Any operation requires crossing the dermis, the deep layer of the skin, which will leave an indelible mark: the scar. Healing is a complex and slow process that takes place for 18 months after the operation.
Several factors will influence the quality of this healing and its cosmetic result.
Some of these factors are related to the operation itself. The first of these is the care taken by the surgeon in closing the skin and subcutaneous areas, an act which for me cannot be delegated to the operating aid as the scar is the visible part of the attention paid in depth.
Depending on its location, a scar can also undergo more or less important tensions which can lead to a “spreading” of the scar. To limit this risk, the scar must be parallel to the Langer lines, that is to say the lines of tension in the skin, but this is unfortunately not always made possible by the nature of the operation to be performed.
In other cases, abnormal scarring occurs by excessive accumulation of collagen in the dermis leading to the formation of a thick scar or even keloid. This is more commonly the case on dark skin tones.
Certain pathologies such as diabetes, especially if it is unbalanced, or certain immunosuppressive drugs such as corticosteroids are also a source of healing problems. All this must be evaluated before the operation so as not to run a too high risk of abnormal healing or even infection.
However, the operated patient may have an active role during healing which will have a positive effect on the final appearance of the scar.
The first of these is for sure to stop smoking for at least 1 month after the operation because it alters the skin microcirculation and is responsible for delayed healing and infections.
The choice of the type of dressing is also important. Occlusive dressings which lead to maceration of the scar should be avoided and breathable dressings should be favored. As soon as the condition of the scar allows it, often after 2 weeks, it can be left in the open air unless it is located in a zone of friction in which case it is better to protect it with a bandage for 1 to 2 months.
If scabs occur, they should not be torn off, which would create a new wound, delay healing and risk revealing a new mark. Instead, they must be softened with a fatty cream such as petroleum jelly so that they come off and fall off on their own. When there are no more scabs, the scar should be massaged 2 to 3 times a day using a hyaluronic acid-based cream such as Epithelial AH Duo® which accelerates the skin repair process, moisturizes the scar and allows it to be softened by removing it from the underlying planes. Massages should be continued as long as the scar is red. They are slow, soft and light at the beginning, then more supported (after about 4 weeks). The scar should whiten under pressure and then re-color.
When the scar is subjected to strong skin tensions or when it is hypertrophic, it may be useful to apply to it for 2 months a silicone film such as Cica-Care® which limits traction and creates excess pressure on the scar thus limiting its spreading and its thickening.
Finally, so that the scar can whiten and take on the color of the surrounding skin, it is very important to avoid its pigmentation by protecting it from the sun for the 2 years following the operation, ideally using a bandage, otherwise by using a sun protection cream with a high protection factor (IP 50) to be renewed every 2 hours.
In summary, optimal healing requires:
- An applied surgeon
- Smoking abstinence
- Avoid friction on the scar
- Softening of scabs
- Use of a healing cream based on hyaluronic acid
- Scar massage
- Protect the scar from the sun