Facial Plastic Surgeon Reveals How to Minimize Scarring

"How do I prevent scarring after getting a cut, scrape, or after getting sutures in the emergency room?"

I get this question from a friend or family member on a weekly basis.

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The bad news is that two of the biggest factors that determine how badly you will scar are the degree of the injury itself (how damaging was it) and your skin type/genetics. Unfortunately, those two items are beyond your control.

0:58 You can't control the degree of injury
1:23 Your genetics affect how you scar
1:41 Clean the wound
2:10 Ensure you're up-to-date with your tetanus shot
2:44 Does the wound require stitches?
3:14 Stitches vs glue vs tape
4:32 Healing with stitches
4:50 Use peroxide to clean "weeping" and "crusting"
5:38 Cover the wound with non-antibiotic cream
6:35 How long do the stitches stay in?
8:09 Icing the area
8:50 New scars are pink and stiff. This is ok!
9:29 Use silicone sheets or gel to reduce scars
10:46 Laser resurfacing can sometimes improve appearance
11:24 Surgical scar revision
12:44 ER or wait for a plastic surgeon?

1) Dirty wounds must be thoroughly irrigated and cleaned and may require antibiotics to prevent infection. A tetanus booster is also a consideration if you can't clearly remember the last time you had one. Tetanus kills, and boosters are cheap insurance.

2) It is better to be examined and treated early, and have any areas that need sutures closed, as soon as possible. Do not wait to find a plastic surgeon days later - your final outcome has the best chances of looking good if repaired early. Yes, even by the emergency room doctor! Of course, if there is a plastic surgeon on call to the emergency room, that is the best-case scenario.

3) If the wound goes "all the way through" the skin into the fat/tissue beneath, it will need to be closed in layers. Dermabond ("glue") and/or Steristrips ("butterfly tapes") can close the surface of the skin and hold it together, but there would still be a separation in the deep layers of the skin or subcutaneous tissues. That separation increases the risk of a depressed, widened, or hypertrophic scar long term. There is NO substitute for properly performed layered sutures.

4) Cuts and scrapes heal best in a moist environment, free from excess scabbing. I usually recommend gently cleaning sutures with a peroxide-soaked q tip 3-4 times per day, only for the first 3-4 days. The peroxide gently dissolves crusting and dried blood that forms around fresh sutures. There is no need for peroxide after the first 3-4 days. Excessive cleaning (more than 3-4 times per day, or longer than 3-4 days) does more harm than good. In most cases, it is safe to shower 24 hours after sutures.

5) The clean sutures, and any scrapes/abraded areas that did not require sutures, should be kept constantly coated with a layer of NON-antibiotic ointment. I prefer Vaniply ointment, but Aquaphor ointment and Vaseline are good alternatives. All are over-the-counter. If you feel that you must use an antibiotic, plain bacitracin is the best choice. Neosporin, triple antibiotic ointment, or any other neomycin-containing products often sensitize the skin and do more harm than good due to dermatitis.

6) Icing and elevation can help minimize bruising and swelling, but you must be careful not to give yourself frostbite! Make sure not to put the ice pack in direct contact with your skin - use a towel as a buffer - and only ice for 20 minutes at a time, taking 20-minute breaks in between.

7) Optimal suture removal timings vary - face is usually 5-7 days, and body maybe 7-14 days. In general, the thinner the skin, the sooner sutures should be removed. I usually like to remove even "dissolvable" sutures at these times to minimize inflammation. Abraded/scraped areas that are not sutured, but kept moist with ointment, will usually heal up with new skin in these same time windows.

8) Once sutures are out or scrapes have healed, it is common that the affected skin is pink and stiff. I believe silicone ointments are much more effective than Mederma in helping the scars fade. Sunscreen and sun avoidance is also important. Dr. Nayak's own formulated scar gel, Advanced Medical Silicone Scar Gel, available without a prescription here (https://www.dermspastore.com/products..., is proven to improve the color, texture, and overall appearance of scars from surgery, injury, c-sections, cosmetic procedures, burns, or acne. Advanced Medical Silicone Scar Gel does not contain sunscreen.

9) It can sometimes be helpful to treat healing scars with a laser at 4-8 weeks. Surgical revision is usually not possible or prudent until 6-12 months after the injury when the tissues have relaxed and the scar has softened.

10) Final results take 1-2 years, and any residual scar will continue to improve slowly for many more years to come.