.

A.J. Amadi, MD · Answer

For the most part, it is the action of massaging the scar than can accelerate scar softening and evolution. The cream/ointment is recommended mostly to decrease the friction on skin so that the skin doesn't become overly inflamed and irritated.

	Except for Silicone sheets or sprays, no other products have been shown to accelerate the scar flattening phenomenon. And Silicone products are not meant to be massaged in, but rather they are used as coating for the scar.

	So to answer your question no cream or ointment is better than any other. However, to facilitate massaging around the eyes, the safest ointments to use are Ophthalmic Ointments. You can buy these over the counter. Sometimes a steroid cream [Tobradex or FML, for example] can help decrease swelling and redness if this is also an issue. You should be aware that longterm steroid cream use in or around the eye could potentially [though rarely] increase rate of cataract formation or increased eye pressure [leading to glaucoma]. You should not use steroid creams in or around the eye for more than 2 weeks without being closely followed by an Oculoplastic surgeon or Ophthalmologist.

	Massage for 5 minutes two to three times a day is a good regimen, and you can do this for 3-6 months for scars. Again:  please do this only under the direction of your surgeon.

Raffy Karamanoukian, MD, FACS · Answer

Plastic surgery scars require attention after surgery so that they remain cosmetically-appealing and barely noticeable. In our office, we use a protocol for scars that minimizes their activity in the 6-8 weeks after surgery. If you have late plastic surgery scars, you may also require laser and RF therapy to help reduce the longterm effects of the scarring. Keloids, hypertrophic scars, widened scars, red scars, and hyperpigmented scars all require scar modulation with topical creams followed by lasers and RF therapy. Topical skincare should be directed to a specific need, whether for pigmentation or hypertrophy and our office can guide you through the process to obtain the correct Plato’s Scar cream or Melarase cream for hypertrophy and discoloration. In terms of lasers, we would employ the vbeam laser for redness, Venus Viva RF, PRP microneedling, chemical peels, and Morpheus 8, fractional erbium, or fractional co2. All of these have their individual benefits. Most of all, we recommend you visit a solid plastic surgeon who understands surgical scar revision, laser therapy, and RF therapy for scars. 
 
Best, 
Dr. Karamanoukian
Realself100 Surgeon

Amir Nakhdjevani, MBBS, MRCS, FRCS(Plast) · Answer

Thank you for your question.  You can use which ever cream you like, it really does not make that much difference, massaging is good to soften any scar tissue.  Kelo-cote is not really used as a massaging product, you can put a little of the product on the tip of your finger and film the scar.  This need to be left on.  Please use the protocol that your surgeon provides you with.  All The Best

Richard J. Bruneteau, MD · Answer

It's not unusual for patients to be concerned about the appearance of their eyelids in the immediate post-operative period. At this time, normal scars are often irregular, red and raised.It's important to realize that healing goes on for up to a year following surgery. In an effort to facilitate wound healing, many plastic surgeons recommend that patients massage their eyelids following this procedure.The primary benefit of massage is the mechanical break down of scar tissue. Lubricants and ointments can be utilized to facilitate this process. For this reason, many surgeons use Aloe Vera, Mederma, Vitamin E Ointment, Cocoa Butter and a variety of lotions. Massage should be accomplished with gentle pressure and a circular motion.If you're concerned about scarring following blepharoplasty surgery, it's important to consult your plastic surgeon. Your surgeon should be able to formulate a treatment plan that addresses your scarring and alleviates your anxiety.

James R. Gordon, MD, FACS, FAAO · Answer

Thank you for this question which will help many patients who often ask about preventing scars. The truth is no doctor knows for sure how to prevent or improve scars during the healing phase. Some feel massage is helpful and others feel it is detrimental. There are many scar prevention creams on the market. The only type of cream that might have some value for scar prevention are those with steroids. Steroid creams cannot be used too long. Some surgeons have successful used lasers on scars during the initial procedures or during follow up. The good news is that scars usually improve without treatment over for about a year.

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. Using ointment or Vaseline does well - avoiding creams and lotions to eyelids. Other things that have been shown to add some benefit, albeit controversial, are silicone sheets, hydration, and topical steroids. 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.Hope that this helps! Best wishes!

Vincent N. Zubowicz, MD · Answer

Don't massage your scar. Massage releases histamine which increases inflammation and prolongs the remodeling process. Topical agents don't work. Don't waste your money. Best treatment for a remodeling scar: leave it alone.

Elizabeth F. Rostan, MD · Answer

I always have my patients avoid Vitamin e. A great choice is the Avene Cicalfate cream which has zinc, sucralfate copper and avene spring water to promote healing. Very popular healing and moisturizing cream.A thick moisturizing cream with no fragrance should work also.

Jasmine Mohadjer, MD · Answer

I usually ask my patients to use an antibiotic cream on their incisions for the first 2 weeks of surgery.  After that, I ask them to massage the incisions firmy with clean fingers in small, circle-like motions.  I ask them to especially focus on the inner corners.  The ointment isn't really necessary at this point, but the massage helps break up deeper scar tissue that may try and form.  I don't recommend the Vitamin E oils near the eyes.

	 

	Good luck!

Jacob Freiman, MD, FACS · Answer

The idea behind massaging the scars is to break-up the contracture and it works very well. In other parts of the body, kelocote or biocorneum is great but I don't feel comfortable with getting the silicone cream in the eye. Either use nothing and just massage with clean fingertips or use tobradex.

What Should I Use when I Massage Upper Eyelid Scars Scars?

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