Sensible Solutions for Surgical Scars

Nearly every woman who has had breast surgery, whether it was a lumpectomy, mastectomy – sometimes even a biopsy – finds herself dealing with scar tissue or keloids after her wounds have healed.

On a very basic level, scars are caused when the dermis, the layer of skin underneath the surface, is damaged. The body produces a fibrous tissue called collagen to close the wound and assist in healing. When collagen is left behind once the damage to the dermis has been repaired, a scar is the result.

The extent of an individual’s surgical scars has much to do with genetics, age, the type of surgery, and whether or not the skin has been previously radiated. Just as no two surgeries are identical – neither are the outcomes. And since we heal from the inside out, although a woman may feel that she is finished with the process several months after surgery, her skin may still be a work in progress.

It’s no wonder many women are troubled by the appearance of scars; they often feel like yet another assault on a body that has already endured so much. Although most scars will fade and diminish over time, it’s not unusual for a woman to feel impatient and look for ways to make this happen sooner rather than later.

While there are countless claims online and in commercials touting the effectiveness of one product or another, to date there is nothing that can absolutely guarantee a positive end result. Having said that, we searched on blogs, message boards and websites in an effort to share some of the remedies women are discussing.

Before we get started, we want to remind everyone that it is important not to use any products (other than those provided or approved by your doctor) on the surgical area until you’ve been given the green light by your healthcare team. It’s essential for the surgical site to be completely healed before you begin trying to find ways to reduce or eliminate scars.

Some Topical Topics – Lotions and Potions

There appears to be a consensus that massaging the scarred area often helps to reduce the uneven texture and lumpy/bumpy feel. This also seems to help ease the tight, uncomfortable pulling sensation so many women experience as their surgeries heal. Since massaging an area that may still feel tender is more comfortable using creams and oils, many of the treatments discussed include some sort of lubricant.

Plenty of advice floats around about massaging -- with everything from Vitamin E creams purchased at the local pharmacy to high-end potions created specifically for this purpose. What’s interesting is that one person will swear by a product they’ve used, while another will say they have used it to no avail. This again, illustrates the basic fact that everybody (make that every body) is unique! The following are just a few of the topical treatments women have used with varying degrees of success.

Castor Oil

Although applying oil to a scar will not promote new skin growth or remove the scar completely, sometimes oil will soften the area and possibly smooth out some of the fibrous tissue. When this occurs, it may help to reduce the appearance of the scar and make it less noticeable.

Since Castor oil will not block pores and is believed to help break up excess oil produced by the body, it is thought this may assist in diminishing the appearance of scars.

Remember, a little goes a long way, so applying a small amount of castor oil to your fingertips and massaging the oil over the affected area for a few minutes is suggested. You can do this a couple of times a day. The goal is to soften the scar tissue and help reduce any inflammation. Massaging promotes circulation and healing, and using oil reduces friction so you are less likely to irritate the area. Of course, you will want to rub softly.

It may go without saying, but we’ll say it anyway – any time you are using oils you should wash your hands thoroughly afterwards, so you don’t get the oil on your clothes.

Vitamin E cream

Vitamin E, or tocopherol, is a fat-soluble antioxidant that can be readily found in capsule, liquid or cream form either online or at your local drugstore, grocery, or health food store. Although Vitamin E has been shown to penetrate layers of the skin and reduce the formation of free radicals that are believed to interfere with healing, it has not conclusively been shown to eliminate or reduce the appearance of scars.

Since Vitamin E influences the production of collagen there have been many studies conducted to determine its usefulness in healing scars. Although nothing definitive has been found, there is actually a concern that using Vitamin E may exacerbate the problem.

Onion Extract

Onion (or Allium cepa) extract has been found to have anti-inflammatory and antibacterial properties and regulate the formation of collagen. Although no studies have shown a significant improvement in the appearance of scar tissue, in a study of 97 people using either an onion gel or a placebo gel, more people using the onion gel thought their scars were softer and less noticeable. There’s something to be said for perception, especially if it brings peace of mind with it.

Aloe Vera

The aloe vera plant is well known for its natural anti-inflammatory properties which provide the ability to cool and soothe irritated skin and to help heal. Many people use it on burns and some people believe it is beneficial in helping reduce the appearance of scars.

It’s not uncommon for the size, color, and texture of a scar to continue changing for a couple of years after surgery as the dermis continues to re-form under the scar tissue. Proponents of aloe vera’s use feel this is the ideal time to apply it since it may reduce the inflammation associated with ongoing healing.

Using aloe vera in its pure gel form without any additives is believed to be the most effective method, and it doesn’t appear that frequent application has any adverse effects. Even its proponents say that aloe vera is not a miracle cure, since it may only minimally reduce the appearance of scars even after several months of treatment.

Argan Oil

Although its use is relatively new here in the United States, Argan oil (traditionally extracted from the nuts of the Argan tree in Morocco) has long been valued for its purported nutritive, cosmetic and medicinal properties. Some believe that its balance of Omega-6 and -9 Essential Fatty Acids (EFAs), phytonutrients and phytosterols (plant derived sterols or stanols that promote heart health) may provide an anti-aging regenerative, hydrating, protecting and healing power for the skin.

Once again, because of its anti-inflammatory properties, Argan is touted to assist with everything from healing acne, erasing wrinkles, revitalizing and fortifying hair and nails, projecting the skin against sun damage and climate stress – and improving the look and feel of scars.

Scar Recovery Gel

Allergan, a pharmaceutical company perhaps best known for Botox® and Restatis® has created Scar Recovery Gel with Centelline™ designed to diminish the appearance of red or pink scars over time. Their website shows the before and after results for a woman with mastectomy scars, and claims although results may vary, this product has shown promise when used as intended. This product is rather pricey compared to many other over-the-counter preparations, but if it delivers the promised results, it may well be worth the expense for some women.

iS CLINICAL®

iS CLINICAL, a well-respected skincare company, has a product called Super Serum™ Advance+ that they claim has been clinically proven to reduce the appearance of scar tissue.

The Super Serum™ (although fairly expensive) was developed to reduce fine lines and wrinkles, increase collagen production, treat hyperpigmentation, hypertropic scar tissue (a raised scar but not as much as a keloid) and stretch marks, as well as providing UV protection.

Esthetician Julie Phillips, owner of Skin Essentials in Montecito, CA, has used this line with good results and feels women who may not have had results with other products may want to give this a try. As she points out, it is very good for the face, so if it doesn’t work on a particular scar, the product won’t necessarily go to waste.

Mederma® (and Mederma® PM)

One of the most popular and perhaps well-known products for dealing with scars is a favorite of both physicians and pharmacists alike. Mederma® offers an entire line of products designed to improve the overall appearance, color and texture of scars. They claim their products will make scars softer, smoother and less noticeable.

Their relatively new night cream, Mederma®PM claims to be the first and only overnight scar cream specifically formulated to work while you sleep. With a once-nightly application they say it has been clinically shown that scars become smaller and less visible in as little as 14 nights.

Vaseline®:

Blogs and chats alike very often contain commentary extolling the benefits of using the time-honored standby: plain old Vaseline®. According to Dr. Terence Davidson, professor of surgery at UC San Diego School of Medicine, in an article appearing in the Los Angeles Times in April of 2011, you should “Save your money. There are many old wives’ tales to buy into and a slew of products you can buy, but none have been scientifically proven to work.

“If a scar gets better after months of applying a remedy, how do you know if the treatment or time made a difference? Scar remedies are a gray area because it’s hard to test them with well-designed studies. Since everyone heals differently, a good study would compare treatments on two similar scars in the same person, or on two halves of the same scar.”

He concludes, “The only thing really shown to help the healing process and minimize scarring is keeping a wound moist and covered. Most scar products do that, but so does petroleum jelly. In fact, in two randomized comparison trials of Mederma® and petroleum jelly, Mederma® did not improve the appearance of scars any more than petroleum jelly, and Vitamin E doesn’t do any better.”

The Silicone Peaks and Valleys of Scar Treatment

A very popular method for treating scars involves the use of gels and strips (or sheeting) using silicone. We will touch on a couple of the better known products so you will have some idea of what they involve – and what they say they can do for you.

Newgel™+ Scar Management Solution

NewGel™+ manufactures soft, flexible silicone water product sheets, strips, and dots designed to aid in the prevention, reduction, and management of scars. According to their website, their scar management solution not only fades scars, but also flattens and softens them as well. In addition to the topical gel, they also offer a variety of sizes and shapes of silicone scar sheets.

NewGel+ silicone gel sheeting is non-invasive, self-adhesive, reusable, and formulated from medical grade silicone, available in soft, stretchable beige or clear. Their beige backing is slightly thicker and more durable than the clear backing, while their clear backing is thinner and often more comfortable for the user (both provide the same amount of silicone).

ScarAway® Silicone Scar Healing Sheets

ScarAway® is another type of ultra-thin silicone scar sheeting. They say that their proven Advanced Silicone Technology has been shown in countless clinical studies to reduce the appearance of scars new and old, by simulating the natural barrier function of healthy skin, hydrating scar tissue to soften the scar, thereby shrinking, flattening and fading it.

How About a Couple of Hands-on Modalities?

Acupuncture

On the website Acupuncture Today, Skya Abbate, DOM, says: “The treatment of scars has an historical base in Oriental medicine and can often be the key to the successful resolution of chronic, persistent, intractable conditions. Essentially, scars can be viewed as ‘potential’ organ-meridian disturbances, that is, as a physical or energetic disturbance of a meridian precipitated by the trauma induced to the tissues.

A few of the benefits associated with acupuncture include:

• decreased pain
• improved range of motion, mobility and flexibility
• increased blood flow to an area potentially helping to improve healing
• decreased swelling
• from a cosmetic perspective, it can help “flatten” out scars that are thick, potentially improving sense of confidence and well-being
• improved posture from the amelioration of the immobility of the scar
• from a Chinese Medical perspective a mobile scar can help the flow of Qi (or the body’s life force/healing intelligence)

Acupuncture needles are different from the injections you may have received from your doctor. The Acupuncture needles used are hair thin and most people feel a light prick or pressure or even zero sensation when the needles are inserted.

It is common for patients to see a positive change after only a few treatments, but every patient will have a different and individual response.

Massage Therapy

We talked a bit about self-massage using creams and lotions, but you may actually want to consider going to a massage therapist to see if they can provide some improvement. Again, you will want to get your doctor’s approval, but generally once the wound has healed, massage therapy can be performed. Obviously during the initial stages of wound recovery, you will want to be sure your massage therapist uses a gentle approach.

Following are a few techniques that may improve scar tissue:

Manual Lymph Drainage optimizes lymphatic circulation and drainage around the injured area. Lymph drainage is enhanced by gentle, circular draining motions within the scar itself or a firm stretch to the skin above and below the scar, first in a straight line and then in a circular motion. Placing the fingers above the scar, then making gentle circular pumping motions on the scar also helps drain congested lymph fluid. As the massage therapist gently works down the scar, the tissue will feel softer. Drainage techniques should not hurt or make the scar redden.

Myofascial Release helps ease constriction of the affected tissue. Your therapist will stretch the skin next to the scar, place two or three fingers at the beginning of the scar and stretch the skin above the scar in a parallel direction. They will then move the fingers a quarter of an inch further along the scar and repeat the stretch of the adjacent tissue, working their way along the scar. An alternative method is to follow the same pattern of finger movements using a circular motion instead of straight stretches.

Deep Transverse Friction can prevent adhesion formation and rupture unwanted adhesions. Applied directly to the lesion and transverse to the direction of the fibers, this deep tissue massage technique can yield desirable results in a mature or immature scar. You will definitely want to let your massage therapist know your comfort level!

Stretching aids in increasing range of motion. Scar tissue will lengthen after being stretched, especially if the stretch is sustained for several seconds and is combined with massage.

Heat Application helps the pliability and flexibility of the scar. Common tools used to apply heat are paraffin wax, moist heat packs or ultrasound.

Of the utmost importance is finding a massage therapist with experience and training that focuses on scar massage.

Something New That Should Not be Under the Sun

We all know that excessive sun exposure is associated with the increased risk of skin cancers, but many people feel a bit of sunshine can help them heal. For scars, this is a big no-no!

Be sure not to expose new scars to the sun, since the ultraviolet rays can slow the healing process as well as stimulating melanocytes (the cells that produce pigment), causing dark discoloration. When you're outdoors, always use a broad-spectrum sunscreen with an SPF of 15 or higher.

So, there you have it. Although there is nothing that can absolutely promise to get rid of scars, there are plenty of options available to try. Whether you decide to try a bit of petroleum jelly, bite the bullet and spend money on one of the higher-end products, or find yourself somewhere in between, you have possibilities.