How I Got My Scars

After being attacked and stabbed a few years ago I ended up on the intensive care in a local hospital. A coronary artery had to be closed surgically to save my life. In order to stop the accumulation of blood within my chest (hemothorax) the surgeons had to open up my chest just like they do with open heart surgery.

Apart from the large vertical (thoractomy) scar on my chest due to the surgery I also had cut scars on my face, neck and lower back as a result of the attack. Once back at home and recovering I was determined to do anything in my power to fade the scars as much as possible. Since my scars were new I didn’t want to get surgery or other invasive treatments. So I asked myself, ‘how to get rid of these scars at home?’ And thus I started my search for an over-the-counter scar product that actually works.

Finding Out Which Over-The-Counter Scar Product Actually Works

Following the advice of my general practitioner as well as a surgeon I started using all kinds of products. After a while I had learned by trial and error that most scar creams like Mederma, Bio Oil or Calendulan are not effective. At least they were not for me. Apart from that I now knew that there are as much different opinions on scar treatment as there are different products. I was disappointed that the level of education concerning scar treatment among medical personnel was this low. I thought that there must be something that works. If only a little bit.

That’s why I started reading articles on scar treatment and contacted several cosmetic clinics to ask for advice. The cosmetic surgeon of one of the clinics told me that the best scar cream available was Zeraderm. (If I’m correct it’s not available in the US.) This is a silicone cream that lays a thin film over the scar. This led me also on the discovery of so called silicone sheets. These are made of the same material as the silicone gel but seemed to work even better.

“silicone sheeting has certainly come out as one of the best ways to deal with fresh and chronic scars” (Aesthetic Plast Surg, 1994; 18: 307-13).

Using Silicone Sheets

After ordering the silicone sheets and the gel I started using them immediately.This took some dedication because the sheets have to be worn at least 16 hours a day, every day. When a particular sheet (or patch as they are called also) has been worn for a few days it gets less adhesive.

I used silk tape to make sure the sheets sticked to my skin. Sometimes, e.g. when sweating or during physical exercise the sheets and silk tape let loose despite the tape. So I had to reattach them. I mainly used the sheets and the gel only when I was not able to use the sheets. I found the gel especially suitable for areas not covered by clothes when I was out in public. This because the gel seems to be less effective.

But the good thing was that I noticed a very slight improvement already after a few days. The scars became softer. This motivated me to go on with this treatment. Already after several weeks I could see my scars fade to a less red, less thick and softer state.

Conclusion

So concluding, the ultimate scar treatment requires a fair amount of time and dedication. This is the reality, the stories about creams that will fade scars almost completely only by applying them twice a day are just not true.

But the good thing is that when you are dedicated and disciplined to use the products day in day out and have the patience to maintain during a few months you will eventually get an optimal result. My scars faded to a huge extent. Not only did they become almost skin color instead of the red color they were. They also are flat and soft and do not itch anymore.

Silicone Sheeting Brands

There are differences between silicone scar product brands. The so called medical grade products contain higher quality concentrations of silicones and have better adhesive qualities. An example of such a medical grade brand is ScarAway.

ScarAway silicone sheets are the only scar sheets with the patented Silon technology. This is the same technology recommended by plastic surgeons and used in hospitals and burn centers. This Silon technology was made available for the consumer market in 2002 by Pfizer Inc. under the name Neosporin Scar Solution

Biodermis, Epi-derm silicone scar sheets are made of medical-grade silicones. These doctor-approved scar treatment products are used by hospitals, cosmetic surgeons, burn care practitioners, dermatologists, and other health care professionals.

They are FDA and C.E. (Europe) approved, breathable and permeable which is important because sheets that don’t allow oxygen to pass through may cause maceration. Silicone sheets are clinically proven to be a safe and effective scar treatment option. Epi-Derm sheets are also used for burn scar treatment.

How to use Biodermis Epi-Derm sheets? For optimal results they must be applied for a minimum of 12 hours per day for a period of 8-12 weeks.

Does using Biodermis Epiderm sheets bring side effects? All silicone sheets may cause skin rash although this happens rarely. This is very normal since any topical skin agent may potentially cause contact dermatitis (rash). If this occurs discontinue using Epi-Derm. The only exception is if you develop excessive moisture beneath the sheets which may lead to skin maceration which on its turn could predispose you to a fungal infection.

Are Biodermis silicone sheets any good? Some silicone brands are better than others. Some people gain better results with a certain brand than others. This may depend on skin type, humid or dry climates, and many other circumstances. Biodermis is a quality brand. What also makes it stand out is that Biodermis offers a variety of pre-cut, special shaped sheets. This way there is no need to cut them into the appropriate size yourself.

Studies mentioning Biodermis Epi-derm silicone sheets.
Study comparing the results of Epi-derm with Contractubex. Conclusion:
“Silicone products, either in gel or sheet, are superior to Contractubex® in the treatment of the hypertrophic scar.” Source: burnsjournal.com

Where to buy Biodermis Epi-derm sheets? They can be ordered online at MakeMeHeal and Amazon.

Action of Biodermis Epi-derm silicone sheeting

Here’s some info on the various sizes and shapes Biodermis sheets are available in:

Sizes and Shapes of the Biodermis Epi-derm products

Small silicone Patch (size: 5 x 6 cm / 2 x 2.5 in) The patches are only a few inches (max) and are ideal for preventing and treating small hypertrophic and keloid scars. Epitabs are small round and square shaped patches and are the smallest within the Biodermis range.

Standard Silicone gel sheet (size: 12 x 14.5 cm / 4.7 x 5.7 in) Best for mid-sized hypertrophic and keloid scars. Here’s a YouTube video on standard Biodermis Epi-Derm silicone sheets

Large Silicone gel sheet (size: 28 x 40 cm / 11 x 15.75 in) A full-sized sheet, ideal for the reduction of post-burn scarring. Can be wrapped around a limb or cover large scar areas on the torso.

Silicone Gel Strip (size 3.5 x 29 cm / 1.4 x 11.5 in) Strips are recommended for surgical scars such as C-section, tummy tuck, and heart surgery scars. Take a close look at the Biodermis Epi-derm strip in this video.

C strips are specially made for C-section and hysterectomy scars. (size: 3.6 x 15 cm/ 1.4 x 6 in)

Mastopexy shaped gel sheet. (size 32.0 x 9.6 cm / 12.6 x 3.8 in) The Mastopexy form is ideal for breast reduction (mammoplasty) and breast reconstruction surgery, and can be cut to size. Pairs of mastopexy forms and pairs of areola circles are sold separately.

Areopexy shaped sheets. Recommended for the “Lollipop” shaped scar as a result of the Lejour surgical technique used in areola reconstruction, breast reconstruction and breast reduction surgery. Sold in pairs. Can be cut to size.

Areola Circles (size: 7.6 x 1.9 cm / 3 x .75 in) Ideally dimensioned for small hypertrophic and keloid scars resulting from areola reconstruction and breast augmentation surgery. Watch this vid for an indication on how to apply special shaped breast surgery circle shaped silicones. Short video on breast surgery silicone patches

Various silicone scar sheets brands are available. There are some distinct differences in the type of silicones, fabrics, thickness, and adhesiveness among these brands. So which are the best buy? In my opinion the best silicone scar sheets are ScarAway and Oleeva. This because these are the only two brands that use the patented Silon technology. (ScarAway is the former Neosporin Scar Solution)

In short, Silon is a blend of Teflon and a certain type of silicones “which has unusual physical and chemical properties – particularly when formed into thin membranes. Research suggests that Silon acts to hydrate scar tissue, which in turn works to soften scar tissue, reducing its development and causing it to fade away faster.” Wikipedia

But there are more reasons why these two brands offer the best silicone sheets:

Breathability
Apart from silicones another material is commonly used to create a layer on the outside of the sheets. It is very important that this fabric is breathable. Oxygen should be allowed to transfer because if it doesn’t it can cause skin maceration. Maceration of the skin occurs when it is consistently wet. The skin softens, turns white, and can easily get infected with bacteria or fungi. Source: About.com: Dermatology. A visitor of one of my Squidoo lenses described this wrinkled white skin effect during the use of Dr. Blaine’s Scar Care sheets.

Stickyness
Those who have used silicone sheets know that keeping them attached can be somewhat of a burden. Especially on some (moving) parts of the body such as the face or neck. It should however be noted that the stickier the better does not apply here. If silicone sheets are too sticky they could create too much tension on the freshly formed, still delicate scar tissue which is not desired because it might worsen the scar. The ideal sheet would be sticky enough to help you position it on the scar, and use a medical tape (i.e. cotton or silk) to secure further if necessary.

Thin sheets versus thick pads
Thinner sheets with a compact layer of silicone are more comfortable and more “durable” which means they do not break down and you get more use out of them. The thicker “gel” type pads get dirt, etc embedded in them which is not sanitary when sealing to your skin for hours each day. The thinner sheets can be washed.

The only silicone scar sheets that have the breathable fabric and the thin, washable, medical grade, Silon technology silicones are the ScarAway and Oleeva sheets. Both doctor-level products are manufactured by BioMed Sciences inc. Oleeva Scar Shapes are pre-cut pieces of Oleeva Fabric for targeted scar management following surgery.

Hydration
It is theorized that hydrating properties play a major role in the mechanism of silicone sheeting. After serious skin injury trans-epidermal water loss is increased. [1] This water loss is more significant in hypertrophic and keloid scars and may be responsible for increased collagen production (abnormal scar tissue). The semi-occlusive nature of silicone scar sheeting improves scars by providing adequate but not excessive hydration. Dressings that are too permeable to water may be ineffective on scars because they fail to block water loss and related skin healing processes, whereas dressings that are too occlusive may cause skin maceration.

ScarAway is available online at Amazon and Drugstore.com. Oleeva can be ordered online at Makemeheal.com.

Note: also Scar Fx and Biodermis Epi-derm silicone sheets are medical grade products. This means they have a higher percentage, better quality silicones than some of the brands available in the drugstore.

[1] Suetake T, Sasai S, Zhen YX, Ohi T, Tagami H (1996) Functional analyses of the stratum corneum in scars: Sequential studies after injury and comparison among keloids, hypertrophic scars, and atrophic scars. Arch Dermatol 132:1453–1458

Has anyone tried Rejuvasil? It’s a silicone scar cream that also contains emu oil, vitamin C and squalene. According to the manufacturer it:

” has more effective ingredients than any other liquid silicone products and has been clinically proven to reduce keloids, hypertrophic scars, surgical scars, and burns. [...] is made with emu oil and squalene (shark oil) to make this treatment even more effective.”

I would love to hear your experiences because there are little to no reviews of this product. The reason I think it might be an effective scar treatment cream is because it also contains vitamin C.



Next to the, proven effective silicones (dimethicone), vitamin C is backed by several studies as an effective scar cream component. It is mainly considered a wound healing agent but topical use seems to have some benefits regarding scar treatment.



Some of these benefits include:

• promoting healthy scar tissue regrowth (collagen synthesis),
• protection from harmful sunlight radiation (ultraviolet A and B),
• lightening of dark colored scars (hyperpigmentation),
• and improvement of skin irritation, inflammation, itch, redness (inflammatory dermatoses).
• It’s also thought to have excellent hydrating properties.

Source: Wiley Interscience.



The problem with the addition of vitamin C (L-ascorbic acid) to skin care products is that it is highly unstable. This means that it reacts when exposed to e.g. air. Cosmetic manufacturers found a solution by using a more stable vitamin C variant called tetrahexyldecyl ascorbate. RejuvaSil contains this stable form of vitamin C.



I’m not aware of emu oil having any scar treatment benefits. Nevertheless the addition of this natural oil to Rejuvasil scar cream might still be useful because it is considered to be one of the few oils able to penetrate the skin. This trait would allow active ingredients to be carried with it into the deeper layers of the skin.

The only review I could find online is this one: (Average Customer Rating: 5 out of 5 )

“So far, the best scar gel for the price. I don’t see much of a difference between this one and another best seller scar gel that I have tried from the Derm Store, except this one is about $20 less. This was my second purchase and I plan on purchasing again.”

Rejuvasil scar cream can be purchased online at Amazon (cheaper) and MakeMeHeal. (two for one)

After application silicone creams provide a thin film covering the scar. The area should be clean and dry before the self-drying cream is applied. Daily use is recommended for optimal results. Major advantage of silicone ointments over patches is that it can easily be used on the face and other parts of the body that are hard to keep covered with patches.



“The application of silicone gel improves the redness, itching, texture and thickness of hypertrophic and keloid scars in 60% to 100% of cases “ (Poston, 2000)



Ingredients: Silicone (dimethicone), Emu Oil, Squalene (Shark Oil), Tetrahexyldecyl Ascorbate (Vitamin C)



Did you use RejuvaSil? Please let others know what you think. You can share your experiences below.

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.

Silicone scar sheeting is used by hospitals, burn centers,  cosmetic surgeons, and dermatologists to treat and prevent scarring. Having used many products myself I have come to the conclusion that not only are silicone sheets the best solution for (surgical) wound scars but also that it matters which brand you choose. The best option is to use medical grade, or the so called doctor approved brands. ScarAway is such a brand.

ScarAway (formerly known as Neosporin Scar Solution) is released on the consumer market by Bio-Med Sciences. These sheets ( or patches, strips) are manufactured with the proven Silon technology. The last years ScarAway silicone scar sheets were improved with a slightly larger size and significantly better adhesion.

Supporting my own findings here are two comments/ reviews posted on my web page about my experiences with scar treatment:

Lori D says:

The only silicone sheet available that is professional grade and also thin (more comfortable) is Scar Away. I tried a few without success and then finally found scaraway sheets. Here is my experience. I tried rejuvaness, but it is just piece of rubber…it does not have any stickiness to help it stay on so even when i taped it on, it would slide and fall off. No effect whatsoever on my scar. I tried another sheet (blaines scarcare?) it was so thick and lumpy that it was really uncomfortable and felt itchy. No way I could wear that 12 hours a day!. I was very discouraged. When I went to my doctor for help with my scar, she recommended ScarAway. I used the 7″ x 1.5″ strips for my C-section scar. The strip was VERY thin and has a nice soft fabric on the outside . I left mine on almost all of the time and each strip lasted longer than the week suggested. The package came with enough for the whole treatment (my doctor recommended 12 weeks). My scar is barely even visible now

steve p says:

I just went to drugstore.com to order ScarAway silicone scar sheets and found out they have a new 100% silicone gel that does not have any “useless” ingredients like vitamin e. cortizone. etc. So if you are looking for the scienticfically proven silicone only, I am going to use the scaraway sheets in combination with the silicone serum when i am not wearing he sheet. I know I have to wear the sheet 12 or more hours, and will wear the gel the other hours. I read that the longer silicone is in contact with your skin, the better. I also found the scaraway on drugstore.com and amazon.com comes with a free case to keep it in.

Why you should avoid silicone strips that are too sticky and too thick, and more advice on silicone scar products in this ScarAway review.