No, vitamin E does NOT improve scars. There is no scientific evidence confirming this claim. In fact, some studies do demonstrate vitamin E may cause skin irritation which actually worsen scarring. Anecdotal reports also mention widened scars after using vitamin e topically.

In this study (The Effects of Topical Vitamin E on the Cosmetic Appearance of Scars) the researchers concluded:

This study shows that there is no benefit to the cosmetic outcome of scars by applying vitamin E after skin surgery and that the application of topical vitamin E may actually be detrimental to the cosmetic appearance of a scar.

In 90% of the cases in this study, topical vitamin E either had no effect on, or actually worsened, the cosmetic appearance of scars.

So if vitamin E doesn’t work, what should we use?

The only proven effective scar treatment product you can use at home are Silicone Scar Treatment Sheets . (links to Amazon, read the reviews to learn how they can help you improve your scar tissue)

There are various studies demonstrating the benefits of silicone gel scar sheets. Here’s one published by Archives of Surgery.

Important to remark is that this modality does not work on all types of scars. Burn scars, discolored, and raised scars are known to improve. In some cases keloid scars may also be repulsed by silicones. Such scar tissue will become flat, softer, more pliable, and discolorations will tone down. Also itch and pain will be reduced.

Silicones have been used since the 1960′s in burn centers and hospitals. Only the last decades they have become available on the consumer market. Many people are still not aware of the existence (let alone effectiveness) of silicone sheeting for scars. Among those who are unaware of the benefits of silicones are not only consumers but also medical personnel. It’s a sad fact that many doctors, but even dermatologists, and plastic and cosmetic surgeons are not aware of the clinical proof that backs the use of silicones for scars.

For depressed scars silicones will not be the most appropriate treatment. These types of scar tissue will most likely be treated with fillers, dermarolling (needling), and collagen injections.

Cuts, and abrasions as a result of bumps and falls are a natural part of children’s lives. Many times the wounds are superficial but in some cases stitches or sutures are needed. In these cases, as well as in case of lacerations and chicken pox, parents may become concerned about scars. Children may become self-conscious. Especially when a child’s scar is located on a prominent location such as the face. Read on to learn about the best way to treat scars on children.

Here are some things for parents to know:

Scabs
Children are known to pick off scabs. This should be avoided if possible. In fact, scabs should best be prevented at all. Scabs contribute to scar creation. After a scab has fallen off the scar commonly stays red and bumpy for a while (this redness may last for a few months). When a wound is kept covered and moist it won’t scab, and heal more quickly which diminishes the risk on scarring. More info here.

Effective Treatment
The best non-invasive option available are silicone sheets or gels. Silicones have demonstrated to help to reduce itch, pain and sensitivity and render scars flat, soft and
supple. Especially useful for kids who are more prone to keloids such as children with dark skin because silicones help preventing such scars.

Difficulties
A difficulty of using silicone sheets on children is adherence. Silicone sheets can be difficult to keep attached. Especially in toddlers because they are so movable. I commonly recommend using ScarAway sheets but for young children you might want to use Cica Care sheetsbecause these are stickier.

Another solution is to use a silicone gel cream (a liquid that dries to a thin transparent film). According to medical evidence these ointments are (slightly?) less effective than sheets or patches. According to many this is because sheets apply pressure but medical science isn’t convinced about that. Here’s a list of commercially available silicone gel creams.

Polyurethane Dressings and Pressure Garments
Other over the counter products backed by clinical evidence are polyurethane dressings (although less evidence available and probably slightly less effective), and compression garments (the formerly used method, especially in case of burn scars)

Other Measures
Gently massaging on and around the location of the scar tissue is thought improve circulation, which should minimize scarring. Massage is also used to make surly tissue more supply and pliable.

Don’t forget to protect your child’s scar against sunshine with sunscreen and/or clothing. This is important because UV radiation will worsen the scar and may reduce the distortion of skin color and texture. Thin clothing only has a very low SPF so in most cases sunblock is a must. It is commonly recommended to apply sun block on the area for a prolonged period. Some dermatologists recommend to apply sunblock every day for a year because scar tissue pigments differently. Sometimes it’s the change in pigmentation that is more visible than the scar itself.

A popular product is Mederma for Kids. Although there’s minimal evidence this onion-extract based product really fades scars, there is a vast amount of positive anecdotal reports. But this is also the case for vitamin E oil.

Avoid Vitamin E Oil
Pure vitamin E oil, e.g. from capsules should be avoided. Especially when wounds or scars are fresh. Studies have shown vitamin E oil to cause rash or other skin irritation in about one third of the test persons. In the worst case this may worsen scar appearance.

Do children scar more easily?
Well, the opinions differ. I think they don’t, except for the fact that they may be injured more easily because it’s a part of growing up. I guess it depends on the severity, depth, of the wound and the healing process. Also genetics are of major influence because the tendency to scar is hereditary. On the other hand I think wounds and scars tend to heal more quickly in children and thus scar appearance may be less prominent. This because children have a young, elastic, and resilient skin.

Upcoming innovative medicine designed to prevent surgical scars
In the near future a new medicine designed to prevent post-surgery in children will be launched. Read more about it here.

Photo by wsilver

The c section scar is the result of the vertical incision made during the surgical procedure and is approximately 4-6 inches long. How wide it is depends on how well it is treated, how healthy someone lives, genetics, and how well the wound heals. The scar is located on the lowest part of the tummy, just above the pubic bone. Because of its location it is mostly covered by underwear or clothes. Here are some c-section scar photos.



I stumbled upon this question on Yahoo Answers about c-section scar treatment and the answers given point out how many misconceptions about scar healing (in general) exist.

The question:

“I had a C-section 6 weeks ago and the scar is red and puffed up. Does anyone recommend a scar treatment for it? and when should I start applying the scar treatment?”

In the answers many of the common, so called effective, scar treatments are mentioned but a really truthful and helpful answer isn’t there. Yes, of course scar tissue improves over time as mentioned by one of the answerers. But no, Mederma is not a proven effective remedy actually. Studies show it works just as good, or even slightly less effective, as Vaseline.

Why so many people swear such products work for them possibly has to do with the massaging of the scar, improved blood circulation, and hydration. Regarding vitamin E capsules, better leave those where they are, or use them where they are intended for but do not use them topically. Studies have shown rubbing vitamin e into scars can make their appearance worse and cause skin reactions.



Wound Care vs Scar Treatment
Also the remark that the wound shouldn’t be treated until it’s fully healed should be clarified. In fact, optimal scar healing actually starts with proper wound treatment and if done well this can really make a difference. When speeded healing occurs and problematic aspects such as inflammation and infections are avoided the chances on developing more prominent scar tissue are decreased. The other way round; wounds that are not kept clean and looked after are prone to poor scar healing. Always consult your surgeon about the fastest way to heal open wounds. Tip: ask your medic about Medihoney wound dressings.

But the person giving this advice has a point. A clear distinction should be made between wound care and scar treatment. Scar healing remedies of a c-section scar should never be started before the incision wound has healed and closed.

The Best C-Section Scar Treatment
In this particular case, where this woman’s c-section scar is red and puffed up silicone strips can be a practical solution. It it is true that many scars, especially those resulting from surgery, can be red, bumpy, and look awful but eventually will improve. But silicone strips, which are in many cases FDA Class 1 Medical Devices, do not only improve the scar appearance, they also reduce or take away itchiness and pain. On top of that they reduce the chance on developing hypertrophic (red and raised) and keloid c-section scars. (keloids are scars that grow beyond the normal wound boundaries.)

Here’s a short review:

“The patches are called scaraway and are silicone sheets. I used them for my c-section scar and am VERY pleased. (My friends scar got red and bumpy..mine healed flat and pretty thin and is regular skin color now).. They adherer to your skin without tape (but they are not sticky like bandaids)..hard to explain..I hardly noticed they were on me…hope that helps”

Scar Pain and Massage
Some women experience pain in their c-section scar. This can vary from tingling to real pain as well as a numb feeling. Where some women loose sensitivity on the skin located around the scar tissue others experience extra sensitivity. Sometimes scar contractions can cause pain and discomfort. This can be solved by massaging the scar tissue because massage loosens the tissue, boosts circulation and thus makes the tissue softer.



C-Section Scars and Compression
Next to silicone strips compression is another scar healing therapy for which clinical evidence exists it actually works (although in lesser amount). Some women use compression belts also called C-Section compression bindersfor extra comfort, pain reduction and faster wound and scar healing. (Also scars seem to benefit from compression.)

Always avoid exposing your c-section scar to direct sunlight or use a high SPF sunscreen. Also when wearing thin clothes because many fabrics do not prevent the sun radiation from coming through.

It will soon be possible to get a medicine injected just before surgery in order to prevent scars (or at least to reduce scarring considerably). Three clinical trials have shown this medicine promotes the regeneration of healthy skin thus resulting in less prominent scarring.

The medicine administered in these studies was Avotermin which is marketed by the biopharmaceutical company Renovo under the brand name Juvista. The studies examining both short-term and longer-term effects showed improved scar appearance compared with standard wound care and placebo.

“With low doses injected locally around the time of surgery, Avotermin is a well tolerated and convenient treatment. These studies suggest that avotermin has potential to provide an accelerated and permanent improvement in scarring.” says Mark Ferguson, of the University of Manchester, United Kingdom.

The active constituents of this scar reducing medicine work according the same principle as that in scarless healing embryo´s. The technical name for this ingredient is Transforming Growth Factor Beta 3 (TGFβ3). This is a protein present in high levels in embryonic skin and wounds. This substance is also present in adult wounds but only in very low levels. Source: Renovo

Juvista can also be injected near the wound location when no surgery is performed. For example when an open wound as a result of an accident needs to be stitched. When this scar preventing medicine will be injected at the time of wound closure it will probably help prevent scar development.

At the moment Renovo is still conducting clinical trials. When these are finished, approximately 2011, the product will be available around the world.

polyurethane scar dressings

Polyurethane dressings are used in scar treatment. Brands available on the consumer market are Curad Scar Therapy and Cutinova Thin Dressings. Both brands offer self-adhesive, breathable, flexible products in either semi-transparent, skin tone or clear formulations. But do polyurethane dressings really work on scars?

Studies on polyurethane dressings show a positive effect on scar appearance. The dressings are hydroactive which means they maintain a moist environment and prevent bacterial contamination which is useful when the dressings are used as a wound occlusive. (they are used both in wound care as well as scar treatment) There is also some evidence for the prevention of hypertrophic scar formation. Some studies show a slight advantage when these dressings are combined with pressure therapy.

One study of 60 patients noted significant improvements in blood supply (microcirculation) and surface qualities in patients who were treated with polyurethane dressings for 6 weeks after surgical incisions.

A report called ‘Topical Treatments for Hypertrophic Scars‘ by Zurada, Kriegel, and Davis notes that the use of polyurethane dressing in scar therapy has: “unclear effects on the development of new hypertrophic scars but has been shown to improve the prominence and appearance of mature scars in a small randomized trial. Further studies are necessary to elucidate its role in hypertrophic scar treatment.”
Conclusion of this report: There is questionable evidence for the effectiveness of polyurethane scar dressings in preventing hypertrophic scars and some evidence for effective treatment of mature scars.

The same report mentions silicone scar sheets as a more effective product; “the most accepted treatment for old and new hypertrophic scars is silicone gel sheeting”. A score rating the overall efficacy of the two products is given.
Polyurethane dressings: +/-
Silicone sheets: ++

The dressings should be applied daily (most convenient will probably be overnight) for approximately 12 hours. This should be maintained for at least a month or two. One study compared the use of the dressings for 12 hours with 24 hours per day. No relevant differences between the scars appearance (color, softness and elevation) was noted.

Which are better for mature scars, polyurethane dressings or silicone dressings?

In another study four treatments on mature scars (2.5 to 4-year old) were compared. The four therapies were;  polyurethane dressings; polyurethane with compression; silicone sheeting with compression; and compression alone.

“All treatment modalities were found to have significant effects both on tissue function and scar tissue surface structure. The most pronounced effects were achieved with the combination of polyurethane dressing plus compression or silicone sheeting plus compression. The positive effect of the polyurethane dressing alone on scar tissue was even slightly superior to that of compression therapy alone.” Source: Effect of four treatment variants on the functional and cosmetic state of mature scars.

Another report by Dr. Thomas Mustoe states:

We have investigated the effects of silicone gel sheeting (Cica-Care: Smith & Nephew, Largo, FL) in a rabbit model of hypertrophic scarring . As expected, silicone gel sheeting effectively reduced scar hypertrophy in this model system. A polyurethane dressing (Op Site: Smith & Nephew, Largo, FL) [..] did not have similar beneficial effects on scarring.

Since advantages over silicone sheeting in immature scars are unclear or not present and this type of therapy is equally effective on mature scars I would tend to conclude silicone sheets have more evidence behind their overall efficacy.

centella asiatica

Centella Asiatica is a mildly antibacterial, anti-viral, anti-inflammatory herb indigenous to south and south east Asia. The plant grows in swampy areas in India, Sri Lanka, Indonesia, Malaysia, Iran, northern Australia,  Melanesia, and New Guinea.

The herb has been used for ages for its medicinal qualities in both traditional Chinese medicine and traditional Indian (Ayurvedic) medicine as well. It is also known as Gotu Kola, Asiatic or Indian Pennywort, Rau má in Vietnam and Saraswathi Plant” in India.

(photo by suatu ketika | Creative Commons)

Ascribed benefits of its culinary and medicinal use are stimulation of overall health, rejuvenation, boosting the nervous system and increasing concentration. Some extracts have been used traditionally to treat leprosy. In Thailand it is used as a detoxifying agent to aid treatment of opium addicts.

A popular folklore tale from Sri Lanka speaks of a prominent king from the 10th century AD named Aruna Withane who claimed that Gotu Kola provided him with energy and stamina to satisfy his 50-woman harem.  Source: Wikipedia

Centella Asiatica Scar Creams
Several studies show Centella asiatica’s ability to improve wound healing. Some aspects of the chemical compounds in this herb seem to aid scar treatment as well. More specific; the main substances; asiatic acid, asiaticoside and brahminoside seem to stimulate type 1 collagen production which leads to less prominent scars.

Also inflammation, which is a major factor in (abnormal) scar creation, is reduced. Apart from this, the process of myofibroblast production, which boosts wound healing by contracting the edges of the wound, is decreased. It is theorized that residue myofibroblasts are the reason for hypertrophic and keloid scar development.

Madecassol
A segment of the chemicals in the Asiatic acid are also described as madecassol. This madecassol has shown to be an effective treatment of keloid scars. (E1-Hefnawi H: Treatment of keloids with asiaticoside. Dermatologica 125:387, 1962)

Another scientist found that when taken orally madecassol turned out to be “an active scar improver with few side effects”.  His conclusion was that although more extensive study on its true mechanism of action and long-term safety needs to be done, it is promising regarding effective treatment of keloids. (Bosse JP: Clinical study of a new anti-keloid agent. Ann Plast Surg 3:13, 1979)

Landes reported about his 20 years of experience with madecassol ointment. He reported to use madecassol as additional treatment after cosmetic surgery. (Landes E: Konservative Therapie yon Narben und Falten. Z Hautkr 62:805, 1987)

No Side Effects
Studies as well as anecdotal reports have not shown any side effects of the topical application of Centella asiatica extract.  Because the plant and its three main chemical substances (terpenoids) are weak sensitizers skin irritations are considered unlikely, and have not been reported.


Centella Asiatica based Scar Creams
A well known scar cream is Alpha Centella cream. This product is used by some physicians, especially in Asia, to prevent and treat scars. The cream has two main ingredients.  Apart from the aforementioned three extracts of C. asiatica it also has extracts of the Bulbine frutescens plant in it. This herb possesses moisturizing and antibacterial properties and its action is sometimes compared with Aloe Vera (as is C. asiatica).

A newcomer on the market is Scartini serum with main ingredients Centella asiatica and lychee extract. As far as I know, this is the first cream with this centella asiatica (Gotu Kola) ingredient on the American consumer market, which could be promising. How much of the Centella asiatica ingredient is present in the product is unclear. Also the dermal benefits of lychee extract are not convincing when examining available research.


Conclusion
The positive effects of C. asiatica in wound healing are convincing (documented to aid wound healing in a large number of scientific reports) Also evidence for the improvement of, especially, keloid scar appearance is available but more research has to be done. Key effects appear to be speeding scar maturity, anti-inflammatory action and the decrease of excessive scar tissue (myofibroblast production). 

Or as this study abstract on New Innovations in Scar Management puts it:

“Centella asiatica has been documented to aid wound healing in a large number of scientific reports. The most beneficial effect appears to be the stimulation of maturation of the scar by the production of type I collagen and the resulting decrease in the inflammatory reaction and myofibroblast production.”
That’s why this report mentions Centella asiatica together with effective measures such as; pressure therapy, hydration, and silicone sheeting.

Since there do not seem to be any really effective scar ointments (except for the prescription cream Imiquimod (brand name Aldara) and silicone gel creams) Gotu Kolu based scar creams might be a worthy contribution to the effective scar products pool.

The anchor pattern surgery is the most invasive breast reduction procedure. This variant is also called; T-incision, inverted T pattern, or Weiss Method. This 30 sec. YouTube video shows clearly how this procedure is performed and the scar it will leave: Anchor Breast Reduction Procedure.

Because this is the most radical procedure it results in the most scarring. In order to avoid ugly scars it is recommended to treat them right away. This means as soon as the wound has closed and certainly not before.

Anchor shaped, self-adhesive silicone gel pads are the most efficient way of preventing hypertrophic and keloid scarring. Silicones have shown to make surgical scars less red, flatter and softer. These dedicated products also come in an aureola circle shape. This way maximum convenience is provided and cutting large sheets into customized shapes is not necessary.

Dedication and determination are required because the pads should be worn on the breast reduction anchor scar for at least 12 hours every day for a period of at least two months.  But the efforts are worth it because it is clinically proven that the results are far better then those gained when using creams or lotions. More information here.

Hypertrophic scars (Cicatrix Hypertrophica) are discolored, mostly red – sometimes pink, purple or other colors, widened, and elevated. They are the result of an excessive healing process after the skin has been damaged. They can be painful, may itch and can be very sensitive. Touching them, sliding clothes or the pressure of for example a seatbelt may produce discomfort.

The disorganized collagen structure of the tissue leads to the thick and elevated appearance. An increased amount of blood vessels results in the red color of the scar tissue. Common causes of hypertrophic scarring are burn injury, wound infection, and tension on the wound and or scar tissue. After a while the scar growth stabilizes and in some cases regresses.

Common hypertrophic scar treatment includes collagen reducing corticosteroid injections, laser therapy, cryosurgery, surgical revision and topical over the counter treatments. Downside of steroid injections is that they flatten the scar but do not treat the discolorization. It is recommended to indulge in these topical DIY measures first because they are easy accessible, low cost and more important; non invasive. The aforementioned more invasive treatments have risks of worsening scar appearance involved.

Most effective topical hyperthropic scar treatments are silicone sheets. Originally used by medical professionals these sheets are now widely used to minimize the size, thickness, stiffness, redness, and itch. Not only do they make the scar softer, flatter and more supple they also prevent new hypertrophic scars from forming.

Silicone ointments such as creams and gels as well as polyurethane dressings have shown to be less effective. The latter are less easy to use and it remains unclear how this therapy works on fresh hypertrophic scars. Vitamin E has shown no efficacy and is associated with skin reactions. On Aloe Vera no research has been done. Onion extract based creams (e.g. Mederma) haven’t shown a demonstrable effect either.

Since hydration seems to be beneficial petrolatum based ointments could be a useful addition. Studies show no benefits of dedicated scar creams compared to e.g. Vaseline.

Learn more about hypertrophic scars by reading my experiences with researching and treating them.

Red and raised scars are called hypertrophic. They are characterized by the discolorizaton, thick tissue, and can itch and sometimes cause pain because of contraction. Because the trauma has damaged the nerve endings this can result in pain or discomfort too. Also non-elevated scars can be red. This redness fades after a few months to a year in most cases. Sometimes it doesn’t and might even get worse. This depends on the skin type, race, age, lifestyle of a person, and the location on the body. (Some skin areas are far more sensitive)

Especially surgical scars, which are remains of relatively deep wounds, are prone to developing scar redness (erythema).  Immature scars are still in development. New cells and tissue are being created. To support this process the body creates additional blood vessels and an increased blood flow. This is what leads to scar redness.

Things you can do to reduce scar redness are massaging the scar gently and regularly. Keeping the scar hydrated. For example by daily applying Vaseline or another hydrating ointment. Also warmth seems to benefit the healing process studies show. Heat packs or paraffin wax are used for this purpose. Something very important is to keep the scar out of the sun at all times. Sun radiation is very detrimental to the tissue and will result in more redness and probably even worse effects.

The best product to use are silicone patches. These have been used for decades by burn wound centers and hospitals. These patches are especially effective in toning down the color and flattening elevated scars.  Visit this page for my experiences with and additional information on how to reduce scar redness.

A great deal of people, especially children find it difficult having to cope with a heart surgery scar. A Canadian (2006) study of adults with this type of scar reported that 58% of the respondents saw themselves as “disfigured,” but 60% said that the scarring did not bother them as much now (At the time of the study) as it had during their younger years.

Providing the best heart surgery scar treatment available can offer some relief. Knowing you are doing everything within your powers to pursue the best final appearance might help a little. It also decreases the risk of developing abnormal scarring such as hypertrophic or keloids scars.

Taking really good care of the wound is the first step into accomplishing this. For the best results it is crucial to avoid infections. Luckily there are products such as medical grade honey dressings which have shown to be not only more effective than conventional methods but also have little to no side effects when compared to antibiotics.

Making sure not to overstretch the wound and scar tissue are also important. Especially the location of the sternotomy scar (vertical on chest) is subject to tension caused by movement. Gently massaging the tissue on the other hand can be very beneficial.

And of course using a product that actually works is essential. Silicone gel patches have not only shown to be the most effective treatment (according to studies) but they also help prevent hypertrophic and keloid scars from developing.  This is a great advantage especially for heart surgery scars because of the delicate skin and tissue on this part of the body.

For more information and tips visit this page about heart surgery scar treatment.