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Scars are an inevitable consequence of any elective surgical incision or traumatic injury. It is never a question of whether a scar will form, it is merely a question of how noticeable it will be. The natural history of scar healing is that the majority will improve over time, changing in color from red to white. Some scars, however, will get worse with time becoming wider, raised and evening worsening in color. Some scar worsening is predictable based on the nature of the injury (e.g., burns), its location on the face or the body and the patient’s skin type and degree of pigmentation.

The natural healing process in scars is done through the production of collagen. Collagen is made by the wound edges to fill in and close the gap in the wound. Collagen is a tough fiber-like protein that comprises a greater percent of scar tissue than it does in normal skin. The collagen fibers in scar tissue in addition to being more abundant are also irregularly arranged. This is why scar tissue feels more firm and inflexible than normal skin does as well as discolored or even raised. All of these factors combined contribute to what makes a scar visible and the degree to which it is so.

Despite the natural healing process, the outcome of scars can be managed in some cases by various topical therapies. Prevention or improving adverse scar formation can be challenging as not every phase of the process can be completely controlled. This has led to a wide variety of scar management strategies from topical to invasive therapies. But the prevention of adverse scar formation is preferred and the most accepted non-invasive approach is through the use of topical silicone.

There is substantial documentation that topical silicone has a favorable outcome on a scar’s appearance. This has consisted of either the application of a thin layer of silicone gel or the use of silicone gel sheeting. Its application should be done within a few weeks after the incision or laeration is made and to be used for up to three months of daily use. How the silicone favorably influences scar tissue is not fully understood. Multiple theories have been proposed including occlusion, hydration, pressure, oxygen tension and even static electricity mechanisms. But the most accepted belief is that it acts simply as a moisture barrier that keeps the scar’s surface hydrated.

The optimal topical scar treatment approach is a combination of both a gel and gel sheeting. The gel can be used during the day when the scar may be visible and the silicone sheets at night. In more hidden scars, such as the breasts, abdomen and arms, the gel sheets can be used exclusively. During the healing phase of new scars, gel sheets add an additional layer of protection. They appear to exert their effects very much like an occlusive bandage, providing surface support and reducing water loss from the scar’s surface.

Why is scar hydration or good moisture levels important? Keeping the protected and preventing evaporative water loss appears to reduce surface tension across the scar’s surface and deeper into the scar. Tension across scars, including surface tension, may prolong the inflammatory process and lead to stretched or hypertrophic scar appearances. Any method or prevention may avert poor scar outcomes and the potential for scar revision later.

Dr. Barry Eppley

Indianapolis, Indiana

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