All surgery will result in a scar – but how noticeable that scar is depends on a number of factors. In this article our Practice Nurse Alecia explains the variables and what you can do about the ones under your control!
What influences how noticeable your scars are?
There are three main groups of factors:
1 – The surgeon and the surgical technique. Of course Dr Moncrieff tries to minimse scars by choosing the right operation for the right patient and then using surgical techniques such as extensive internal stitches to support the wound from the inside out. The less pressure there is on the external incisions the better. And on the external incisions, Dr Moncrieff uses lots of small stitches using fine suture material to minimise scars.
2 – Factors outside your control: There are a number of things you can’t control. For example, lighter skin tones tend to scar better, as does older skin or skin which has been stretched through weight loss.
3 – Factors you can control: how well you look after yourself after surgery can make a big difference to the outcome. Following your post-operative instructions by limited movement of the area, eating well, rests, wearing your garment etc will make a big difference. More detail is outlined below.
What are the top 4 things you can do?
1 – Wear your support garment and keep your dressings in place:
Your compression garment is effective in managing post-operative swelling and fluid retention by increasing blood circulation and nutrients to the surgical area. It assists in decreasing discomfort, bruising, and pressure on the incisions which can help reduce visible scars.
Your dressing keeps the wound together while the body’s healing process is taking place. They are vital to keeping the wound from stretching and avoiding infection.
The main purpose of a surgical dressing is to cover the wound, control post-operative bleeding and protect newly formed cells as the healing process progresses.
Dressings used post operatively are designed to remain in place for up to 3 weeks post op. They are low adherent and transparent which allows nursing staff to visually assess the surgical wound without disturbing the dressing itself.
There are 2 main reasons dressings are intentionally left undisturbed for this period of time. Firstly, dressings are applied in a sterile operating theatre which means that while they are intact there is less chance of possible external bacterial contamination and infection to the healing surgical sites. Secondly, it is counterproductive to remove dressings in the early stages of healing as it disturbs the healing wound bed and ultimately affects the long term functional and aesthetic appearance of the surgical scar.
Although the dressings are waterproof it is important that water does not get under them. Breaching this dressing barrier may result in a breakdown of the surgical incision and surrounding skin and lead to further more serious complications.
It is important to keep your dressings on unless instructed to remove them.
2 – Limiting movement:
The goal of post op wound healing is to allow surgical wounds to heal quickly and without complications and with the best aesthetic result. Limiting movement and following your post-operative instructions carefully throughout your recovery period will allow wound edges to become well approximated and heal properly.
During the initial phases of wound healing collagen fibres are forming and epithelialisation is occurring.
It is important during this period to limit or avoid any movements which place excessive tension, stretch or strain on the wound edges and can potentially lead to impaired wound healing.
3 – Post op scar management (once the wound is healed):
This involves a multipronged approach of massage and application of a nourishing cream or oil.
As scars mature they can become hard and raised and stick to underlying tissue or muscle. You will be instructed when it is beneficial for you to begin massaging your surgical incisions using a moderate pressure and a slow, circular motion with your fingertips.
This will produce a paler, flatter and softer scar as it matures. It is recommended to carry out scar massage at least once a day for at least 5 minutes to achieve the desired result.
To assist with lubrication while massaging and nourish the scar and surrounding skin it is recommended that a vitamin E oil or cream is used as part of your scar management regime. Vitamin E is rapidly absorbed by the skin and is both a nutrient and antioxidant which means that it has anti inflammatory and skin healing properties.
Scars may feel sensitive or strange when scar massage is first commenced, but regular massage will help to desensitise the area and cause it to become less sensitive over time. A consistent scar massage regime will not only assist scars to heal and become more flexible it will also actually cause the production of new collagen which leads to a stronger and smoother scar in the long term.
4 – Limit sun exposure:
Premature exposure of scars to sunlight particularly during the first 3-6 months post op. Increases the risk of hyperpigmentation and thickening of the scar. This means that the new skin or scar is more sensitive to the UV radiation from the sun and as a result the skin will burn more easily, may discolour to a darker pink or brown colour and become more noticeable.
The best course of action is to avoid scars becoming sunburnt by covering where possible with clothing and by limiting the time of direct exposure. When areas are directly exposed it is essential to apply SPF30+ sunscreen ideally with a zinc oxide to all the uncovered skin. Looking after the scar and protecting it from harmful UV light will lead to a smoother flatter and less visible scar.
What about the best scar creams for after surgery management?
We have trialed different creams and gels over the years and find for most patients, a simple Vitamin E cream is enough. We recommend gently massaging it over the scar once the wound is completely healed over.
Some patients who have a propensity to scar have found products like Strataderm (available from most chemists) can be helpful.
What about LED devices, laser or other treatments?
In the first few weeks, our Healite LED light therapy device is shown to promote wound healing and reduce pain. All our surgical patients have some complimentary Healite sessions after their procedure.
Once the wound is healed but before it starts to mature around 6-9 months, some of our Glow Laser can be helpful.
Once a scar is fully matured, treatments like our Dermapen skin needling can help to break up the existing scar and help minimise the appearance.
Need ideas about recovering from surgery?
General information about bouncing back from surgery is available in this article.
Alecia Baker, Practice Nurse, Hunter Plastic Surgery
Alecia joined us as our Practice Nurses in 2018. She is a Registered Nurse with extensive experience in nursing and patient management in some of the busiest hospital settings in the Hunter! She really cares about helping our patients become healthy and happy. Her kind and calm manner help them feel comfortable during their journey with us.