Scar Management ( General Links )
http://www.makemeheal.com/mmh/product/s ... ?procid=42
http://www.breasthealthonline.org/cgi-b ... ?tid=46478
And to quote a medical review, "Nutritional cofactors play a major role in the wound-healing process. Deficiencies of specific nutrients, especially proteins, vitamins, and minerals, may significantly impair the healing process. The recognition of deficits and understanding of methods of repletion are a critical part of modern surgical practice."
Will update this list as I source more information
To summarise on Scar treatment , I break the scar treatment phase into three phases. Preliminary Phase, Re-modeling Phase, Terminal Phase. Please avoid scar treatment until Preliminary Phase. Before the preliminary phase, there is not even a scar. It is a WOUND and silicone gel, mederma and other ointments even aloe vera should not touch it!
Preliminary Phase : Scar tissue is weak and require support. Wound has recovered, and is probably 2 weeks after. Dr pat recommend apply silicone gel only 2 weeks after wound closure.
Possibilities : Silicone gel/sheeting
Those that do not most likely not work and may worsen : Vit E, Vit C, Aloe Vera, Honey, Various scar gels which contain harsh agents which damange the skin, AHA, etc.
Re-modeling Phase : Its been a few months and scar tissue is at maximum tensile strength ( 4 months
for max tensile strength I read ). But to be on kiasu side, I would wait a few months before commencing aggressive therapy to destroy the scar and re-model it.
Possibilities ( supportive ) : Silicone gel/sheeting
Possibilities ( aggressive ) : see doctor if recommend aggressive treatment methods, which may destroy scar integrity and make scar worse. they are : laser, microderma, dermabrasion, scar revision.
Terminal Phase : Terminal phase is generally not reached until 1-2 years after wound closure.
Possiblities : Continue silicone gel and hope it works though chances are very low already, Scar revision surgery, Laser, Microderma, Dermabrasion, IPL, and what not. Scar almost resembles your natural skin.
A. Silicone Scar Gels or Silicone Scar Sheets
Silicone Scar Gel has been clinically proven in many studies to work and many dermatologists claim it works ( 76% ). Silicone scar sheets have been clinically proven to reduce formation of hypertrophic scars. The way it works is unknown.. Using dermatix I have noticed improvement in scar pain ( from abit of pain to none at all, to some pain when I stop putting the gel, however I use it only once daily instead of twice as reco, will use it twice ), and I have noticed improvement slightly in flatness of scar. However scar is still red. Though it has become less red.
- Dermatix ( Using it currently, can't live without it, helps to moisturise scar greatly)
* recommended by singapore plastic surgeon.
http://www.telegraph.co.uk/health/33201 ... ction.html
http://www.primexpharma.com/pdf/product ... -study.pdf
http://www.ncbi.nlm.nih.gov/pubmed/1770 ... d_RVDocSum
http://www.ncbi.nlm.nih.gov/pubmed/1675 ... d_RVDocSum
http://www.ncbi.nlm.nih.gov/pubmed/1796 ... rom=pubmed
http://www.ncbi.nlm.nih.gov/pubmed/1827 ... rom=pubmed
B. Laser / IPL
Ablative and non-ablative lasers are available for laser revision. In my experience, tokai clinic did laser revision for me. Its very painful and can feel the laser cut through and burn the skin together with burnt smell. However after the scab drops off ( about 1 week ) it orms a new layer of skin which contains a much better scar than before.. Around 50% improvement. I think with repeated laser-ing it can become totally gone.
I think it is useful for scars which are slightly pitted like my alarplasty scar where the line of incision is visible, however it does cause redness which has persisted until now.
More info about laser : http://www.medscape.com/viewarticle/467347
Even more from med site , a review of Laser techniques by Lupton & Alster : "A variety of lasers can be used to treat scars and striae effectively. It is of paramount importance that the type of scar be properly classified on initial examination so that the most appropriate method of treatment can be chosen. Classification also allows the laser surgeon to discuss with the patient the anticipated response to treatment. The 585-nm pulsed dye laser (PDL) is the most appropriate system for treating hypertrophic scars, keloids, erythematous scars, and striae. The PDL carries a low risk of side effects and complications when operated at appropriate treatment parameters and time intervals. Atrophic scars are best treated with ablative CO2 and Er:YAG lasers; however, proliferative keloids and hypertrophic scars should not be vaporized because of the high risk of scar recurrence or progression. The appropriate choice and use of lasers can significantly improve most scars. As research in laser-skin interaction continues, further refinements in laser technology coupled with the addition of alternate treatment procedures will allow improved clinical efficacy and predictability."
Btw, IPL has also been found to work ( 92% report significant imporvement )
C. Mederma Ointment
I am currently using Mederma for my chin implant scar, and I will update if it works. Could the +ve reviews be due to massage effect or maybe placebo effect? Needs to be applied 3-4 times a day. And could it also be due to natural healing process? Clinical Studies have shown that it doesn't really work. If at all.
http://www.epinions.com/review/Mederma_ ... 3160-prod4
http://www.essentialdayspa.com/forum/vi ... p?tid=7580
http://www.makemeheal.com/mmh/product.d ... &catid=543
However, there is one supportive medical study :
http://www.ncbi.nlm.nih.gov/pubmed/1848 ... d_RVDocSum
"The surgical sites were allowed to heal for 2 to 3 weeks, at which time the subjects returned to the research center for randomization to either the onion gel treatment group or the no-treatment group. Forty-seven subjects in the active treatment group were further randomized as to the site of study product application. Thirteen control subjects applied nothing to either side."
"The study showed that the onion extract gel significantly improved scar softness, redness, texture, and global appearance at the excision site at study weeks 4, 6, and 10 as assessed by the blinded investigator."
D. Vit E cream
Do not apply this in the first few weeks of wound closure because it may cause wound to re-open or scar tension to be less.. Caution!.
Recent studies have found it makes scar worse.
http://www.oohoi.com/healthy_living/vit ... -cream.htm
http://altmedicine.about.com/od/qalibra ... yscars.htm
E. Vit C cream
http://www.environ.co.za/contents/artic ... amin_c.htm
Never heard much about Vit C Cream. Any inputs
F. SPF 50 Sunblock when in Sun
Scar tissue is more pigmented and fragile than normal tissue and thus can get sun damage. Sun damange can potentially worsen scars.
G. Steroid Creams
Dr pat recommended use of this to reduce scar redness. specific brand reco was bentovoate. What I read is that all it does is relieve redness and itch, it does not improve the underlying cause, so I shall stick to silicone gel.
http://www.netdoctor.co.uk/skin_hair/ec ... 003762.htm
http://uk.answers.yahoo.com/question/in ... 557AAQSEv9
H. Scar Revision Surgery
For major hypertrophic / keloid scars, the scar tissue is removed and a better incision is approximated and sutured back. Also incision location may be altered, and various plastic surgical techniques are used to improve scar outcome.
http://www.nlm.nih.gov/medlineplus/ency ... 002991.htm