How do I choose which scar gel to use?
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Everyone of us has scars, as they are a part of our life journeys. However some scars are quite obvious and unsightly, and some even cause us to feel discomfort like itchy or pain. Let’s discuss what are scars, when and how to treat them, and also what are the future developments in scar management?
What are scars?
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Scars are collagen tissue formed by our bodies following any wound. Once we have an open wound, be it from traumas, surgeries, burns or ulcers, the skin will undergo the 3 phases of wound healing. These phases are the Inflammatory Phase (first 2 weeks), Proliferation Phase( 2weeks to 3 months) and Remodelling Phase ( 3months to 2 years).
The final scars that we see are the result of collagen deposition following these phases, meaning that the more collagen that is produced, the more prominent the scars will be.
What is Keloid?
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Keloid on the other hand, is a scar that has become extensive and disturbing. The word Keloid comes from Latin origin, meaning Crab. They imitate the action of a crab that claws out of their original wounds to invade the surrounding skin.
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Keloid can be passed amongst family members but sometimes it can be sporadic. Generally, if you are in adulthood and never gets Keloid before, it is quite unlikely to acquire a new one. However, you may still get a Hypertrophic Scar, which is also an elevated scar but less extensive that Keloid and easier to treat.
Studies also have shown that Keloid happens at very specific locations such as the Deltoid, Sternal, lower abdominal, back and Mandibular areas.
It is very rare to happen on the other parts of the face, with the exception of Ear pinnas.
How to treat a scar or Keloid?
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The treatments of these conditions must be tailored in accordace to the principle of wound healing that I discussed earlier. Remember, they are not lesions in the actual sense, meaning that they are part of out healing process. Thus, performing certain procedures, like surgically exciting the scars may end up creating more problematic scars at the exact same site.
The best surgical technique is call Intralesional Excision where we remove just the content of the scar tissue and combining with other modalities such as steroid injection or topical chemotherapy application or low-dose radiotherapy.
I have been using scar gels but it’s not working, Why?
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The 2 most common mistakes of using scar gels are
1) Wrong timing
2) Wrong technique
1) The best time to apply scar gels is during the end of first and throughout second phase of wound healing. That means but the end of the first week until the 3rd months. This is when the collagen is still fresh and applications of scar gels will directly affect the scar formation.
When the application is done after the 6th months or even 1 year after wounds started, the collagen is already being remodelled and hardened.
Sometimes the doctor will do procedures like LASER treatments or Surgeries to refresh and resurface the scar. These procedures essentially revert the scars back to the first phase of wound healing and this is why scar gels can be used again.
2) As for the technique of application, the scar gels should be applied using a deep massage and pressed onto the scars.
The most common mistake is when you apply with a gently layering on top of the scar surfaces. This will not only lead to faster drying of the gel, but also minimal effects to the scars themselves.
Which brand should I use?
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There are many brands of scar gels in the market. I am not going to promote any specific brands but will give a guide as how to choose the ingredients.
a) Silicone gel
example : Dermatix Advance, Dermatix Ultra
This type or ingredient is good as it will be absorbed into the healing scar areas. Silicone will help during the proliferation phase as it will provide hydration and reduce the surface tension.
b) Vitamin E and C
example: Dermatix Ultra
This is another good ingredients as they offer antioxidants properties. Antioxidants will assist in reducing the darkening effects of post-inflammatory hyperpigmentation.
c) Onion extracts
example : Mederma
Contains anti-inflammatory compounds and phenolic antioxidants that reduces pigmentation and acute inflammation on the scars.
d) Kojic acid / Arbutin
example : SkinCeuticals Phyto
Acts as depigmenter agents to lighten up scars.
d) Silicone Sheet
example :Cica-care Gel Sheet
Acts to reduce scar surface tension and promotes skin hydration. Usually this can be used in combination with scar gels.
e) Green Tea extracts
Example : Tosowoong Essence
Also contains antioxidants to reduce inflammation and hyperpigmentation of scars.
Other than the correct TECHNIQUE AND TIMING of using scar gels, these following tips also will help to improve the scar appearance
1) Avoid direct sunlight on the scar as this will stimulate more pigmentation from melanin formation. If needed used oral or topical sunscreen.
2) Eat a lot of natural antioxidants such as coloured vegetables and fruits. They can further improve the scar
appearance.
3) During the wounds healing process, it is important to follow the doctors instruction and ensure the timely healing. Delayed healing, be it due to infection or wound breakdown, will eventually lead to excessive scar formation and even Keloid.
4) Drink plenty of water, exercise regularly and get enough sleep as a healthy body will definitely assist in scar healing.
5) Do regular scar massage as advised by your doctor.
I hope this information will be useful to all of us for daily use. Please share it around with your loved ones.
Dr Wan Syazli
Plastic Surgeon.