The Fine Art of Scars

by Dr. Paco Canale

A scar is like a brush stroke of paint. Some scars are like Leonardo Da Vinci strokes: small and barely visible, they blend into the surrounding landscape. Others are like Vincent Van Gogh strokes: broad, raised, and colorful, they attract attention. While Vincent Van Gogh’s paintings sell for millions of dollars, no one wants a Van Gogh scar! Fortunately the medical industry is developing ways to improve Van Gogh scars. Some offer good results, and others don’t. Here are a few things that are known to help:

• Avoiding tension across scars can help prevent scar thickening. (Our plastic surgery practice is participating in research of a new anti-tension device which shows great promise.)
• Pressure can help flatten scars through massage, garments, or, for raised pierced ear scars, pressure earrings.
• Silicone gel treatments have been shown to help, and there are now many on the market.
• Petroleum emollients like Aquaphor and Mederma, an onion product, have been shown to help as well.
• No studies have shown that vitamin E helps the appearance of scars.
• Surgery can improve some scars, but a common misconception is that plastic surgeons can take scars away. A scar from a full-thickness skin injury is like torn fabric that has been sewn up. The seam will never go away, but sometimes a sloppy closure can be narrowed or smoothed out. Unfortunately, scars that are thick and raised will heal the same way after a repair.
• Steroid injections sometimes flatten scars that are thick and raised, but they should be used judiciously, since the skin can atrophy and thin out.
• Dermal Fillers are sometimes used to level out indented scars.

Thick, raised scars are called “hypertophic scars,” and are often amenable to treatment. “Keloid” scars are are more like sculptures than brush strokes, since they grow beyond the boundaries of the scar like a mushroom. Unfortunately, keloids are difficult to improve, even with the most aggressive therapy, like radiation. The good news is scar treatment modalities are increasingly effective, but there is still no magical treatment. A plastic surgeon with good surgical technique in addition to good patient genetics can all contribute to the formation of Da Vinci scars after surgery. For information on any aspect of plastic surgery, contact us online.