The are a couple of things I adhere to in order to reduce scarring. Sometimes scarring is hard to avoid when the person’s genetics are predisposing them to scarring. But we take every effort to reduce scarring. First we try to avoid tension to the skin closure. This is done by decreasing the tension on the surface by cinching the deeper structures together. Usually the goal is to have the skin be a little puckered in the above the rest of the areas. This reduces tension the part of the incision that is most seen on the surface. We also take face sutures out at 5-6 days and eye sutures out sometimes a little earlier depending on what I’m trying to accomplish. The average is usually 7 days. The reason why this is important is that the longer you leave the sutures in, the more train tracking or marks are left on the surface which can lead to more scarring and more marks on the skin indicating that an incision was made previously. So I err on the earlier side at 5-6 days.
We also use monofiliment sutures, like 5-0 and 6-0 prolene. Monofiliment (sutures like nylon, ethilon, etc), means that the sutures is made out of one strand of suture material. Polyfilament means that the sutures is made out of more than one strand. When the suture is made out of more than one strand, the is an increase in the interstitial spaces between the strands. This allows bacteria to hide from our white infection fighting cells and the results can be infection, more inflammation, and ultimately more scarring. Prolene is not absorbed by the body and needs to be taken out. It creates less inflammation than absorbable sutures (like vicryl, fast absorbing gut, chromic gut, biosyn, polysorb, etc) and thus can avoid more scarring. There are many studies that support this notion on a clinical level (on the level of patient outcomes). Here is a video on Scar Revision.
These same principles are what I do for Scar Revision and scar improvement procedures.
Thanks for reading, Dr Young
Dr Young specializes in Facial Cosmetic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington