What is the best way to prevent scars?

Best Methods to Prevent Scarring

The most effective approach to prevent scarring is early application of silicone gel sheeting or silicone gel to the wound after epithelialization, combined with proper wound care techniques. 1, 2

Understanding Scar Formation

Scarring occurs as part of the natural wound healing process, but excessive scarring can lead to hypertrophic scars or keloids, causing both functional and aesthetic concerns. Prevention is significantly more effective than treating established scars.

Prevention Strategies by Wound Stage

Immediate Wound Care

• Keep the wound clean by gently irrigating with sterile water or saline 3
• Apply a greasy emollient (50% white soft paraffin with 50% liquid paraffin) to maintain moisture 3
• Avoid preparations containing sensitizers or irritants that could worsen inflammation
• For open wounds, decompress blisters by piercing and draining fluid while leaving the epidermis in place as a biological dressing 3

After Epithelialization (Most Critical Phase)

1. Silicone-Based Products (First-line therapy)

   • Apply silicone gel sheeting or silicone gel to the healed wound 1, 2
   • Begin application immediately after epithelialization 4
   • Continue application for at least 12-24 weeks 2
   • Mechanism: Creates optimal hydration environment and reduces excessive collagen production

2. Topical Corticosteroids (For high-risk areas)

   • Consider intralesional triamcinolone acetonide (10-40 mg/mL) for areas prone to keloid formation 5
   • Particularly important for high-risk individuals (darker skin types, family history of keloids)

3. Pressure Therapy

   • Useful for areas where pressure can be consistently applied
   • Most effective when combined with silicone products 5

Special Considerations for Different Wound Types

Surgical Wounds

• Apply silicone gel sheeting immediately after suture removal 4
• Studies show significant reduction in hypertrophic scarring when silicone is applied early (RR 0.46,95% CI 0.21 to 0.98) 1

Facial Wounds

• Use silicone gel rather than sheeting for better cosmesis and adherence
• Consider gentle cryotherapy for early signs of hypertrophic scarring 3
• Avoid aggressive treatments that may cause additional scarring 3

Ear Piercings and Body Modifications

• Individuals with history of keloids should avoid ear piercing or other body modifications 5
• If performed, immediate prophylactic measures such as pressure, silicone, or triamcinolone should be considered 5

Burns and Extensive Wounds

• For larger wounds, consider consultation with wound care specialists or burn units 3
• May benefit from more aggressive early intervention with combination therapy 3

Combination Approaches for Enhanced Prevention

For high-risk individuals or areas prone to problematic scarring:

• Silicone products + topical retinoids have shown comparable efficacy 6
• Silicone gel + intralesional steroids for areas showing early signs of hypertrophic scarring 5

Monitoring and Adjusting Treatment

• Assess the wound/scar every 4 weeks during treatment 6
• Watch for early signs of hypertrophic scarring (redness, raised appearance, itching)
• If signs of abnormal scarring develop, intensify treatment with combination therapy

Common Pitfalls to Avoid

1. Delayed intervention - Starting scar prevention too late after epithelialization significantly reduces effectiveness
2. Inconsistent application - Silicone products must be used consistently (12-24 hours daily) for optimal results
3. Premature discontinuation - Continue treatment for at least 3-6 months for optimal outcomes
4. Aggressive mechanical trauma - Avoid friction, stretching, or trauma to healing wounds
5. Ignoring high-risk factors - Patients with darker skin types, previous keloids, or family history need more aggressive prevention

Evidence Quality Considerations

The evidence supporting silicone products for scar prevention is moderate quality, with some limitations in study design. However, silicone gel sheeting and silicone gel consistently demonstrate benefit across multiple studies 1, 2, 6, 7 and represent the current standard of care for scar prevention.