Silicone scar sheeting is used by hospitals, cosmetic surgeons, burn centers, and dermatologists to treat especially surgical and burn scars and prevent the formation of new scars. The sheets are thought to provide a protective barrier which mimics the natural barrier function of normal, healthy skin.

Neosporin scar solution is a silicone scar treatment brand for the consumer market that does not exist anymore. The Pfizer company held the license to manufacture Neosporin Scar Solution using patented Silon® technology since 2002. In 2006 Johnson & Johnson purchased Pfizer Inc. and took it out of production. Because the demand kept growing the product was continued under the new brand name ScarAway in 2008.  These ScarAway silicone sheets, produced by Mitchell-Vance Laboratories, are largely the same as the Neosporin sheets. They are improved by making them bigger, thinner, and more adhesive.

A common heard complaint is the (lack of) adhesion. I have used them myself and I know from experience the sheets can be, especially on difficult parts of the body such as the face, hard to keep attached. Especially when the sheets have been worn for a few days and are cleaned and dried (which is recommended after a while) they get less sticky. I solved this by using silk tape to keep them attached. For my face I used a silicone gel (liquid version) during daytime. Although less effective than sheets according to studies the gel was a welcome addition.

So if you are searching for Neosporin scar solution, keep in mind they are called ScarAway nowadays. And keep in mind that it will take some dedication to keep them attached but it’s worth the effort because there is no better over the counter scar treatment available. The sheets are available online at Drugstore.com and Amazon

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.

Those who have read other posts or my Squidoo lenses probably know the first step in effective scar treatment is proper wound care*. Wounds should not be exposed to the air and let dry out but instead kept moist and clean. Effective ways to do so are by using manuka honey or Vaseline. (* side note, the actual first step in preventing acne scars is to reduce acne outbreaks as much as possible. Make sure to avoid picking at the pimple and treat it early with an appropriate anti-bacterial, anti-inflammatory medication. See the link at the end of this post for more about this.)

Both have clinically shown to provide excellent hydrating properties. Which is a major factor in rapid wound healing. They also form a barrier which prevents bacteria and other causes of infections out. Additionally manuka honey also has powerful antimicrobial, anti-bacterial, and anti-viral properties known to prevent and treat infections. If you have the right type of this honey (not all manuka honey has these medicinal characteristics) it, in some cases, is more effective than conventional medicine such as antibiotics. Furthermore it also has no side effects such as deteriorating skin. But more about Vaseline now.

Vaseline is the brand name for petroleum jelly or petrolatum. This ointment is cheap and easy to use, hydrates, soothes, and keeps wounds clean. Acne like all other skin injuries can potentially leave scars. This occurs as a result of inflammation and irritation of the acne. When using Vaseline to treat or prevent acne scars it should be applied on the red marks left by the pimple, the wound or scab only. Not on the pimple itself. Another remark; it’s no miracle cure it just speeds wound healing, promotes new tissue growth which leads to less or most ideally no scar tissue. Also it seems Vaseline is unable to clog the pores because its molecules are too big (it is a so called non-comedogenic product).

Use it regularly on wounds and fresh scars that are still red or pink. It will lead to improvement I am convinced. If you are not check out these forums for experiences of other acne sufferers.

Click here to learn about manuka honey acne treatment. Here some more info on the question: Can manuka honey get rid of acne? (Are there clinical trials proving it works and other related information)

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.

Popular beliefs on over the counter scar treatment products differ considerably. Frequently used products are scar creams based on vitamin E, topical vitamin E, ointments based on onion extract such as Mederma, Aloe Vera, Bio Oil, cocoa butter, cucumber butter, lime juice, skin remodeling copper peptides and so on. Abundant positive reviews on these remedies seem to support these beliefs. Less commonly accepted is the fact that there is no scientific evidence these products work. In some cases clinical trials showed these products in fact do not work.

Mederma for example, a currently popular scar treatment cream containing onion extract, does not seem to improve scar appearance and has not shown any benefit over petroleum lubricants (Vaseline). Several studies show the onion extract gel did not benefit scar treatment when results were compared with a petrolatum-based ointment. A leading dermatology website advices medical personnel to tell their patients that using products based on onion extract will likely not cause any harm but will not lead to an improvement either.

This applies to the other aforementioned products as well. For example the topical application of vitamin E on scars. Clinical trials illustrate that vitamin E provides no more effect than other moisturizing ointments, and hydration appears to be its only beneficial effect. Furthermore, topical vitamin E may actually cause more harm than good, possibly worsening a scar’s appearance and causing contact dermatitis (red rash), and other skin irritations in a large percentage of patients.

A comparison of available studies on popular over the counter scar treatment products leads to the conclusion that, either there is clinical proof or there has not been done any research on the effects of the product. (On cucumber, lime,  lemon juice and cocoa butter are no studies done)

A remarkable exception are silicone gel scar treatment products. Although it remains uncertain how these silicone scar patches actually work, various studies demonstrate their efficacy. Silicones are known to be the most effective over the counter scar treatment for burn, surgical, and other deep wound scars. They also prevent the development of hypertrophic and keloid scars. Used and recommended by burn centers, cosmetic surgeons and dermatologists they are considered ‘the golden standard in scar treatment’. Although starting treatment in an early stadium is recommended silicone patches also benefit treatment of older scars. Additional advantages are they are relatively easy to use, relief itch and pain and their use has no side effects.

Furthermore there are clinical trials showing hydration is a crucial scar treatment factor. Silicone gel sheets are thought to aid hydration but there’s no consensus among experts. Others say it’s the occlusion of the scar tissue. It is clear that hydration of the scar tissue and the surrounding skin benefits scar treatment. None of the examined products have shown to perform better than the commonly used petroleum ointment called Vaseline. In fact, in some cases Vaseline showed to have better hydrating properties than the scar creams it was compared with.

Another, potential, effective scar treatment product is honey. It is clear that the use of honey in wound care speeds wound healing and thus, indirectly, results in less scarring.  A recent review (evaluated the results of 22 clinical trials involving more than 2,000 patients) concluded that honey also minimizes scarring, removes infected and dead tissue and speeds healing by stimulating new tissue growth.

A 1996 study from India showed that burns treated with honey healed sooner than those treated with conventional methods (petrolatum and gauze) and that scarring was reduced. (6.2% of the 450 patients treated ended up with scars compared to 19.7% of the same number of patients who received conventional treatment) So these preliminary studies are promising regarding honey and its scar fading properties. More dermatologists say applying honey to a healing wound or existing scar has not shown to be harmful and may improve scar appearance. Whether or not the topical application of honey on scar tissue works has to be seen. There has not been done  any research on this particular subject but a certain type of honey, Manuka honey, is renowned for its many healing properties of which one is its excellent moisturizing action.

Recent trials show an increased temperature will significantly increase the process that decreases scar tissue (collagenolysis). So heat application products such as paraffin wax and heat packs could be useful too.

Summarizing, the best scar treatment products are silicone gel sheets, moisturizing agents such as Vaseline (and maybe Manuka honey) and paraffin wax or heat packs. More information consumer experiences with brands .

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.

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.