Reducing scarring after skin procedures

Skin procedures can leave scars. Care is tailored to the wound and stage of healing, with goals that may include reducing itch, tenderness, tightness or a raised scar as well as its appearance.

Follow your procedure-specific instructions. Good wound care supports healing but cannot guarantee that a scar will be prevented.

What causes scarring?

All procedures leave scars. They are a normal result of skin growth and repair after an injury. The new skin has a different composition from the surrounding undamaged skin and will usually look different.

In the early stages after a procedure and for about a year after, the scar will be red or pink. This is normal and usually fades.

After that, the scar usually returns to the approximate colour of the surrounding skin, but its surface consistency and pigmentation pattern remain different so the scar can still be seen.

Large scars

Large or overgrown scars may be raised above the level of the surrounding skin or extend sideways further than the original incision. This type of scarring is called hypertrophic or keloid scarring.

Hypertrophic scars are more likely when:

• The original excision procedure is large.
• The spot was removed from an area of the body that stretches, such as the chest, back or shoulders.
• The skin needs to be stretched slightly to close the wound.
• The patient is a growing child or teenager.
• A skin graft is used.
• The wound becomes infected or breaks down.
• The patient has a darker skin type.

Some people are simply more prone to develop hypertrophic scars even when none of these factors apply.

Suture marks

Some scars have crossing lines from where stitches were inserted. These are more likely if the stitch material was thick (sometimes necessary for stitches on the back) or if the skin was stretched tightly to close the wound. In these cases, the doctor will sometimes use two layers of stitches where one is buried beneath the surface of the skin. This makes the wound stronger and reduces the risk of scarring.

In the short term

Follow the aftercare instructions provided by your doctor or nurse to reduce the risk of wound infection, breakdown and dehiscence (edges pulling apart).

If you have any concerns about your wound, such as pain, bleeding, bruising, or infection, see your doctor as soon as possible.

If your dressing is blood-stained or coming off, or you have other concerns, we are happy to replace it at our clinic.

In most cases, after 3 days, you can remove the dressing and leave Steri-Strips across the wound until you return to the clinic to have the stitches removed.

LED low-level light therapy

LED therapy may be offered to support healing. Small studies suggest possible benefits, but faster healing or prevention of raised scars is not guaranteed. Your clinician can advise whether a course is worthwhile.

Care as the wound heals

The advice below depends on whether the wound is open, closed with sutures or fully healed. Ask your clinician when to start each measure.

Avoid stretching

Your skin will take up to twelve months to return to maximum strength (which is still less than the strength of intact skin). For the first few weeks after the stitches are removed, the wound is relatively weak and may pull apart if the skin is stretched.

Minimise movements that involve stretching the area for about a month after your stitches are removed.

Be especially careful when lifting heavy weights or moving suddenly. If you routinely do gym work, Pilates, or yoga, talk to your instructor or trainer about ways to exercise that reduce tension on the affected area.

Wearing tape over the wound can help you be aware of stretching in the area and act as a warning to be careful.

Wound and scar gels

We may recommend Epicyn silicone/hypochlorous acid hydrogel early after a procedure, including for an open wound or a closed excision with sutures, according to your clinician’s instructions. It helps maintain a moist wound environment.

For healed skin, silicone scar gels such as Dermatix, Kelocote or Strataderm may help manage a raised scar. Products are not interchangeable: follow the instructions for the specific gel and your wound. Evidence does not establish that one product will give a better result for every patient.

Tape

To further flatten the wound and reduce stretching, apply a surgical tape such as Micropore. For best results, keep the wound covered with tape for 4-6 weeks after the stitches are removed.

Massage

Once the wound has healed, your clinician may suggest gentle massage for scar comfort or flexibility. Do not massage an open wound or begin before your clinician advises it. Stop if it causes pain or damages the skin.

Sun exposure

Sunburn may cause healing scars to become darker. Avoid unnecessary sun exposure to your scar for at least 6 months by applying tape or sunscreen.

What not to do

Smoking

Smoking impairs wound healing. Improving the outcome of your procedure and reducing the risk of scarring might be the incentive you need to help you stop.

Vitamin E cream

Do not use vitamin E cream. Evidence of benefit is limited, and it can cause contact dermatitis.

Antiseptics

If your wound is red or weeping, do not apply any antiseptic such as Dettol, Betadine or tea tree oil.

Wound redness is common and it can be a normal part of the wound healing process. It doesn’t necessarily mean the wound is infected. Antiseptics can help treat infections, but they are toxic to new, healing skin as well as being toxic to bacteria. If you think you have a wound infection, you should see your doctor for assessment and advice.

If your wound is red or weeping, do not apply any antiseptic such as Dettol, Betadine or tea tree oil.

Treating existing scars

If you have a pre-existing keloid or overgrown scar, multiple treatments are available including fractional laser or microneedling, steroid injections, broadband light/IPL and low level light therapy.

References

‍Min P, Goo B 2013 830 nm light-emitting diode low level light therapy (LED-LLLT) enhances wound healing: a preliminary study Laser Ther 2013;22(1):43-9.

Calderhead RG, Kim WS, Ohshiro T et al 2015 Adjunctive 830 nm light-emitting diode therapy can improve the results following aesthetic procedures Laser Ther. Dec 30; 24(4): 277–289

Barolet D, Boucher A 2010 Prophylactic low-level light therapy for the treatment of hypertrophic scars and keloids: a case series Lasers Surg. Med., 42: 597-601