Nobody leaves this world without a scar, without a scar on the skin.
All patients undergoing surgery with an incision on the skin will end up with a scar. There is no such thing as scarless incision.
A skin scar forms after a wound on the skin is caused by trauma or created by the surgeon. Skin scar is a form of wound healing.
There are three outcomes of wound healing after surgery with a linear skin incision:
- Normal scar formation – a linear scar that is flat and pale in color or almost blending with the surrounding skin.
- Hypertrophic scar – a scar raised above the skin level that stays within the confines of the original wound.
- Keloid – a scar raised above skin level that proliferates beyond the confines of the original wound.
Normal Scar Formation – flat and pale in color scar
Hypertrophic scar on some segment of the scar (left side of the picture)
Keloid on the upper chest; hypertrophic or beginning keloid on the lower scar.
What factors affect the outcome of wound healing, whether there will be a normal scar formation, hypertrophic scar, or keloid?
- Status of the wound at the time of wounding or surgery such as whether it was a dirty wound, linear, ruggedly lacerated, or big gaping wound, etc.
- How the wound was treated by the physician or surgeon
The physician or surgeon can only do so much in promoting a normal scar formation such as:
- Close wound by primary intention if possible
- Close wound without tension
- Close wound with proper apposition of skin edges
- Use of proper sutures
To use or not to use topical scar reduction medication after surgery:
Determine the risk for hypertrophic scars and keloid
High risk – past history of hypertrophic scars and keloids; location of the wound if in areas where hypertrophic scars and keloid is frequent
If high risk – try topical scar reduction medication after wound is covered completely with skin, usually after 2 months.
If not high risk – observe wound. At the first sign of hypertrophic scarring, try topical scar reduction medication.
The topical scar reduction medication that can be used are the following:
- Hiruscar gel
- Hirudoid cream
- Contractubex gel
- Dermatix Ultra gel
- Silicone gel sheet
At the moment, there is no good research that shows superiority of one medication over the other. (will do a research on this)
Cebo de Macho is popular in the Philippines. However, there are no research on its true effectiveness.