Q: Dr. Eppley, I just got stitches above my top lip. The stitches go across the ridges under my nose. I’m so worried it’s going to leave a ugly scar. My dog jumped on the couch and his hind foot landed on my face. He felt like he was losing his balance and used his claws and that is how I got the cut in my face. The ER doctor did a good job on stitching up the cut. The cut goes from my lip to my nose. What can be done to keep the scarring down?
A: What you want to do to get the best lip scar result is the following. First, get the lip sutures removed in no more than 5 to 7 days after surgery. I don’t know if the doctor used a layered closure or what size the skin sutures are. If there is no dermal buried sutures below the skin sutures, then have a glue dressing (e.g., Dermabond, Indermil) applied once the sutures are removed. Second, beginning three weeks after surgery begin to apply a topical scar treatment twice a day. There are many type of scar gels and strips but on the lip a scar gel is far more practical. Continue twice a day scar gel application until three months after the injury. At three months after injury it is time to evaluate the scar. If it is quite narrow and flat and the redness is fading fast then I would only consider scar gel for another month. If the scar is fairly narrow and flat but still very red, then I would do BBL (broad band light) therapy to work out some of the redness sooner. If the scar is irregular in contour or slightly wide then I would have some fractional laser resurfacing done to even it out. Only if the scar edges are widely separated and irregular would actual surgical scar revision be necessary. Expect the final scar result to take a full 9 to 12 months until the final and best scar outcome is seen.
Dr. Barry Eppley
Q: Dr. Eppley, do you have any recommendations for topical ointments for my forehead laceration which was fixed about a month ago to help with the scar. Which are the best on the market? Do you have any knowledge or recommendations of using supplements like enzymes and vitamins to help reduce the scarring? I have read serraptase like in Vitalzym helps break up and remove scar tissue and was thinking of trying it. I’m trying to do anything I can to reduce it. Thanks very much for your time and advice!
A:I don’t think there are any magical scar creams, lotions or potions…despite how they are marketed and promoted. I also don’t think there are any vitamins and enzymes that help scarring either. While you can use any or all of them, they are as much psychotherapy as anything else for the typical non-problematic scar or surgical incision. This is not what most patients want to hear as understandably everyone wants to do the most they can for their scar. Time will create as much improvement as anything else. I think if it makes you feel better to use them then you should. There are other early scar treatments to consider, such as fractional laser resurfacing and broad band light therapies, that may have more profound effects than topically applied creams and ointments. This should not be construed to imply that the treatment of known problematic scars, or those that might potentially become so, will not respond well to the use of silicone gel sheeting and topical silicone gels and oils. But whether these are of benefit in many lacerations and wounds that might otherwise do well on their own is a matter of debate.
Dr. Barry Eppley