Dr. Dirk Lazarus

Plastic, Reconstructive & Cosmetic Surgeon

MBChB (UCT), FCS (SA) Plast & Recon Surg

Scars

Normal scar formation

Every time the skin is cut healing will occur with a scar. Although plastic surgeons will place scars in inconspicuous places, often camouflaged in natural skin creases, and will create the minimal amount of scar possible by keeping incisions short and suturing beautifully, how you scar is often more a product of your genetic make up than anything else.

Scar healing and maturation

Scars need up to 2 years to mature. Initially it is normal for a scar to appear red and raised, but over time the scar will fade to form a thin, fine, inconspicuous line. It will, however, never disappear completely. Proper scar management can improve the quality of the final scar.

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Before, 9 months after and 18 months after with no surgical intervention, just normal healing and scar management.

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Scar management: How to get better scars

There are a number of important, but simple treatments which can improve the appearance of a scar by about 50%. These include:

  1. Taping of the scar with a simple tape such as micropore (3M) provides a splint for the skin in the same way that a plaster cast is a splint to aid the healing of a broken bone. The tape once applied can be left in place for about a week and should be worn constantly until the scar is no longer red – about 6-12 months after surgery.
  2. Gentle massage in the line of the scar improves blood supply and can help flatten the scar.
  3. Scar nutrition with vitamins A, C and E may be helpful although the benefits are largely unproven.
  4. Sun avoidance: Contrary to popular belief the sun is not good for scars (or other skin) and sun exposure can cause pigmentory problems. Use creams with an SPF of greater than 15.
Same patient, same surgeon. No tape was applied on the left. Tape was applied on the right.

Same patient, same surgeon. No tape was applied on the left. Tape was applied on the right.

Scar revision

Some patients present with established scars which they want removed or fixed. Scars cannot be removed – the skin always heals with a scar – but scar appearance can usually be improved such that the scar is less conspicuous. This procedure is called scar revision and entails surgical excision of the scar and re-suturing. This can improve the long term appearance of the scar although initially there is a period during which the scar may be red and raised. During this period scar taping is advised. Sometimes a small re-orientating procedures such as a z-plasty may be required to additionally improve the scar. Acne scars or ice pick scars can be helped by laser (which I do not do), dermabrasion or multiple tiny excisions.

Abnormal scars

Other patients may present with abnormal scars which are red and raised – either hypertrophic scars (fresher scars) or keloids (older scars). These can benefit from non surgical treatment such as the application of silicone gel sheets and pressure garments (from an occupational therapists, certain long-acting steroids can be injected, or occasionally, surgery may be offered, although surgery is associated with a very high recurrence rate of keloids.

Testimonials

Just wanted to drop a quick line to say thank you so much for all your help and your patience with me! Back home in a not so warm England, missing the warmth already. Was very impressed with the service provided by yourself and Dr Lazarus and not only will visit again but will recommend to my colleagues and friends. I know from my own industry people are quick to complain but not so much to compliment so thought I would just say how happy I am and once again thank you!

Testimonial 21 June 2021

“I have been meaning to provide feedback with regards to my scar revision procedure but I have been a bit busy. Words cannot explain how happy I am with the results. The scar healed so nicely, almost invisible now but I still keep the micropore tape as instructed by Dr. Soon, I will send you guys pictures. Please Thank Dr Lazarus for me. This has been life changing for me, has boosted my confidence and I am so thankful to him.”