Scar Prevention: Surgical and Nonsurgical Aspects to Reduce Scar Formation, Including Early Therapies

Hypertrophic scars and keloids can be aesthetically unpleasant and may be associated with functional and psychosocial impairment. Treating a pathological scar, once established, can be difficult and frustrating. For this reason, prevention of excessive scarring is preferable and much more efficient than treatment, both in case of elective surgery and accidental injury. Prevention measures to reduce scar formation should be applied even before starting any surgical procedure: the surgeon must carefully design a plan to avoid skin stretching tension on the wound edges and prevent factors that promote excessive inflammation such as infection, foreign bodies, or delayed healing. Postoperatively, many invasive and noninvasive options to prevent excessive scar formation are available, nevertheless, there is no single therapy proven to have a consistent and absolute efficacy. A personalized and multimodal approach is recommended and may include the use of physical therapy, silicone sheeting or topical silicone gel, pressure garments, and steroid injections. Patient history of scarring, etiology of the injury, patient expectations, and the likelihood of compliance, influence in the selection of a preventive therapy.