Scar formation is the end result of healing. The wound healing process after surgery is actually very lengthy and goes through multiple stages. Dr. Bonness will take many steps starting with placement of the sutures to ensure that your scar is as faint and soft as possible.

Within 24 hours of your surgery the incision has already sealed itself, which means it is waterproof. But the healing process has just begun and will continue on for many months as new collagen is made. Collagen is what holds the skin together and makes the scar strong. During this time you will feel a thickening under the scar. This is called the healing ridge and is normal, it will soften with time.

In some patients too much collagen is made in the scar resulting in a thick, rope-like, elevated scar instead of a flat, thin scar. Certain groups of patients are at risk for this: African, Asian, Hispanic, Indian and Mediterranean. Also certain parts of the body are more prone to this: back, shoulders, neck and midline chest.

Medical issues can also contribute to how an incision heals. Patients with diabetes, obesity and steroid use all have impaired healing. Scars in these patients will be wide and irregular because they have healed slowly without much collagen.

To ensure the best scar for you the care after your surgery can be very important. During the first 6 months after  surgery the scar is constantly remodeling.  Collagen is being made and broken down. If genetically you make more collagen than you break down your scar will be thicker than someone who can break it down as quickly as it is made. It is important, therefore, that during this initial 4-6 months  you  continue  scar care. And the earlier, the better. If you try to manipulate the scar one or two years after the surgery it is usually too late.

To optimize the conditions for a favorable scar Dr. Bonness and you can:


1.  Stop smoking! Tobacco use has a significant deleterious affect on the wound healing process. There are thousands of chemicals in tobacco smoke all which decrease the oxygen that you deliver to the skin. Without adequate oxygen delivery the cells in charge of making collagen (fibroblasts) do not work well. The resulting scar will have areas that are slow to heal leaving small open areas that will eventually lead to a wide, noticeable scar.

2.  Multiple small sutures will be placed in many layers deep in the skin. Dr. Bonness will avoid placing stitches on the outside of the skin. Sutures placed on the outside of the skin that are not taken out  early will lead to marks making the scar appear like a railroad track. Instead of sutures Dr. Bonness will frequently use stiri strips or tape on the surface of the skin.

3.  Leave steri strips on as long as possible.  Studies have shown that this small amount of pressure will improve the scar.

4.  Silicone sheeting - Studies have shown that the application of silicone sheeting or gel can help prevent a scar from becoming elevated. The sheets will add pressure to the incision and increase the hydration in the wound. Silicone sheeting needs to be used as much as possible day and night for 4-6 months. Silicone sheeting may be applied as early one week after surgery. There are multiple over the counter sheets as well as available  on-line.  Silicone in the form of a gel is also available called Scarfade.  www.scarfade.com

5.  Creams - Mederma is an over the counter cream that can be applied to the incision twice daily. Mederma is easier to use than the silicone sheet but may not be as affective. www.mederma.com

6.  Multi vitamin with C and zinc - Vitamin C and zinc are critical to the healing process. If you eat a well-balanced diet you most likely have enough vitamin C. If you do not eat a lot of fruits and vegetables you should take an extra vitamin with C and zinc.

7.  Eat well - a lot of fruits and vegetables.

8.  Avoid exposing the scar to the sun for 6 months. Exposure to the sun can result in a dark scar especially if the scar is red at the time of exposure.

9.  Massage- Massaging the scar will help breakdown scar tissue and hasten the resolution of swelling in the area.  Massage should be done multiple times during the day for a few minutes.

10. Steroid injections.  For scars that continue to elevate despite the above treatment, steroids can be injected by Dr. Bonness. This procedure is done in the office every 6 weeks.  Great care is taken to avoid too much steroid as this will result in thinning of the surrounding tissue which  itself causes an unsightly scar.