With appearance-consciousness at an all-time high, several companies have introduced products aimed at least in part at causing less scarring or reducing scarring after surgery. But although the designs of the products seem to make sense, actual clinical evidence about scar reduction so far is scarce. Here's a look at five products that may help reduce scarring.
DermaX from US Surgical. The rule of thumb in plastic surgery is to use the smallest suture needle. "Because the smaller the needle, the less tissue damage you see," says Beverly Hills plastic surgeon L. Leslie Bolton, MD. The DermaX cosmetic suture needle from US Surgical is 30 percent to 40 percent thinner than competitive products, which US Surgical says reduces the size of puncture holes. The needle's sharp, four-edge geometry makes it less likely to drag, therefore reducing microtears in the tissue, says the company. Unlike traditional sutures that have three-edged cutting needles, DermaX has a fourth edge that the company says allows for improved four-directional control, both horizontally (left/right) and vertically (up/down). The company says this control lets surgeons line up the tissue for better results. Boxes of 12 list from $80 to $92, depending on the needle-suture combination.
The company says a physician recently conducted a small study of facelift procedures, closing on one side with DermaX and the other with a competitive brand. According to a company spokesperson, the results show superior results with the DermaX suture. Outpatient Surgery was unable to evaluate the study or the photos pending publication in a peer-reviewed journal.
Dermaglide from Surgical Specialties. This suture also features a four-sided design said to penetrate tissue especially smoothly. Surgical Specialties claims that its Dermaglide needle is one of the sharpest available for skin and subcuticular closure. Instead of grinding the needle edges, which is the typical manufacturing process, the company etches the edges of the needle with acid. The company claims that this process creates a more consistently sharp needle, which holds its edge as it is passed through tissue. Again, though, Outpatient Surgery was unable to view clinical evidence for the claims. Dermaglide is available with all types of suture materials and, according to the company, is priced from 20 percent to 25 percent less than comparable needles.
CVD Diamond Knife from Rhein Medical. Surgery facilities that host ophthalmic procedures know that diamond knives are much sharper than steel. Rhein Medical, which makes diamond knives for ophthalmic surgery, began marketing this man-made diamond knife for plastic procedures about two years ago. The company says the knife is appropriate for cleft palates, blepharoplasties, face lifts and mammaplasties. The company believes the sharpness of the blade produces improved tissue reapproximation, enhances healing and betters post-operative cosmetic results, but thus far there have been no clinical studies of the device.
CVD Diamond Knife
Michael T. Yen, MD, a Houston ophthalmologist who evaluated the CVD diamond blade two years ago, has used the knife for blepharoplasty and face-lift incisions and found that it easily cuts through very thin and loose eyelid tissue and avoids bunching, which can cause drag. "It also makes a very precise incision," says Dr. Yen. "But I don't think that we have the evidence right now to show that it reduces scarring or speeds wound healing; more clinical trials are needed."
Two scalpel sizes are currently available on retractable handles for repeated sterilization and usage. Facilities that don't have experience with diamond knives should also know that they require special handling; dinging a blade on a hard surface will require blade replacement, which is expensive. The company didn't release prices.
OTC post-op scar treatments
Studies indicate that several therapies can be effective for reducing elevation and redness of hypertrophic scars. In a 2002 literature review published in Plastic and Reconstructive Surgery, an international panel of experts recommended the use of silicone gel sheeting and intralesional corticosteroids. Two over-the-counter products now available attempt to make these therapies easily accessible.
Neosporin Scar Solution from Pfizer. The company claims Neosporin Scar Solution inhibits the formation of keloids and hypertrophic scars and improves the color and texture of scars. Once the wound is healed, the patient applies the sheet to the scarred area. It should be worn for 12 hours per day. Each package contains a 12-week supply for $28.95.
The company didn't provide any scientific evidence to support the efficacy of the product. "I recommend products like these to my patients," says Dr. Bolton. "At best, they work, and they certainly can't hurt. We do know that for patients with thick burn scars, pressure does lessen the scarring. So the thinking is that if it works for a deep ugly burn scar, it will work with small surgical scars."
Neosporin Scar Solution
Scarguard ScarCare. Scarguard ScarCare is an over-the-counter scar treatment that combines five elements shown in studies to have varying degrees of effectiveness in improving the healing of scars: pressure, occlusion, silicone, corticosteroids and vitamin E. The clear liquid brushes on and dries to form a clear protective film over the wound. Bottles cost $65 for one ounce, $35 for a half-ounce.
To study the effectiveness of the product, dermatologist Drore Eisen, MD, DDS, studied 12 patients with a history of keloid and hypertrophic scar formation. Patients had two moles removed by shave excision. All patients were instructed to apply a topical antibiotic to both surgical wounds until they were completely healed. Once healed, one wound was treated with Scarguard ScarCare. The other was left to heal without any treatment and served as the control. Patients continued this treatment for two months. Patients and the investigator evaluated the surgical wounds based on color, contour, texture and overall appearance. Nine of 12 reported the ScarCare-treated wound was less red and noticeable than the control wound. Half of those studied found their treated scars to be less raised and softer than the control wound. Dr. Eisen's theorizes that ScarCare stimulates the production of endogenous collagenase, which helps the incision heal, but he says further studies are needed to confirm his results.
In these image-conscious times, sutures, knives, pads and gels that purport to reduce scarring or speed wound healing may be worth a look.