Scar Management and Revision
Scarring can be minimized by proper post-operative management. During the first 1-2 weeks, application of moisturizing agents with or without antibiotic added such as aquaphor, petroleum jelly, bacitracin, polysporin, or neosporin help the wound to heal more rapidly with less scarring. Once the wound is visibly healed (i.e. no more scab or open areas) the application of silicone gel sheeting (ScarAway sheets at Walgreens or any other silicone gel sheeting product) continuously if practical (12 hours per day minimum) or scar cream (such as ScarAway gel at Walgreens) for a minimum of 3 months up to 24 months will generally improve the final appearance of the scar. Currently it appears that silicone gel sheeting is the most effective readily available topical treatment for optimizing scar appearance. At sites where it is impractical to wear a sheet of silicone, topical scar creams containing silicone (dimethicone) appear to be the next best alternative. Other scar creams including Mederma and Aloe Vera are all probably better than leaving the scar dry but may not be superior to plain Vaseline. Vitamin E oil may not improve scars and may cause skin irritation/rash. Topical steroid (hydrocortisone) does not appear to improve scars. Taping scars with porous tape may be of benefit to prevent scar spreading but is difficult to maintain for any period of time due to skin irritation. Scar massage may make scars softer and more pliable early on but it is unclear if this dramatically improves the final outcome. Sun protection/sunscreen can help to prevent unsightly pigmentation of scars. Remember, scars tend to look their worst 1-2 months after the procedure and tend to improve after that.
In some instances, unsightly, thickened, of painful scars may result. This is especially common following traumatic injury. Factors such as genetics, the mechanism of injury, the orientation and location of the wound, the type of repair, and postoperative management all play a role in the final appearance of the scar. Some scars may be amenable to surgical scar revision which involves the excision of the old scar and subsequent reconstruction utilizing plastic surgery technique. Usually scar revision surgery is covered by auto insurance and workers compensation insurance but not by medical insurance which deems scar revision to be “cosmetic surgery”. The only exception is if the scar is causing some type of functional problem such as preventing motion at a joint.