There are several treatment options available for managing and treating scars post-operatively. Treatment recommendations will depend upon physician preference, the origin of the scar, the location of the scar, the length of the scar, Fitzpatrick skin type, and perhaps any prior history of unsatisfactory scarring.
Prolonged swelling in a scar may lead to a hypertrophic scar – an excessive, thickened, and/or raised scar. A common and simple way to manage swelling in a scar is to perform scar massage. The purpose of scar tissue massage is to reduce swelling within the scar, and to soften the skin adjacent to the scar so the area may heal optimally. Repeated massage over time will help swelling resolve more quickly, and may help prevent or minimize hypertrophic scarring.
Suggestions for scar massage are listed below:
- A scar begins ‘maturing’ about three weeks after the surgery. This maturation and remodeling process may continue for 9 – 12 months.
- For several weeks (or perhaps months) after surgery you may feel a “healing ridge” beneath the scar. This is swelling which is located within the tissue layers deep to the skin. Scar massage helps this swelling resolve more quickly.
- Individuals may begin scar massage three weeks after their surgical procedure. This allows time for the initial soreness to subside, some initial swelling to resolve, and for the skin closure to become stronger and gain some integrity.
- When performing scar massage directly on the skin/scar surface, lotion is used as a moisturizer and lubricant so the massage can be performed without friction. You may use any commonly available skin, hand, or body moisturizer. [The silicone-based scar creams (BioCorneum+, ScarGaurd, etc.) are usually not utilized for scar massage, but are meant to be placed on the surface of the skin. If you chose to use one of these products, perform the scar massage before applying the scar cream.]
- If your doctor has recommended that you apply tape over your scar for an extended period of time, then the massage can be performed directly over the tape without the need for any lotion.
- Scar massage is performed by using your index and middle fingers. Begin by firmly and systematically rubbing along the direction (the length) of the scar. It is important that you apply moderate pressure to the scar line to help reduce swelling within the scar.
- This massage exercise should be performed consistently for five to ten minutes at a time, three times per day.
- You may notice that the scar softens a bit following the massage. It is normal for it to become more firm again, as the swelling returns, once you have completed the massage. Repeated massage, over weeks to months, will help to reduce swelling and improve the appearance of the scar.
- It is important to remember that the effectiveness of the scar massage probably depends more upon the method in which it is performed (i.e. depends more upon the massage itself), rather than the type of moisturizer used.
- Scar tissue massage should be continued during the scar maturation process (for about 3 – 9 months depending upon the situation) until the swelling has resolved and the tissues feel soft and normal.
- It is very important to protect the scar form the sun’s damaging rays for 9 – 12 months after surgery. This will help reduce the risk of darker pigment (hyperpigmentation) forming within, or adjacent to, the scar. Daily use of a broad spectrum sunscreen (SPF 30) that blocks both ultraviolet-A and ultraviolet-B rays is recommended. For scars in sun-exposed areas, the sunscreen should be applied throughout the year for optimal protection. And, remember to reapply sunscreen often (at least every 2 hours) when active outdoors or swimming.
- If scar massage does not appear to be reducing the thickness of a scar, speak with your physician; other treatment alternatives such as topical silicone gel sheeting and corticosteroid injections may be available.