Article: Scars

Rest, rest and once more … rest

A scar can not be prevented after surgery, but when I make the incision I take the forces which work on the skin into account. The least force on the scar the sooner it becomes tranquil and the prettier it will heal. I always make an estimation of the scar forming beforehand.

Development of scars

When the sutures are removed after one or two weeks, the scar is not strong yet. In fact the healing starts only then. The scar becomes red and thick as a sign of an increased blood circulation through it and the formation of cartilage. During the following months the scar becomes slowly thinner and smoother; the red color turns purple and starts to fade. The scar enters the so-called “quiet phase”.

This development depends on the age of the patient: children have a more violent scar response than adults. Furthermore the type of skin plays a role: in people with red hair you see often a strong scar forming and also the location of the scar is an influence. Scars show little response after an eyelid correction and enter the tranquil stage quickly. But scars on the shoulder or on the breastbone frequently show a violent scar response, which can last longer.

Limitation of scars

You can limit the formation of scars with rest, rest and more rest; at least four weeks, preferably longer.

Fading of scars

With “fading” we mean that the scar bleaches and becomes tranquil. It doesn’t really fade; but it becomes less striking. A scar is noticeable because it is red or purple. Later the color bleaches and eventually becomes even lighter than the surrounding skin. This bleaching lasts at least a year. Therefore it is not advisable to have a scar correction done within a year of surgery.

The development of scar pain

Violent, red and thick scars are painful due to swelling and increased blood circulation. When the scar becomes tranquil, the pain disappears. It is abnormal when the pain continues. If the pain is unbearable when the scar is touched, it can be a sign that a nerve is caught in the scar tissue. Sometimes this happens at the wrist. This doesn’t disappear by itself but needs to be resolved by surgery.

The treatment of problematic scars

The first thing you can do is massage the scar daily. Besides that, you can rub it with a special scar cream; often I prescribe a silicone based cream.
Furthermore it seems that applying pressure on the scar can have a favorable effect. Therefore in the treatment of burns special pressure garments are prescribed. An elastic panty has a healing effect on the scars after an abdominal wall correction. A problematic scar can be injected with corticosteroids, so-called scar reaction reducing hormones. Because these are only injected in one place and in a small quantity, these hormones generally do not have any side-effects.

The camouflaging of scars

I try to make the scars in natural lines, which means they are hardly noticeable. A curved scar is less noticeable then a straight line. A tranquil scar that attracts attention, because it is lighter in color, can be colored in with the help of a tattoo. You can also camouflage the scar with make-up.

Dr. Erik Jan Timmenga