Massaging in silicone serums or applying silicone strips about four to six weeks after surgery can also help normalization of scar formation. “Silicone strips create a liquid barrier to promote hydration,” she says Suma MaddoxMD, Board Certified Plastic Surgeon in New Orleans. “They also relieve tension and if there’s enough pressure, they can minimize vascularity [presence of blood vessels] on the scar, which will reduce redness and itching and regulate collagen production.” Scar massage works on a similar principle, he tells me: “You press deeply on the scar until you see blanching or whiteness—hold, then release. This reduces vascularity and helps soften the scar.”
Strict sun avoidance and protection is also vital, as UV rays worsen scars, turning them pinkish-purple, says Dr Maddox. They also cause the breakdown of collagen, which is so critical to the healing process and is often lacking in GLP-1 users. If an incision appears dark, doctors may prescribe a whitening cream to slow and lighten the discoloration.
Six weeks is usually when doctors start offering laser treatment for scars. Pulsed dye lasers (like the VBeam) target blood vessels to eliminate redness. Fractional lasers, including CO2 versions, can help flatten raised scars, as can heatless microneedling tools such as SkinPen. “The data show that the earlier the scar intervention, the better the clinical outcome,” he says. Matthew AbrahamMD, Board Certified Dermatologist in Boston.
Only go to a board-certified plastic surgeon or dermatologist for this type of treatment, however: Overstimulating the scar, with lasers that are too aggressive, can have the opposite effect, causing it to lift or abnormally grow into a larger, tighter keloid. “Generally speaking, to prevent over-activation of a scar, we do less aggressive laser treatments,” says Dr. Abram. With fractional devices, this means adjusting the settings for lower energy and lower density. (Density refers to the percentage of skin that is targeted.)
If a scar is thick and lumpy to begin with, certain medications may help thin it out. “We can throw in kenalog, a steroid that reduces inflammation, after we do the fractional treatment to help thin the scar,” says Dr. Abram. (Fractional lasers open holes in the skin, creating channels through which drugs can penetrate.) He believes this method of laser-assisted drug delivery is safer and more effective than steroid injections, which can thin the skin too much, even compress the scar and promote broken blood vessels. Some doctors take a similar approach with a drug called 5-fluorouracil (5-FU), which subdues collagen-producing fibroblast cells “to get a scar to proliferate less,” he adds.
If a patient has a history of keloids, plastic surgeons may recommend superficial radiotherapy (one to three sessions) immediately after surgery. (Dr. Nwubah says, contrary to popular belief, she does not see an increased incidence of keloids in patients of color, specifically.) This targeted type of radiation “doesn’t penetrate deep into the organs,” Dr. Nwubah says. Nwubah. Instead, it “simply hits the skin cells to stop the exuberant healing response.” (As an additional prophylactic measure, Dr. Nwubah may inject steroids along the incision, during the procedure, just prior to closure.)
