The Stitch

How to Improve the Appearance of Scars During Healing

As spring comes into full bloom, we will likely see more people enjoying activities outdoors. With an increase in physical activity, the chances of injuries occurring increases as well. Scratches, cuts and incisions on cosmetically sensitive areas, such as our face, can alter our appearance and increase our chances of infection. With the skin being the largest barrier organ for our body, how do we provide our skin with an optimal healing environment that also creates a good aesthetic outcome?

In a healthy individual scars take a full six weeks to develop, and personal intervention techniques during this time can improve the visual appearance of scars overall.

A person with their shirt pulled away from their neck as they massage a scar near the collarbone.First 3 Weeks:

The first priority after a cut to the skin is to thoroughly irrigate, clean and stop bleeding to the wound. Once clean and dry, it is important to determine how deep the cut is. If it is deep, gapping or has ragged edges, the wound may require stitches. Consult with your primary care provider if you are unsure.

The next important step is to provide the wound with adequate moisture that also prevents infection. Application of a triple antibiotic ointment (such as over-the-counter Bacitracin, Neosporin or Polysporin) three times a day to the wound for a full three weeks helps prevent infection and creates a better foundation for improved long-term scar appearance. It is important to remember that for the first three weeks after a wound, you should not scratch, pick, massage or excoriate the wound. This can cause further breakdown in the skin or uneven appearance. Gently cleansing the area with a mild non-perfumed soap once or twice a day, drying it and reapplying the triple antibiotic ointment is the best thing for the wound during the first three weeks.

Week 4 through Week 6:

After the first three weeks, the wound has built up more than half of its collagen. This allows us to be more aggressive with treating the cut without fear of the wound breaking down. At this time, you can place pressure on the wound, stop applying the triple antibiotic ointment and apply other products to the area. Scars need mechanical pressure to reduce their appearance, and massaging wounds a few times throughout the day can improve overall scar structure at six weeks.

If you are prone to keloids or hypertrophic scars, a product you should begin to use during this time is silicone adhesives (or silicone sheeting/silicone tape). These adhesives provide the mechanical pressure of a sticker on the skin but also provide silicone—a polymer that helps smooth scar appearance. Even if you are not prone to keloids, silicone adhesives will likely help the appearance of any type of scar. Another product you should keep in mind at this time is sunscreen. Wounds, because they contain newly formed cells, will burn quicker with exposure to the sun than other areas on your body. To keep these areas from getting burned or hyperpigmented, you should use sunscreen with at least a 30 SPF UVA and UVB coverage. To have your sunscreen be even more protective, make sure it contains zinc oxide or another barrier mineral to provide more physical protection from the sun.

Week 7 through 1 Year:

It is important to remember that scars are malleable for up to one year of existence. Manual massage, silicone sheeting, and using sunscreen will improve the appearance of scars during this time frame. If you are prone to keloids or hypertrophic scars, laser therapy or corticosteroid injections during this period can also improve the scar’s appearance. After one year, scars are more stabilized and likely will require surgical re-excision to affect their appearance.

Learn more about Baylor Medicine Plastic Surgery services

By Alexandria Sarenski,  instructor in surgery for the Division of Adult Plastic Surgery at Baylor College of Medicine

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