In today’s blog post, we’ll discuss scar management. As surgeons, perhaps the best strategy we have to manage surgical scars is prevention. Preventing cosmetically bothersome scars begins with good surgical technique and includes hiding incisions in cosmetically favorable sites. A common site we use for upper eyelid incisions is the natural eyelid crease. By taking advantage of the natural eyelid crease, we can minimize evidence of our incisions by keeping them out of view. In other cases, we can make incisions on the back side of an eyelid, or in the case of eyebrow lifting surgery, we can use an incision behind the hairline. All of these approaches help us maximize our cosmetic result by minimizing the visibility of our incisions.
Unfortunately, we don’t always get to pick our incision sites. As an oculofacial surgeon, I care for patients that have experienced accidents and injuries to the eyelids and the surrounding areas of the face. I also care for patients that develop skin cancers in the same areas. In these situations, either the injury or the skin cancer plays a big role in creating or determining the incision site. This opens the door for products that help manage visible scars that can’t easily be hidden.
One of the products that has a long record of success in scar management is silicone gel. There are over three decades of experience with silicone gel for managing scars (1). Silicone gel is available in a number of formats, including silicone sheets and a topical silicone gel that patients can rub onto their scar. The sheets are effective, but they are also more visible when patients apply them to the face. Evidence suggests that silicone gel sheets and topical silicone gel both work well (2).
The way silicone gel works isn’t fully understood, but it may have to do with keeping your healing skin moist (1-5). Early after you have an injury or surgery, your skin can dry out faster than normal, leading your skin cells to send chemical messengers into your tissue. These chemical messengers attract some of your body’s repair cells to the scene. These cells are called fibroblasts. Fibroblasts make collagen, a type of connective tissue that forms some of the substance of scars. Silicone gel can help your healing skin retain water, so that your healing tissue loses water at the same rate as healthy skin. This reduces the amount of collagen that fibroblasts produce, while also improving scarring (1). There are other possible ways that silicone gel sheets may improve scaring, including altering blood flow to the healing tissue, as well as other theories (1). One thing is clear, however: silicone gel has a well-accepted role in scar management.
Evidence shows silicone gel works to treat both pre-existing unsightly scars, as well as preventing scars from forming (3). I recommend patients start topical silicone gel after their skin heals to an appropriate point. This varies for each patient, so check with your doctor directly before starting silicone gel therapy. Once the area is healed enough to start therapy, I recommend that patients apply a thin layer of the gel to the treatment area twice a day. It can take several minutes for the topical gel to dry, but once the gel does dry, make-up can be worn overtop (2,5). I recommend that patients use a topical gel that contains sunscreen, as protecting the area from the sun is important to promote healing. I also think it’s important to know that incisions and scars mature over months or even a year, so plan on using a silicone-based product for several months. In fact, it is not unreasonable to use a silicone-based product for 6-to-12 months to get the best effect (4). It may seem like a long time, but think of it as a commitment to the best possible long-term result.
In summary, I hope that by reading this blog you have a little better idea of how to manage scars from surgery for skin-cancer removal or other injuries. Also, please keep in mind you need to consult with your doctor directly before starting any medical therapy, inducing treatment of scars. If you have further questions or would like to learn more, please give our office a call at 563.213.5080. We’re located right here in Davenport, Iowa and serve the Quad Cities and surrounding region. We look forward to seeing you soon!
1. Bleasedale B, Finnegan S, Murray K, Kelly S, Percival S. The use of Silicone Adehsives for Scar Reduction. Adv Wound Care (New Rochelle). 2015 Jul 1; 4(7): 422–430
2. Kim SM, Choi JS, Lee JH, Kim YJ, Jun YJ. Prevention of postsurgical scars: comparsion of efficacy and convenience between silicone gel sheet and topical silicone gel. J Korean Med Sci. 2014 Nov;29 Suppl 3:S249-53
3. Choi J, Lee EH, Park SW, Chang H. Regulation of Transforming Growth Factor β1, Platelet-Derived Growth Factor, and Basic Fibroblast Growth Factor by Silicone Gel Sheeting in Early-Stage Scarring. Arch Plast Surg. 2015 Jan;42(1):20-7
4. Rabello FB, Souza CD, Farina Júnior JA. Update on hypertrophic scar treatment. Clinics (Sao Paulo). 2014 Aug;69(8):565-73
5. Puri N , Talwar, A. The Efficacy of Silicone Gel for the Treatment of Hypertrophic Scars and Keloids. J Cutan Aesthet Surg. 2009 Jul-Dec; 2(2): 104–106