Scars 101: An Interview with Dr. Megan Jack, MD Part One

Happy Monday!! I hope everyone had a wonderful weekend! It’s Scar Week at The Skincare Belle!!! Today I am so excited to share everything you need to know about scars from board certified plastic surgeon Dr. Megan Jack, MD! Dr. Jack practices in sunny and warm Boca Raton, FL, and sees many patients for scar revision surgeries as well as topical scar treatments! She is a wealth of knowledge, and today we are going to go over the basics. Later in the week we will cover types of scars, and on Saturday we will go over the different treatments and interventions available if you aren’t happy with your scar!

Ashli: “So, I have my whole list of questions for you such as what are scars? How do they form? What are some different types of scars? Who is a candidate for scar revision, and how long after a surgery can it be done? I would love to give you the floor and let you tell me!”

Dr. Jack: “Okay, great! Well, to start off, I’ll say this. One thing that I often asked when people come into the office is this question about scars: “I’m not going to have a scar, right?” People oftentimes assume that just because they are seeing a plastic surgeon for a surgery means they’re not going to have a scar. For those of us in the medical community, we know that’s simply not the case and that it’s sort of a myth. Unfortunately, scarring is how the body heals anytime there’s an injury or some sort of trauma to the skin. So, there’s really nothing that you can do to not have a scar or to make it ‘disappear’. The optimal situation then is to make an imperceptible or minimally visible scar. So really the goal when people come to see a plastic surgeon is to put things back together in a fashion that will hide the scars as well as possible, or make it as pretty as possible.”

SKB: “Right!”

DJ: “So, for a plastic surgeon like myself that’s why it’s very important that when we’re planning certain surgical procedures that part of that planning process is planning where the scar’s going to go. That’s a really important part of what we do. There’s certain things that we can do to help hide them a little bit such as within skin folds or natural creases and things like that. When people are initially thinking about having  surgery, a discussion with your surgeon about what they can expect for their scar is really really important. The last thing you want to do is have a surprise after a surgery when you’re trying to recover.

So, when I have conversations with patients that’s one of the topics that we cover in detail: What’s it going to look like, how’s it going to heal, what’s the normal healing process and how does that go? When your body heals after having either surgery or an injury, its’ normal response is to try to heal the tissue so it grows new blood vessels to the area, and then it re-builds some of the natural skin structures such as collagen and elastin. There are specific cells in the skin that have that job.

The normal healing process is that initially, scars or incisions, or repairs will look great, and then the stitches will come out or dissolve, and then the scars will look pink! And that’s a normal part of the healing process, and that’s just the new blood vessels trying to heal that tissue that’s been injured.”

SKB: “Okay! So phase one of healing…”

DJ: “Yes. Normal scars are going to take about 6-12 months to fully mature. Scar maturation means softening, fading, and flattening out. Early on, people can expect that the scar is going to feel thick; it might have some discoloration; most of the time it’s going to be pink and it sometimes can be a little raised- not always- but sometimes it can be a little raised. And then as time goes on the scar will flatten out, it softens up and then it should fade.

Occasionally, people will get hyper pigmentation where you actually have darkening of the skin or the scar itself, and there’s certain populations that are at a higher risk of something like that happening-most often people who have more pigment in their skin naturally, people with darker Fitzpatrick Skin Types are going to be at an increased risk for hyper-pigmentation. Some people will have a scar that will stay pink or red for longer than you would think. People who tend to do that are those that are naturally quite pale that have that natural rosiness to their skin such as people who have rosacea, people who have really blonde hair, red-heads- those people tend to stay a little pink longer than you would think. Their scar maturation process is a little slower.

Also, it just takes time for things to look better. It will look worse before it looks better and that’s what I tend to tell people.”

SKB: “That’s really good to know!”

DJ: “Typically I will tell patients that going to a plastic surgeon is not a guarantee but it certainly will help to minimize scarring, and we’ll do our job to the best of our ability, but then the rest of it is up to them- how their body heals- and then also how they take care of the scar. We do our job but then the patients have a job afterwards to really take care of the site as well.

Some things that I typically tell people to do to help take care of their scars are: 1. Be patient. It takes time for your body to heal. 2. Be diligent with following their surgeon’s instructions. Every surgeon may have different instructions on how they want people to take care of their scars. I put my patients on a scar care program, which includes things like:

  • Massaging the scar several times per day.
  • Protecting it from the sun-that’s a big one because when people put fresh scars out into the sun that pink or that hyper-pigmentation is going to be more prominent and it’s going to last longer. It’s just overall not good for healing. The sun damages our skin and our skin is trying to repair itself- so we don’t want sun exposure. Wearing sunscreen every day on the scar whether or not we’re getting direct sun exposure is important.
  • Taping– I really love taping and I think it works really well to take tension off of that skin while it’s in that healing process to keep the scar nice and tight and flat. I recommend Micropore tape from 3M because it’s inexpensive and effective. It also comes in a tan color which makes it more imperceptible. I ask people to change the tape every 3-4 days and continue taping for the first 6 months after surgery if possible. Another option is silicone tape or strips, which is especially good for people at risk for hypertrophic or keloid scars.
  • I also like topical scar treatments– especially silicone based creams. There are over the counter ones and then there’s medical grade ones that you can get. I like things like BioCorneum which is a good medical grade one that has sunscreen built in. You can also get some that are called ScarGuard and KeloCote,-silicone being the main ingredient-so those are going to be your top ones. There’s also other more natural things you can do that also work very very well for people who like a more natural approach, and that’s going to be things like Emu Oil, Coconut Oil, or Cocoa Butter and things like that. People ask me a lot about BioOil- BioOil’s fine- as long as you’re getting some sort of topical treatment and you’re actually massaging it in, that’s going to be helpful. Obviously, you have to be careful of allergic reactions and so if you notice that you might want to back off and talk to you doctor about it.
  • Another thing I like to offer are laser treatments and those vary depending on what the issue is with the scar such as IPL that helps treat discoloration, to fractional treatments with lasers to help speed along the maturation process a little bit.”

Join us on Friday about the different types of scars! Stay beautiful, Dr. Megan Jack, MD

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