Scar Care

All scars are pink and firm at first. Over time, they become softer and lighter in color. This process can take 6 months to 2 years. For some, a scar will continue to improve for even longer.

How a scar changes over time is different for everyone. Some people have more scarring than others. This is related to skin type, how the skin heals, location of the scar, and even genetic predisposition. There are several things you can do to help your child have the best scar possible. Check with your child’s healthcare provider first before putting any type of gel, cream, or ointment on your child.

Scars should be carefully protected from the sun for at least 1 year after surgery or injury. Sun exposure can darken scars permanently, making them more noticeable.

After about 2 weeks of healing, you can start applying sunscreen over your child’s scar. Apply sunscreen in every season, not just in the summer. Sunscreens contain substances that stop harmful ultraviolet (UV) light from damaging the skin.

You can also use clothing or Band-Aids to protect the scar from the sun.

• Sunscreens come in many forms, like lotions, creams, sticks, lip balms and sprays. Avoid spray sunsceens becuase they can be dangerous if inhaled or swallowed.
• Look for an SPF (Sun Protection Factor) number on the label. Choose a sunscreen with a SPF of 30 to 50.
• The sunscreen label should also say that it is a “broad spectrum” sunscreen, or that it protects against both UVA and UVB rays. Look for sunscreens that have zinc oxide, titanium dioxide, Parsol 1789 (avobenzene), or Meroxyl SX in the ingredient list. Avoid sunscreens with oxybenzone or vitamin A.
• Avoid sunscreens with insect repellent because insect repellent should not be applied as often as sunscreen.
• For babies and children with sensitive skin, use a sunscreen containing zinc oxide or titanium dioxide.
• You can browse sunscreen ratings on the Environmental Working Group website: ewg.org.

• Put sunscreen on 20 to 30 minutes before going outside. Use a generous amount, about the size of a golf ball for the whole body. Reapply it at least every 2 hours, and after being in the water or sweating heavily. Use “water-resistant” sunscreen for water activities and reapply it every 40 to 80 minutes.
• Avoid direct sun exposure between 11 a.m. and 3 p.m. The sun is strongest during these times. Sun is also more intense at high altitudes or closer to the equator, such as in Colorado or Hawaii.
• Use sun protection even on cloudy days, as clouds and smog do not fully block UVA and UVB light.
• Be careful when near sand, water, snow, and cement because they reflect the sun’s rays and increase your sun exposure.

Applying silicone to your scar may help its appearance. Silicone comes in 2 forms: silicone sheeting and liquid silicone gel.

You can buy silicone gel or sheets in stores and online. It does not require a prescription from your healthcare provider. Silicone is available from many brands including ScarFade, ScarAway, as well as generic brands. Choose a product where the primary ingredient is silicone.

Silicone does not give any sun protection. For sun protection, look for silicone sheeting that has a backing you cannot see through, or cover the silicone with a Band-Aid or tape.

You can apply liquid silicone gel over sunscreen. Apply the sunscreen first, rub it in and let it get absorbed into the skin for a few minutes. Then apply the silicone gel. 

If using silicone, it should be started about 3-4 weeks after surgery, or when the incision is well healed. We sometimes recommend waiting until 6 weeks after surgery for larger scars that need more time to heal. Silicone should be applied when the incision is dry, has no scabs or crusts and all the SteriStrips and stitches are gone.

This is a thick, sticky silicone that comes in a sheet. You can cut it into pieces to fit the size of your child’s scar. Like a sticker, it has a sticky side and a protective backing. When the backing is removed, the sticky side is placed directly over the scar.

Silicone sheeting should be taken off before bathing or swimming. It is reusable. When removed, the piece of silicone sheeting should be rinsed or washed gently with soap and water and allowed to dry. When it is dry, it becomes sticky again and can be reused.

This type of silicone is a thick, sticky liquid. It can be put over a scar by putting a little on your fingertip, rubbing it over the scar and allowing it to dry. It dries to an invisible, clear layer. It sometimes flakes off on its own as your child moves around. It should be applied 2 times a day and re-applied after bathing or swimming.

The best type of silicone gel (sheeting or liquid) depends on the needs of your child. Silicone gel sheeting is visible, so you can see that it is in place. It is also less expensive because it is reusable. However, if your child will not leave the sheeting on the scar, would put it in their mouth, or does not like the way it looks, liquid silicone gel may be a better option. Some people use a combination, using the sheeting at night, and the gel during the day.

Liquid silicone gel may also be easier to use on very small scars or in places on the body where it is hard to get the silicone sheeting to stick.

Scar massage is regularly using your fingers to rub your child’s scar.
Massaging might help make your child’s scar be:

• More soft and flat
• Less sensitive
• Less itchy

You can begin scar massage about 4-6 weeks after surgery, when the area is completely healed with no open areas, stitches or scabs.

You can use any kind of cream, lotion, or oil (like Vaseline) that works for your child. Use your thumb or finger to rub it in and massage over the scar in 3 directions:

• Up and down the length of the scar
• Across the scar
• In small circles over the scar 

Use enough pressure that the skin turns white and the scar stretches, but not so much that it hurts. Try to massage the scar for 3 to 5 minutes at a time, 2 to 3 times a day.

The massage should not be painful to your child. If it is painful, stop and try again after a week or two.

Call your child’s specialty clinic or their primary care provider, if the scar:

• Becomes sore
• Blisters
• Reopens
• Develops a rash
• Becomes very big or thick