Definition
For many people, scars are a physical (pain, itching), but also psychological (aesthetic impairment) burden. For this reason, scar care is of great importance for the physical and mental well-being of those affected. The term scar care is therefore used to describe measures that are intended to either reduce the rate of complications when a scar heals (such as avoiding inflammation and reducing pain) or to improve the cosmetic result. The latter can be influenced particularly effectively by regular scar care, especially within the first two years, whereas in the case of older scars only a small amount of positive influence is possible. The various measures described below are also of great importance for the long-term freedom from symptoms, since inadequate scar care can lead to unpleasant complications such as inflammation or painful adhesions long after the scar has actually formed.
What should be considered when caring for scars?
Despite the different types and causes of scars, there are a few basic rules that should generally be observed. These include the regular (preferably daily) cleaning of the scar with clear water, unless this contradicts an explicit medical instruction. On the other hand, contact with soap or shampoo should be avoided in the case of fresh scars, as the ingredients they contain can cause irritation of the scar and the underlying tissue.
The scab, i.e. the body’s own protective layer over a wound, falls off by itself after the healing process is complete. In order to prevent the scab from accidentally coming off prematurely during scar care, the scar should only be lightly dabbed after cleaning and not wiped dry. Furthermore, scars should be protected from particularly high or low temperatures.
Both extremes can slow down the healing process. Until the scar has healed completely, you should therefore avoid visiting a sauna, solarium or ice bath, and avoid too much and long exposure to the sun. In the case of scars resulting from medical suturing as well as non-stitched scars with scabs (e.g. abrasions), it is advisable to avoid wearing tight-fitting clothing in the area of the scar or wound.
Such clothing can irritate the tissue by friction and lead to premature detachment of the scab. Top priority in scar care after surgery is always given to the surgeon’s instructions. This results from the fact that scars vary greatly depending on their localization and extent, but also on the type of suture, and the surgeon, as the “causer”, knows the scar conditions best.
Nevertheless, the following basic guidelines can be formulated. In scar care following an operation, two phases can be distinguished, which are separated from each other by pulling the sutures. Before the sutures are removed, the skin is not yet completely closed (the sutures are intended to help with this process of closure), so that different scar care measures must be applied than after complete skin closure.
So-called healing ointments can be applied even before the skin is closed, i.e. when the stitches have not yet been removed. These support the healing process of the tissue and ensure that the skin in the affected area remains elastic. When choosing a suitable healing ointment, it is best to seek advice in a pharmacy and, if necessary, ask specifically whether it is a product that is suitable for the treatment of wounds that have not yet been completely closed.
Both before and after pulling the stitches, jerky and strongly stretching movements in the scar area should be avoided to prevent the scar from bursting open. After complete closure of the wound and removal of the stitches, massages of the scar area can help to mobilize the scar, making it flatter, softer and more mobile, which can prevent the later occurrence of complications due to adhesions. There is also the possibility of using silicone gels.
These should be applied at least twice a day for several weeks and gently massaged into the tissue. In this way, the healing process is promoted and the elasticity of the scar tissue is improved.An easier to handle alternative are silicone-based scar plasters, which can be stuck to the scar for 12 – 24 hours and have similar effects as the silicone gels. The advantage of all silicone products is the complete absence of pharmaceutically active ingredients, which is why no side effects are known.
This might also be of interest to you: Inflammation of a woundThe scar resulting from a caesarean section differs from superficial skin scars, which are caused by abrasions or the removal of a mole, for example, by the involvement of all deeper tissue layers right into the uterus. For this reason, the caesarean scar represents a special challenge in terms of scar care. In the course of the healing process, which often takes several months, the scar area often develops adhesions, sensitivity to weather, numbness, pain, burning or itching, in other cases the scar heals without complications.
In order to prevent the occurrence of these complications, or at least to alleviate their severity, scar care is of great importance practically from the moment of suturing by the delivering doctor. The measures of scar care include regular cleaning of the scar with clear water and subsequent careful drying. Soap should only be used for cleaning after the doctor has removed the stitches.
In addition, it is recommended to wear additional clothing in the first days to weeks after birth to prevent chafing of the scar. To protect the scar from excessive strain and stretching, no abdominal muscle training should be performed in the first four to six weeks after birth. In addition, it is recommended to unroll over the side when getting out of bed and to lift out of the legs and not too hard.
If the symptoms such as pain, itching or burning become more severe in the course of the birth, consultation with a doctor is just as essential as in the case of signs of inflammation (severe redness and overheating, pain), bleeding or weeping of the wound. Scar care is an important factor in achieving a satisfactory optical result of an upper eyelid lift, although the skill of the surgeon is obviously the main factor. As with all surgical procedures, the same applies after an upper eyelid lift: It is highly recommended to follow the surgeon’s instructions for scar care or to ask him/her specifically about such instructions, if he/she has not sufficiently informed him/herself about the further procedure.
Some surgeons recommend not to use any ointment at all to promote scar healing. Others advocate massaging bepanthen, silicone ointments or vitamin A ointments onto the scar area. However, allergic reactions are frequently reported, especially in the case of bepanthene ointment, which is why its use is only recommended with reservations.
From the above it can be deduced that it is of secondary importance which ointment is used – much more essential for scar healing is the massage and moistening/greasing of the scar tissue achieved by this method. In the first week after the procedure, make-up should also not be applied in the scar area, as make-up particles can lead to a so-called “scar tattoo”. Even after breast surgery, the surgeon’s recommendations regarding scar care are of utmost importance.
Nevertheless, some basic rules apply, which are described below. In the first two to three months after the operation, the tension on the sutures should be kept as low as possible. Since even simple shoulder movements, which everyone performs several times a day, also move the breast, this relief of the sutures is particularly difficult in breast surgery.
For this reason it is recommended to immobilize the seams with fleece or silicone plaster strips. To stabilize the breast and thus relieve the skin, a bra should also be worn at night during the first few weeks. A regular scar massage, which by the way can be wonderfully combined with massaging in greasing ointments, has a long-term positive effect on the elasticity and mobility of the scar tissue.
However, it should only be started after the stitches have been removed (unless absorbable stitches have been used). The ointments used here include, for example, Bepanthen or the more expensive silicone ointments and gels.In addition, the scar area should not be exposed to direct UV radiation, as this can irritate the scar and hinder the healing process. Good scar care is particularly important in the face, as conspicuous scars here cause particularly severe aesthetic impairment.
Another special feature of scar healing in the face is the increased tensile stress on the skin. This in turn is due to the fact that the skin lies very close to the bones and is not separated from them by broad layers of muscle or fat, as is the case with almost the entire rest of the body (apart from e.g. hands and feet, shin, knees). To counteract this tensile stress, scar plasters can be used to stabilize the skin around the scar.
If a wound has been sutured in the face, it is advisable to ensure that no shampoo and dirt dissolved in it gets into the wound until the stitches are removed in the shower. The risk of this can be minimized by washing the hair and scalp with the head tilted backwards. It is also a good idea to raise the upper body slightly when sleeping to counteract the swelling of the tissue under the stitches. In addition to the above measures, the use of a scar cream is recommended, whereby the same rules apply as for scars in other parts of the body.
