There are four phases of wound healing. First is hemostasis, or bleeding. Then inflammation. Then wound proliferation – a.k.a creating the new scar. Then tissue remodelling. This stage is where you can intervene and make a difference. “After the first week of healing, and for the next three to six months, you can make a difference to the scar’s remodelling process and visibility,” says Xing. “After that, the scar is fixed in place.”
Of course, how you got the wound matters in treatment. “Generally speaking, surgical wounds tend to be closed wounds where the skin is sutured together and not exposed to the environment,” says Xing. “Open wounds like cuts, abrasions and burns have a higher chance of infection, so it’s important to clean and disinfect well after the injury occurs.” For both types of wounds, the general rules of wound care would apply. “It’s important to keep the wound moist, change dressings regularly, and use a silicone-based scar ointment once the wound is healed to reduce scarring.”
I believe I am not alone as part of a generation that absorbed the old wives’ tale that you should let a wound “air out.” Xing explains why this is not the right decision. “A lot of people associate letting the wound air out as being better. That is a much older school of thought. Optimally, you should keep it moist, not wet, and not too dry,” she says. “It shouldn’t be weepy. It should also not be scabbed over. Dry cells are not happy, and cannot deposit new scar tissue. A dry scab is actually worse for the final scar result.” Protect it from the sun and keep it covered at night, away from contaminated household items such as your sheets, pillows and clothing.
Once initial healing has completed, Xing recommends a thin layer of Vaseline, or a product such as V-Stat, which was developed by Canadian company Vivier to help with post-surgical scar healing. “The star ingredient is silicone, which helps keep proper moisture and growth factors to facilitate cells to heal properly.” Xing advises patients with facial skin cancer surgeries to use V-Stat, but says it can also be used on household wounds.
Richly pigmented skin is more prone to keloid formation and hyperpigmentation, she says, while lighter skin tones are at less risk. “This is why when it comes to lasers or other cosmetic treatments for scars, the setting and protocol must be customized to the skin type of the patient.”
Keloid scars, she explains, “are thick, raised scars that grow beyond the wound’s edges due to excessive collagen production.” To try to help the scar stay flatter, she recommends a silicone ointment or silicone sheets be placed on the scar. It also matters where the scar is located, Xing says. “For scars that are located over high-tension areas like the shoulder or back, try to avoid doing activities or exercises that would stretch the area for the first 1-2 months as the wound heals. If the scar starts forming bumpy ridges, it’s important to see a dermatologist early on to receive medical treatments like intralesional steroid injections to suppress further scar formation.”
So, great, turns out we can work on minimizing scars for our future selves. But what about the ones I already have that bug me so much? “For older scars, it depends what it looks like and how severe it is to determine whether we can do textural resurfacing,” says Xing. The only option is lasers, which are indeed amazing these days. For some things. “If there is too much redness,” she says, “we can use a vascular laser.” For dark brown scars, she can do chemical peels with a targeted laser.
Unfortunately, the kind of white scars I have are the hardest ones to fix. “In a place such as the forearm, where sun damage tends to happen frequently, you have two different pigmentation issues. Lasers can reduce over-pigmentation from sun damage. But to treat the white scars, you would have to do a different process. There are some topical medical grade treatments to add colour back into the scar, but there is no guarantee of success.
All scars are permanent, says Xing. “But if you work with a dermatologist, you can get it to a point where you can’t see it at a distance.” Tell that to the woman at the cash register yesterday who asked if I was a pro chef, pointing to the scars on my arms. “No,” I said. “Just a particularly clumsy home cook.” But at least now I know how to keep those scars from having more company.
Always asking questions,
—Leanne Delap
