Super Scars! And Lesser Ones

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By Valerie Monroe

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Q: ARE THERE any recommendations for minimizing new scar wounds? I recent had a melanoma removed (stage 1A, thank goodness) on my back and the scar is pretty long, about four inches. Dr. Google has recommendations from low-end to high-end (Mederma, less than $20 and available at drugstores; SkinCeuticals, over $100 via specialty retailers) and everything in between. I know nothing will remove the scar completely, but what ingredients should I look for and in what potency?

A: First, I’m so glad you caught your skin cancer early, Dear Reader, and wish you a quick and full recovery. As for the rest of you HNTFUYF-ers, please have skin cancer checks regularly. Even if you wear sunscreen religiously! In Hawaii recently, I wore SPF 50 sunscreen and a UPF 50 shirt and I still got tan.

As for your scar-related question, HNTFUYF DermDiva Heidi Waldorf has a few excellent suggestions.

“As always, my first recommendation is to ask the doctor who performed the surgery for product recommendations and care instructions,” she said. “The primary ingredients used in topical scar treatment are silicones like dimethicone.” How does it work? Although the exact mechanism is unknown, topical silicone forms a barrier that increases hydration and decreases the inflammation that can impair healing, Waldorf said. Topical silicones are available as self-adhesive pads, gels, or liquids. The best kind for the scar depends on its size and location—its visibility, its shape, whether there’s movement in the area, etc. Though some surgeons prefer silicone pads because of the consistent coverage, pads may be difficult to keep in place—and they’re clearly visible on exposed skin. An invisible cream or gel is more practical, especially if the scar is on the face, and can be used with sunscreen and even makeup.

“The difference between high- and low-priced products? The type of silicone and its feel—but there’s no evidence that one is preferable over another. Depending on your scar’s location and your skin type (dry or oily), you may prefer either a more moisturizing or matte formulation,” said Waldorf.

Some examples Waldorf says you might consider include Serica Moisturizing Scar Formula, ScarAway Scar Treatment Gel or Sheet, Strataderm Scar Therapy Gel, and Silagen Silicone Gel + SPF 30.

She notes that even if a product contains sunscreen, you should use additional sun protection. She frequently recommends Serica, because it’s moisturizing and can be used to massage the scar (which can help resolve thicker scars but shouldn’t be started until cleared by your physician, generally six to eight weeks after superficial suture or staple removal). And she recommends Strataderm because it’s quick-drying, non-sticky, and comes in a range of sizes, so you can buy what you need for either a large or small scar. (She also likes Stratacel for wounds.)

Mederma is in a separate category but used the same way. Its primary ingredient is an onion extract that may have anti-inflammatory effects in a base containing moisturizers, alpha hydroxy acid, plus a smaller amount of silicone.

“Some physicians like Mederma to reduce redness, because of the additional anti-inflammatory ingredient,” said Waldorf, who often had patients alternate it with another silicone product.

All of these products take two months of regular use (usually twice a day) to improve scars and are most helpful when used earlier in a recovery process (but not before fully healed and cleared by the physician), Waldorf said.

At the end of the day, all scars mature over time and some will heal better than others based on variables such as:

• Your genetics
• The size of the wound
• Tension (pulling) on the edges
• Its location (the chest, upper back, and shoulders are more likely to develop hypertrophic and keloid scars)
• Your post-op activity (movement that could pull the wound open)
• Infection

A hypertrophic or keloid scar needs more than topical treatment. Vascular lasers like the Vbeam can help reduce redness. Injection of a combination of triamcinolone (a steroid) and fluorouracil (a medication)—or for larger scars, its application immediately after a laser-assisted drug delivery—can reduce scar thickness, Waldorf said. (I had a laser treatment and an injection to reduce a scar resulting from Mohs surgery on my face eight years ago; the scar is barely detectable.)

You have options, Dear Reader, from over-the-counter to an in-office procedure if your scar is starting to look gnarly. But your surgery is done and your prognosis is good: The worst is (literally) behind you!