General Scar Care Instructions
Important information about scars:
Scars form whenever something “breaks” the skin, for example:
Once the skin is broken, the body heals by lying down fibrous or connective tissue that causes a scar to form. Scars usually take about 12–18 months to fully mature. During that time, they go through a remodeling process. Many noticeable scars greatly improve over the course of a year. In the first few months, they may be pink and raised (hypertrophic) then soften, flatten and lighten over the remaining 9–10 months. Scar tissue is not as strong as normal skin, and therefore, depending on location, direction and tension, it may widen over time, no matter how carefully the wound was closed. Some scars may even remain permanently thick (hypertrophic) or form an excessive amount of scar tissue (keloid) despite best efforts to minimize scarring.
If the incision has been closed with absorbable sutures and Steri-Strips™, scar treatment can begin about 2 weeks later after the Steri-Strips have been removed and the incision is completely healed. If permanent sutures were used and suture removal is necessary, scar treatment can begin after suture removal according to the surgeon’s recommendations.
Treatment of scars
There are many ways to treat a scar:
Time
Since scars naturally improve over 12–18 months, you may just need to be patient.
Sunscreen
It is very important that all scars be protected from the sun. Scars that become sunburned will remain red and unsightly for a long time – maybe even permanently. It is very important to use sunscreen on all scars, especially new, immature scars.
Massage
The collagen in the scar tissue remodels over a year. Gentle massage can help this tissue to flatten, creating a smoother appearance. Moisture in the form of Vitamin E, cocoa butter, skin cream or products, such as Mederma®, can reduce skin irritation and serve as a reminder to massage scars daily for at least 2 months. None of these moisturizers have been proven to improve scars. Most likely, it is the pressure from the massaging fingers that helps to flatten the scar.
Silicone rubber
Silicone rubber is one of the most effective forms of scar therapy. We don’t fully understand why silicone improves scars, but studies have shown that using silicone helps hypertrophic scars flatten and lose their redness faster than untreated scars.
Silicone sheeting, tape and gel can be purchased at local pharmacies or online. Look for products which are made mostly of silicone. All these products should give you similar results.
Silicone sheets (such as those from Biodermis, Rejuveness or SpectraFilm) or silicone tape (such as Mepitac® or Safetac®) have a light adhesive backing and are usually held in place with tape or gauze. They can be cut to the correct size to cover the scar and are generally used on the body and extremities.
Silicone sheets and silicone tape should be applied constantly for at least 3–4 months. They should be removed daily for bathing and then reapplied. If irritation develops, or if the scar is in an obvious location, the sheet can be worn at night only.
Silicone gel (such as Kelo-cote®, Scar Away®, or Spectragel®) is a thick, clear gel which comes out of a tube. The gel may be easier to use for scars on areas of the body with a lot of mobility, where sheets won’t stick. It is also good for more obvious areas, such as the face. BioCorneum®is a product that contains both SPF and silicone.
Silicone gel may be applied twice daily for 3–4 months. However, silicone may be recommended for longer periods of time if the scar remains red and elevated.
Steri-Strips or paper tape
Steri Strips (paper tape reinforced with thread) or paper tape may be used to reduce scar thickening and especially scar widening. Your surgeon will show you how to apply these but in general they are placed in a way that pulls the edges of the scar together.
To be the most effective, the Steri-Strips or paper tape need to be in place almost constantly. Since scar widening and healing can take one year or longer, the Steri-Strips or tape will need to be used for that entire time. Some children react to the adhesive material in the tape, and you may see redness or blistering at the site. If this occurs, stop using the Steri-Strips or tape for 1–2 weeks until the area heals, and then try using them again. If a reaction occurs again, stop using the Steri-Strips or tape.
Lasers
Scars that remain pink and raised may respond to pulsed yellow dye laser therapy. The light is absorbed by blood vessels in the scar and may result in softer, lighter scars. At first the scar will appear darker due to bruising caused by the rupture of the blood vessels. This bruising will fade over 2–3 weeks. It may take at least a full month to see if the laser treatment has been effective. Several treatments may be needed for the best results. There is a mild to moderate stinging discomfort from the laser pulses. A medicated cream is applied 20–30 minutes before the laser treatment to help make it more comfortable. Lasers are usually reserved for scars that are still pink after 12–18 months.
Steroid injections
Kenalog® (triamcinolone) is a long-acting local steroid injection that works to soften and may help to shrink hypertrophic or keloid scars. It takes at least one month for the steroid medication to be completely absorbed, so injections are usually spaced 4–6 weeks apart. A series of injections may be needed for the best results. The injections may be uncomfortable during the procedure, but the pain goes away quickly. Your healthcare provider will decide if these injections are a good choice for you.
Compression garments
Depending on the location, some scars, especially burn scars, may respond to gentle compression from Ace™ wraps, neoprene sleeves or custom fitted compression garments. These garments are worn for at least 6 months or longer. For large scars with some areas of excessive thickness, a sheet of silicone rubber can be worn beneath the compression garment. Your healthcare provider will decide if these garments are a good choice for you.
Scar revision
Scars that fail to heal well may be improved by surgical scar revision. This may be combined with small zigzag incisions to break up a straight-line scar or to change the direction of parts of a scar to better hide it. In some cases, such as with keloid scars, scar revision may be combined with steroid injection and a few days of post operative radiation therapy to decrease the risk of the scar returning and looking the same.
Unfortunately, there is no guarantee that any of the above methods of treatment will result in a favorable scar. In the case of surgical scar revision, there is always a chance that the new scar will be very similar or maybe even worse than the previous scar.
If you have any questions or concerns regarding the appearance or treatments of scars, please call your CHOP healthcare team.
Reviewed December 2023 by Kelsey Reilly, MSN, RN, FNP-BC, CPSN