Scar Management

This is a 2 step process which commences after all wounds have healed. In general this will be at the 2 week mark for face and neck scars but could be longer for flaps, grafts or other sites that may be slower to heal.

Scar massage

Why is it important?

• There is a lot of evidence that pressure applied to early wounds results in flatter, less pink scars
• Scars remodel as long as 12 months or more out from surgery and therefore early pressure application can encourage their remodelling in the desired fashion

What should you use for scar massage?

• Scar massage should be performed using a moisturiser such as sorbolene, vit E cream or Bio-Oil.
• This should be applied with firm pressure enough that the scar and the skin around it blanches due to that pressure. Pressure should be applied in circular motions along the scar.
• Just gently applying the moisturiser to the scar will make the area feel nicer as it will be well hydrated but erhaps not aid in remodelling the scar.

How long should you spend?

A few minutes should be spent on every few cm of scar, with pressure becoming firmer as the wound matures weeks from surgery.

How often should it be done

In general the more often it is done the better, but most of the time we find patients will remember to do it twice and this is a good frequency for most scars

What else do I need to do?

• After massaging you can wipe the skin dry and then apply silicone (see below)
• You should also keep early scars, flaps and grafts out of direct sun as these can pigment
• If you are not keen on using silicone, there is evidence that taping of scars can also improve outcomes, probably from ongoing sustained gentle pressure.

Silicone Therapy

Why is it important?

There is a lot of evidence to show that scarring is improved through the use of silicone. In fact this is probably the only product that has solid evidence in many trials to show its beneficial effect for scarring.

We therefore recommend for the best results, that silicone is step 2 of the scar management process, after scar massage. We will certainly, always recommend its use for any scars that are visible, for example those on the face and neck.

How does silicone work?

It is not completely known how silicone works.

It is probably due to a host of effects including:

• Pressure from silicone taping
• Trapping moisture
• Trapping oxygen
• Active effects of silicone ions

What should you use for silicone therapy?

Silicone is available as a gel or as a sheet

Gel

• We recommend the use of 100% silicone gels.
• These are available as tubes of 5g, 10g, or 20g depending on the size of the wound.
• A common product is Strataderm, and this is available for purchase in our rooms.

Sheet

• This is an adhesive sheet which can be cut to the size of the scar
• A particular piece of silicone can be applied, removed and reapplied for 3-4 weeks meaning that a large sheet can last for a long time
• It does however become less sticky with reapplication and may be secured with micropore tape to the scar
• A common product we recommend is Cica Care, by Smith & Nephew.
• The sheet is probably best for hidden scars on flat surfaces.

How is it employed?

• After scar massage is performed in the morning, the skin is wiped dry.
• A drop of silicone gel is smeared which dries as a clear film, or silicone sheet with micropore tape applied.
• If using silicone gel it can then be covered by sun block or cosmetics (the first layer must be silicone however)
• In the evening the silicone is removed (if this was a gel, by washing the site)
• The process of scar massage is repeated, skin wiped dry and then the silicone reapplied before going to sleep.

How often should it be done?

• In general both step 1 of scar massage and step 2 of silicone gel or sheet application should be done twice daily
• However it is important that the silicone is in contact with the skin for most of the day (ie. Over 20 hours per day)

What else do I need to do?

• You should also keep early scars, flaps and grafts out of direct sun as these can pigment
• If you are not keen on using silicone, there is evidence that taping of scars can also improve outcomes, probably from ongoing sustained gentle pressure.