The first step in the formation of a good scar is the meticulous closure done by your plastic surgeon. In most cases, this is a double-layer closure. This means that there are two layers of sutures: The bottom layer brings the tissue together taking the tension off the top layer while the top layer approximates the edges, or brings them together, so you end up with a clean line. 

The next step involves keeping the incision clean until it is healed enough to start a scar treatment. During this time, it is usually appropriate to wash the area with soap and water, pat dry and apply antibiotic ointment and a dressing. It may also be appropriate for your surgeon to cover the incision with steri-strips. With either option you will be instructed in how to care for the wound. 

Correct post-operative care will help prevent infection and inflammation, factors that may worsen your scar.  

Once the sutures have been removed, you should be instructed in the use of silicone scar gel or sheeting. Silicone has been used for over 30 years to improve the look and feel of scars. It has been proven to reduce redness, flatten, and soften scars. Silicone works by hydrating the skin and regulating the production of collagen. It also forms a layer over the skin to protect from bacteria.

Silicone can be used as a gel which is massaged into the scar twice each day or as a sheet which is applied to the scar and left in place for the day. When applying the gel, you do not need a lot of the product: a little bit goes a long way. Using more will not give you a better result, it will only cost you more money. If you choose the sheets, they can be cleaned with a gentile cleanser and reused. Remember to follow the instructions for the product you purchased. You will be using silicone for a minimum of six weeks to three months on new scars or at least 6 months for old scars.

For most patients, the latter is all you need to do to get a nice result, however there are some patients that will create a bad scar regardless of the meticulous closure and use of silicone. For these patients, your progress will be monitored more closely.

• Steri-strips may be used for longer once the sutures have been removed to keep the scar flat.
• Low dose steroids may be injected into the scar as it matures. There will be a waiting period of 1-3 months between injections for the medication to take effect, this process can not be rushed as too much steroid can atrophy or kill tissue. 
• Lasers can be used once the wound has healed to treat redness and flatten the scar. There are many laser options out there and your surgeon will either have one or be able to recommend the best place for you to go. Lasers are chosen based on your skin color or Fitzpatrick scale, scar condition, and how your skin reacts to it. The number of treatments needed will depend on the laser used. Remember that the darker your skin the more careful you need to be.
• If you are not happy with your results, there is one more option: to cut it out and start again. This is the most invasive way to go, so it is usually the last option. Sometimes, the scar is broken up into a “z” shape. This will be helpful for a long scar or one that is curved. The incision may be closed with a different style of suturing, so it does not indent or protrude. Absorbable vs non-absorbable sutures may be used based on how you healed the last time. As Dr. Fodero always says, “If plan A didn’t work, don’t redo plan A. You need to have a plan B and C just in case.”

❗ Only revise these scars if they are grossly disfigured as the revision may not be better than the original. 

If you have concerns about a scar, Dr. Fodero can help you. Begin your journey to better skin with a consultation at Northeastern Plastic Surgery in Florham Park, NJ. Our professional and dedicated team, led by Dr. Fodero, will assess your scar and the surrounding skin region and help you decide on the best way to move forward. Call (973) 295-6565 or contact our practice online for more information.