Healing And Wound Care
There is no surgery without scarring! Scars are the body’s normal and inevitable response to injury and tissue repair. Patients should understand that healing process extends well beyond the first two weeks when the wound ends have reconnected so that sutures can be removed. At that point immature scar has glued two sides of the wound together, but important, secondary healing processes only then begin. And they take weeks, if not months! With time, scar collagen becomes softer, thinner and paler. Initially red or pink, firm scar line will gradually fade and eventually become white and/or almost regain the colour of the surrounding, normal skin. Scar will also become much more pliable. But patience is essential as this might take between 6-9 months and for bigger scars up to 24 months.
As plastic surgeon, we make particular efforts to leave behind fine scars: use very fine instruments and sutures and handle tissues and wounds in a way likely to result in as favorable scarring as possible. However, patient patience with healing and cooperation with wound care can be very helpful in postoperative recovery too.
Although various procedures require various sutures and dressings, in general, I am very keen for patients to have an active role in their wound care post-operatively. Wherever possible, I recommend early bathing with normal soap and water, sometimes as early as only one day after surgery. I usually tape the wound for the first 2 weeks after surgery. This is done with a light brown, skin coloured surgical tape (picture 1a) which is additionally secured with overlying shower-proof dressings (picture 1b). These dressings are extremely comfortable, robust and usually stay in place for 1-2 weeks, until your first review. Such dressings are shower, but not bath proof, and if they become wet, just dry them using a hairdryer, which easily prolongs their adherence.
After a fortnight, I recommend a scar massage twice daily with a moisturizing cream. Vaseline, VitE based ointments
E45, Nivea, Bio-Oil or any other non-perfumed moisturiser that lubricates and facilitates massage will suffice. I have no particular preferences or strict recommendations which product to use, but would suggest caution with creams/ointments which contain fragranced substitutes as those can be irritating for the fresh wound. I do also see no justification for use of expensive cosmeceuticals as they are unlikely to make notable difference at the early phase of healing. The main thing is that the scar is massaged and moisturized regularly for at least 3-6 months, ideally up to a year. The purpose of this is to speed up the natural healing and repair process and allow the scars to soften, flatten and become paler.
Moisturizers and massage are by far the best treatment for scars but additional treatments such as silicone gel sheeting (eg. Cica-care gel) or silicone gel applications (eg. Dermatix or Kelo-cote] may also be beneficial for patients who develop hypertrophic scars. However, there is no scientific evidence for the benefit of Bio-oil, but many people do use this and like it. Arnica is available, either as a cream or a tablet. Arnica is particularly helpful in resolving bruising and swelling after aesthetic surgery procedures, but can be helpful on other areas of the body too. Tablets are taken from 1-2 days before surgery until bruising and swelling have settled.
Picture 2 illustrates my preferred method of wound closure in majority of wounds – stitch is interwoven, hidden in the deeper layers of skin so that no stitch marks appear later. Picture 3 shows appearance of wound at 2 weeks after removal of
It is essential to protect your scar from the direct sunshine, especially over the summer months for up to a year after surgery. If immature scars are exposed to the sun, they can become pigmented or stay red permanently. It is therefore important to cover scars with clothing or sun protection factors (SPF30 and above) to optimize scar outcome.