The best, and actually only proven effective, risk-free, treatment for raised scars is topical silicone gel sheeting. In this study, published in Dermatologic Surgery in 2001 researchers conclude:

Topical silicone gel sheeting, with a 20-year history of satisfaction in dermatology, now appears to be useful in the prevention of hypertrophic scars and keloids in patients undergoing scar revision.

Also other studies confirm such claims. This type of therapy has been used for a few decades now, initially in burn centers and hospitals.

Not only to prevent excessive scar formation but to improve cosmetic appearance as well. Some dermatologists and other medical professionals refer to silicone sheeting as ‘The Golden Standard in Scar Treatment’.

Steroid Injections
Another treatment for raised scars that works is the, more invasive, use of steroid injections. Generally multiple injections are required to get the desired effect.

Downside are the possible side effects. Such steroid injections (e.g. Kenalog) may deform the scar and surrounding skin by causing dents (skin atrophy). Other complications include; lightening of the skin (hypopigmentation), and red spots on the skin (telangiectasia).

Because of these side effects and the non-invasive character of silicone gel sheeting it is often recommended to use these. Most scars improve upon using this modality.

Raised Scars
Raised scars can be white, red, purple, or even darker colored. The most common types of raised scars are keloids and hypertrophic scars. Hypertrophic scars are more common then keloids. The elevation of scar tissue is a result of excessive fibroblast creation. Fibroblasts are connective tissue cells the body creates to repair the wound.

• Keloids
  Keloids only occur in 10% of people. They look like mounds growing above the skin surface. Sometimes they are mistaken for benign tumors. Their symptoms are itchiness, pain, unusual sensations, redness and skin pigmentation. They grow out of the normal boundaries and can be triggered by wounds, pimples, insect bites, tattoos, and even simple scratches. Keloids are hard to treat effectively and recurrence is typical. These scars are often treated with combinations of laser therapy, steroid injections, and silicone sheets. As a last resort surgery can be performed but more scar tissue may form afterwards.
• Hypertrophic Scars
  Hypertrophic scars have a slightly similar appearance but do not grow as big as keloids. They may restrict movement when located close to a joint. They are more likely to fade in time, generally within 1 or 2 years. This type of scar tissue may develop into keloid scar tissue in some people. Therefore preventive treatment is recommended. (Surgical) wounds are commonly covered with paper tape to reduce wound tension and thus minimize scar tissue creation. (and the risk on keloid development) Scars (wounds that have closed) can be treated effectively by pressure therapy (garments) and silicone gel sheets.

How Do Silicones Work?
Silicones are thought to act by downregulating fibroblast creation thus reducing the amount of collagen deposit in the tissue. They are theorized (their precise method of action isn’t clear yet) to mimic the occlusive barrier function of healthy skin thus increasing hydration.

Hydration seems to be essential in improving (raised) scars therefore it is recommended to keep the scar and surrounding skin hydrated.

They can also improve the appearance of burn and contracture scars.

My Experiences With Silicones for Scars.
I have used silicone sheets myself on the several scars I had when I had been stabbed and needed surgery to safe my life. The sheets made my scars smoother, less itchy, flat, and more skin colored. I therefore recommend ScarAway .

You can also use a silicone gel cream such as ScarAway Serum or Kelo-cote scar gel. A gel is more convenient and once applied is less obvious which makes it more useful to wear during the day. (in case your scar is not covered by clothes.)

Sheets, also known as pads or patches seem to be slightly more effective though. I myself used both. Sheets at night and the gel during daytime.

Most facelift scars, located in front of the ears, are hardly noticeable or not visible at all. The location of the facial incisions ensures such scars are only visible during the first weeks after surgery. The incisions are commonly lined up within the natural curves of the ear.

As with all new scars redness may occur. This is a normal, temporarily, sign of scar healing and can be covered up with makeup. In case the scar turns raised, elevated, bumpy, or otherwise problematic a silicone gel cream may offer the best solution. Such creams dry without residue to a flexible film and are clinically proven effective.

Facelift procedures performed by a qualified, reputable, board certified (facial) plastic surgeon should generally not lead to scar complications. Another reason why there’s no real treatment required for facelift scars is because of the fact that the blood supply in the face is very well developed.

Those who are prone to keloid scars, or otherwise problematic scars, could best use a silicone creame to avoid excessive scar tissue (keloidal scars tend to occur especially on the face). In these cases it could be wise to closely monitor the development of the scar. When the tissue is slowly getting thicker, wider, or darker it may become a hypertrophic or keloid scar.

Caring for the surgical wounds and fresh scar tissue is essential. During the wound healing phase an antibiotic ointment may be recommended. Care should also be taken during scar the scar healing phase (scars take approximately 6-18 months to fully mature). The most essential measure is to prevent exposure from the sun or other UV radiation (e.g. from solar beds) since this will very likely make the appearance of the scar more prominent.

Other means of facelift aftercare are facial bands, neck wraps, and specialized post facelift compression garments. See the carousel below for more facelift aftercare products (by clicking the facelift tab).

After a liposuction procedure it is commonly recommended to wear compression garments. There are two types; stage one* or medical garments and stage two or aesthetic garments.

They can be used following various procedures such as abdomen, breast, back, and flank liposuction.

Stage two liposuction garments are designed to provide continued healing compression and support during the second stage of recovery. This phase typically lasts 2-8 weeks after surgery. They are worn like long underwear underneath clothing.

Generally stage two compression garments are tighter than stage one garments which makes them provide more compression. This is appropriate because there’s less less swelling at this second stage of liposuction recovery. In the critical immediate postoperative period this amount of tension would be inappropriate.

Benefits
The benefits of such garments are that they minimize any swelling that remains, accelerate the healing process, help improve blood circulation, and allow the patient to return to daily routines sooner. Designed for skin retracting and body shaping these medical devices also help the skin fit better to its new contours.

Liposuction compression garments provide support to the surgical areas for better scar healing, and more comfort. They reduce the tension on fresh surgical scars and prevent them from stretching. It’s this tension and stretching which are a cause for hypertrophic, keloid, and widened scars. Compression has been used for decades to keep scar tissue pliable.

Materials
Many high quality garments are made of comforable, yet durable materials. Common is the use of lightweight powernet fabrics, breathable cotton, and lycra. Garments made of 100% latex and formaldehyde should be avoided.

There are several types of garments and they come in different quality ranges and prices. Some have built-in seamless cotton knit bras. Also flat seams to avoid showing through clothing is a useful feature.

(* Stage one garments provide moderate compression immediately after surgery and are typically worn for up to 2 weeks.)

Brands
Some of the more popular, high quality brands are; Marena, Rainy, Isavela, Bella-Jane, and Design Veronique.

For more info on how to measure your right size, instructions on how to use the garment, reviews, purchasing and more visit Makemeheal.

A few studies have demonstrated that topical retinoic acid (the strongest form of vitamin A) has beneficial effects on scar appearance. However, because of the, sometimes serious, possible side effects associated with this type of treatment its use is disencouraged by professionals in the health care sector.

But what about its less strong, thus less risky, sisters retinol and retinyl palmitate?

“In vitro studies demonstrated that collagen synthesis * could be markedly reduced in cultures treated with retinoid acid and its derivates.” [1]

* collagen synthesis plays a role in excessive scar tissue creation.

‘Its derivates’ are retinyl palmitate and retinol which are less strong forms of vitamin A associated with less side effects. For more clarity:

• retinyl palmitate – safest form, best tolerance, fewest side effects, no prescription needed
• retinol, stronger so more likely to cause reactions and is not suited to all skin types.’
• Retinoic acid is the active form of retinol, with prescription only

Since the researchers concluded that its derivates also reduce collagen synthesis retinol and retinyl palmitate creams may help in the treatment of scars.

An interesting NY Times article titled; ‘The Thing About Retin-A: It Works‘, provides some additional insights.

For example: “Retinol, a less potent form of Retin-A, also has some strong science to support its effectiveness.”

“[..] consistent use of Retin-A helps normalize the cells,” said Dr. Min-Wei Christine Lee, a dermatologist in Walnut Creek, Calif.”

“Retin-A can improve skin texture and fade dark spots and freckles because it causes skin cells to turn over more rapidly. It shrinks dilated pores and improves cell turnover within the pores so they are less likely to clog and become blackheads and whiteheads.”

So in conclusion, retinol may have clinical support behind its efficacy but I haven’t found yet what it exactly does for scars. I’m wondering if anyone has used retinol creams on their raised, red scars? And if so, what did it do for you? (A close look at the sense and nonsense of retinol creams in acne scar treatment will follow.)

Read more on the benefits and potential side effects of topical retinoic acid on scars.

[1] Sense and Nonsense of Scar Creams and Gels Cees J. M. van den Helder, M.D., and J. Joris Hage, M.D., Ph.D. Amsterdam, The Netherlands

Vitamin A comes in several forms. The strongest is called retinoic acid which, because of its strength, may cause adverse reactions. Therefore, this active form of retinol is not suited to all skin types. Retinoic acid creams are only available with prescription from a doctor or dermatologist. Because of its potency it’s classed as a pharmaceutical and not a beauty product.

Retinoic acid is not a new product. It has been clinically tested and is used in skin care for almost three decades. Some of these studies, instigated by the observation that oral vitamin A improved the appearance of keloid scars, have examined the effects of the topical use of this potent vitamin A on scars.

Conclusion of examining these reports is that the use of topical retinoic acid on scars, although seemingly effective, is not recommended. This because of potential side effects.

One study report is titled: Reduction of Keloids and Hypertrophic Scars Following Systemic Administration of Vitamin A:

[..] examined the effect of a topically applied 0.05% solution of retinoic acid on keloids and hypertrophic scars. [..] Slight to marked reduction of the size of these scars and a decrease of complaints such as itching were noted in the majority of the cases.

In addition, Hansen reported a 75% subjective and objective improvement in scars as old as three years old treated with a 0.05% topical retinoic acid. This improvement meant softening and flattening of hypertrophy and fading of the scar’s color once the effects of the acid had worn off.

In his series, vertical scars on the abdomen and those across the lines of minimum tension elsewhere on the body showed the most dramatic improvement. Areas that did not seem to respond well were the breast, chin, and jawline.

Another report by Daly et al. [2] presented the results of a randomized, double-blind, prospective study on the effects of topically applied vitamin A:

A statistically significant difference (20% reduction in scar size) was noted between the group treated with 0.05% retinoic acid and the control group treated with the base cream.

In the retinoid-treated group, lesion size was reduced by approximately 20%. Daly and coworkers concluded that the clinical effects of retinoids had been demonstrated to be consistent with the in vitro data.

Side Effects
In some case scarring actually was the result of inappropriate use of 0.05% retinoid gel. Gels seem to provoke skin irritation more often than retinoin creams [3].

Topical retinoids may be absorbed in the body. Therefore it may cause side effects due to excessive vitamin A (specifically retinoid) intake (hypervitaminosis). Especially for those who take vitamin supplements.

Another possible side effect is damage to unborn children (teratogenicity). So pregnant women should steer clear of retinoic acid.

Because of these possible complications and the absence of sufficient research data some experts do not recommend the use of topical retinoic acid on scars.

Conclusion
I would personally opt for silicones because these have no side effects. In case silicone sheeting doesn’t catch on I would possibly consult my doctor about retinoic acid treatment for scars. Although I think steroid injections would be a more appropriate next step.

Maybe prolonged use of an retinyl palmitate or retinol cream could help fade scars. Since these creams are rather safe to use and easy to obtain (I would advice to always start moderately with new skin care products to monitor the results) such creams may offer a valuable addition in case other treatments don’t work.

Read more about the topical use of retinol creams on scars.

[1] Janssen de Limpens AMP: The local treatment of hypertrophic scars and keloids with topical retinoic acid. Br J Dermatol 103:319, 1980

[3] Hogan DJ: Scarring following inappropriate use of 0.05% tretoin gel. J Am Acad Dermatol 17:1056, 1987

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

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.

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.