How to Reduce Scarring After Cosmetic Surgery

Scarring is a side-effect of all surgical treatments, whether they’re for cosmetic purposes or not, and although unavoidable, much can be done to ensure any scars are kept to a minimum and the healing process is as smooth as possible. It’s important to remember that there will always be scarring after a procedure which involves an incision in the skin and even though the scars will fade over time, they won’t disappear completely.

The severity of the scar will depend mainly on an individual’s skin repair response and so there’s no guarantee of how well your scar will heal after an operation.

A good surgeon will ensure any incisions they make are discreet. For example, during a tummy tuck, where possible, the scarring will be limited to below the bikini line, in a facelift the incisions will be made at the hairline. They will also ensure any incisions will be smooth as jagged incisions take longer to heal and can create larger scars.

What causes scarring?

Scars form in response to an injury to the epidermis (the top layer of skin) and/or the dermis, the layer of skin below the epidermis. When the epidermis is injured, the scarring tends to be minimal, if at all, however, when damage is done to the thicker dermis layer it is likely to create a noticeable scar. Cosmetic surgery procedures involve making incisions into the dermis which is why most procedures result in scarring of some kind. When the dermis is injured, the body goes into action to heal the wound by producing collagen, which is a family of structural proteins that gives skin its elasticity. Collagen cells in effect ‘glue’ a wound together and create a scar by shrinking the edges of the wound so it begins to close. Even when the skin is healthy and the wound is healing well, it can take around 18 months for a scar to fade from red, to pink to white and how much it fades will depend on an individual’s skin.

What if my scar isn’t healing properly?

Scars form once a wound has fully healed so if you are experiencing bleeding or oozing from a wound then this isn’t because it hasn’t scarred properly, it’s because the wound hasn’t healed properly. Pre-existing conditions such as diabetes, lymphedema, cancer or thyroid problems can affect how well a wound heals but if you don’t suffer from a pre-existing condition then the problem could be that the wound is infected. Signs of an infected wound include discharge from the wound, an unpleasant smell or swelling or pain from the wound increasing. If you experience any of these conditions then speak to your consultant who will be able to advise on a course of treatment for you, usually involving antibiotics. The best way to avoid a wound from becoming infected is to take care of it properly by cleaning and redressing the wound regularly as advised by your health professional. Although it can be tempting, try to refrain from pulling at your stiches or touching the wound as this can transfer bacteria from your fingers to the wound site.

Why are some of my scars redder than others?

The colour of a scar depends on many things, including how long ago the scar formed as newer scars tend to be redder and then fade in colour with age. It also depends on the type of scar, keloid scars for example tend to be redder than regular scars and form when the body produces too much collagen, making the scar swollen in appearance. Keloid scars are rare and can be treated with steroid injections or by using pressure garments to reduce the swelling. Unfortunately you won’t know if you’re a risk from keloid scars until your wound starts to heal but as a rule of thumb, they tend to be more common on people with darker skin tones who are under 30.

What will affect how my scar heals?

• Smoking – If you’re a smoker then this can impact on how well your scar heals as the smoke from cigarettes can affect how much oxygen reaches the wound. Not getting enough oxygen can slow down the white blood cells’ ability to heal and therefore increase the risk of infection. The NHS offers advice and support on giving up smoking.
• Diet – A healthy diet featuring plenty of foods rich in iron, zinc and vitamin C can help your body to heal more effectively after surgery.

o   Foods rich in iron include beans, tofu, pumpkin seeds, green leafy vegetables, beef and turkey.

o   Foods containing high levels of zinc include spinach (also a good source of iron), kidney beans, shrimp, garlic and eggs.

o   Foods with good sources of vitamin C include red peppers, kale, broccoli, kiwi fruit and strawberries.

If you’re having surgery then a healthy diet leading up to the procedure is advised so your body is in good shape to cope with the demands your body will be put under during the procedure and recovery.

• Age – Older people tend to have less collagen in their skin which can mean that their scars take longer to heal.
• Weight – People who are obese can experience poor blood supply to their adipose tissue which can delay healing. If you are planning to have surgery then speak to your doctor about losing weight if you are obese as obesity can lead to a number of issues during and after surgery.
• Chronic illness – Diseases such as cancer, lymphedema and diabetes can cause wounds to heal more slowly.
• Sunshine – When your scars are new you should avoid exposing them to direct sunlight for 6-12 months. Scars are very sensitive to the sun and can darken easily after excessive exposure.
• Exercise – Don’t do any exercises which will put undue stress on your scars in the first two weeks post-surgery as you don’t want to stretch them. Gentle exercise over the first 7-10 days is encouraged but you shouldn’t be doing anything too strenuous. You can normally get back to doing exercise properly within six weeks depending on your operation.

Speak to your surgeon about any concerns you have about how your lifestyle could affect your scarring and the success of your surgery in general.

What you can do to minimise scarring

Your surgeon will give you instructions on the type of dressing they used on the incisions after the operation and how often it should be changed.

• Look after your wound – During the initial recovery period be sure to change the dressing as instructed and don’t do anything that might pull at the skin around the incision – keep activity to a minimum. The less stress and strain you put on the area, the better the chances of reducing any breast enlargement scars. It’s important to keep the wound clean to minimise the risk of infection which could cause the wound and therefore the scarring to worsen.
• Support clothing – After certain operations you may be advised to wear special clothing to support the healing process. For example, after breast surgery, your cosmetic surgeon may suggest you wear a support bra to minimise the movement in the breasts.
• Invest in cream – Certain creams can help reduce the visibility of any scarring. Initially you may be prescribed a cream after the operation to reduce the risk of any infections that could cause tension around your incision. When you’re on your way to recovery then you might want to invest in a scar cream which you can buy over the counter in a pharmacist. There are also natural creams which may also help with the healing process including coconut oil and aloe vera gel as well as supplements such as vitamin E. Check with your surgeon to see if there are any particular creams that they would recommend and apply this directly to the scar.
• Silicone tape – If you have scars on your stomach or breasts you might want to wear silicone tape which can reduce the appearance of scars by imitating the natural barrier of the skin and hydrating the scar. If you use it you really need to wear it as much as you can for 3-4 months for it to help reduce scarring.

What if I’m not happy with how my scar has healed?

Although the majority of patients are happy with the minimal scarring caused by cosmetic procedures, in some cases people might be self-conscious about how their scar looks. If this is the case then once the wound has healed and formed a scar, there are a few ways to help minimise the look of it.

Scar reduction surgery (commonly known as scar revision surgery) can be done in one of many ways. A popular choice is laser treatment where the area of the scar is resurfaced to soften the scar tissue. Dermatography is another option, where a medical tattooing needle is used to inject flesh-coloured pigment to the scar to camouflage it. The scar can also be surgically cut from the body and the skin replaced with a skin graft from a healthier area of the body.

A chemical peel could help reduce a scar’s uneven texture as the peel is made up of acids, such as glycolic acid, and when it’s peeled off it takes any uneven skin with it.

If you have any concerns about any aspect of a cosmetic procedure, including scarring, then speak to the team at Stephen McCulley who can give you the advice you need