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Scar Be Gone!

Posted August 02, 2016 in Surgical procedures

Whether it is from a cut, scrape, trauma or surgery, almost everyone with a scar would like for it to be less noticeable.  The means for scar reduction can vary from creams, to lasers, to surgery.  I have compiled some information from the scientific literature to try to make sense of all of these treatments.

Handsome man applying moisturizing cream

Topical Scar Reduction

The easiest way to reduce scars is with topical therapy that you apply at home.  Immediately after a cut or scrape, keep the area clean and moist with anti-bacterial ointment until it has healed.  After it has healed, the choice of topical therapy becomes more complicated.  Of course, always consult with a physician first to get an accurate diagnosis and optimal treatment plan, because not all scars are the same!

Creams That Can Work

Many of the other products that are available over the counter contain silicone (silastic) as the active ingredient in a cream on in a sheet.  Although the exact mechanism by which silicone improves scars is not completely elucidated, both silicone sheets and silicone creams, have been shown to increase tissue moisture which reduces inflammation, over-reactivity of scar-related cells and collagen deposition, leading to flatter and smoother scars.  Silicone also reduces over-vascularization of scars that can lead to pigmentation changes, and scar height.  The studies do not find a difference between using silicone sheets or creams, but do support silicone products as the internationally recommended first-line of scar management. The prescription cream Imiquimod reduces inflammation by modulating the immune system did have some improvement over petrolatum or a control of no treatment.

Creams/Treatments That Don’t Work As Well

Most of us have heard of applying Vitamin E to scars.  Unfortunately, the studies give conflicting evidence whether or not this improves the appearance.  The over the counter product Mederma, is widely available and heavily marketed.  Mederma has a few different formulations on the market, but it contains avobenzone, octocrylene, oxybenzone, and allium cepa (onion extract), the active ingredient.  In a split scar study, in which half of a scar was treated with Mederma and the other was treated with petrolatum, the Mederma showed no advantage over petrolatum (Vaseline).  Therefore, its difficult to say that the active ingredients are effective.  Massage can be helpful for surgical scars, but does not seem to help pliability or appearance of burn scars.  Retin-A (Tretinoin 0.1%) works by stimulating cell turnover, but in clinical studies does not cause significant change in scar appearance.

In office treatments

The next step would be to see your Dermatologist or Plastic Surgeon for other options for scar reduction.  Surgical scar revision is an option for certain scars.  This is such an individualized process, a consult with a Plastic Surgeon is advised.  Pulse Dye Lasers reduce hypervascularity and impair (fibroblasts) scar-related cells to improve scar texture and height.  This requires 3-6 sessions every 3-4 weeks.

Nonablative fractional lasers, like the Fraxel Dual has been shown to improve the appearance and texture of scars with at least 4 treatments every 4 weeks.  This treatment can take a few minutes up to an hour depending on the size that is treated.  The skin is red and swollen like a sunburn for 2-3 days and makeup can be applied once the skin is no longer swollen, usually day 3-4.

Injections by Your Physician

Injections have been used to diminish the appearance of scars.  Botox was used with the theory of reducing muscle movement around the scar while it is healing to avoid pulling on the scar.  However, the studies showed mixed findings making it difficult to say that the Botox had a positive effect.

In raised scars, like hypertrophic scars or keloids, steroids, like Kenalog, and a substance called 5 Fluorouracil have been injected directly into the scar to reduce collagen synthesis, inflammatory signals and (fibroblast) scar-related cell proliferation.  Both substances have been found effective in reducing over-growth of scars, making them flatter and improving the texture.  Another study found that 5-Fluorouracil is most effective when combined with steroid and Pulse Dye Laser.  So, if the scar is very resistant, this can be a good approach.

Although these are some of the treatments that have been shown to be effective in scar reduction, you can never truly remove a scar.  Our goal is to make the scar less noticeable, less visible or easier to cover, so that you can enjoy life and not think about your scar!

Posted in: Surgical procedures