Wound healing is a complex, delicate process during which time many factors can affect your outcome. Anything which creates trauma or injury to the skin can create a wound.

In cosmetic surgery, this can be as limited as a surgical incision or more extensive such as laser skin resurfacing. Fortunately, you don't have to rely completely on good genes or your surgeon's technique to improve your chances at timely, aesthetically pleasing results, although those two factors do help considerably.

The healing phases

In the initial phase, during which time bleeding stops, white blood cells fight bacterial infection, and collagen formation begins. (Collagen is what scars are made of and what holds wounds together). In this phase, the wound is usually warm, red, swollen, and painful. Over the next 3 - 4 weeks, large amounts of collagen are produced, pulling the wound tighter together, while new blood capillaries form to aid healing.

Cells that help to keep the wound clean can cause the wound to be wet, weeping, and white or yellow in appearance. Over the next few months to years, depending on the individual, even more collagen is formed to strengthen the wounds, and then scar "remodeling" to break down excess collagen in the scar. Scar remodeling is what can change a thick, red, raised scar to a thin, flat, white scar over a period of months to years.

Factors that affect wound healing and scar formation

Your surgeon's skills

Sutures that are placed deep beneath the skin's surface result in lesser scarring because this takes the strain off the skin edges. Depending on the surgeon's skill and experience, this can be done with great final result.

Your surgeon should close the wound with the skin's edges just 'lightly' kissing . Increased tension causes the wound to pull apart and stimulate your body to create more scar tissue. Wherever possible, limit any strenous physical activity to lessen this possibility. Compression garments are a great aid to this area and as well as minimizing swelling.

Personal factors

Nutrition - Eating well and leading an active lifestyle prior and following recovery can aid the healing process of scars.

Smoking - Smoking almost always reduces the body's ability to heal and detrimental to wound healing, leading to infections and other complications.

Diabetes - Heightened levels of sugar in the blood impair healing and should be monitored.

Excessive movement - Too much movement can cause fluid accumulation (swelling) and prevent cross-linking of collagen and fibrin which are necessary to hold the wound together. I

Steroids - Systemic steroids commonly used to treat inflammation, pain, asthma, or allergies can significantly slow healing and thin the skin.

Alcohol - Alcohol thins the blood, slows healing, and increases bruising. You should stop drinking at least 1 week before surgery, and abstain for 1 week after or longer if you are taking narcotic pain medications.

Overexposure to sun - Sun exposure can cause darkening and thickening of scars for up to a year after surgery. Therefore, your incisions or wounds should be covered during the day and sun block is recommended after 3 weeks of surgery.

Genes - People with oily, thick skin tend to heal faster than those with thin, dry skin.

Age - Younger people generally produce more collagen, therefore increasing the chances of thicker scars, but tend to heal faster.

Supplements and creams

Whether it's to flatten, smoothen, soften or lighten scars, all scars - post surgery, hypertropic and keloid scars need time to heal. Products do help reduce or lighten but it all depends on the individuals natural healing ability. While lighter skin individuals normally heal better for scars, darker skinned individuals will almost always darker and thicker scars.

Scar gels, creams, and adehesive silicone scar sheets can help reduce the scar size, thickness, height, and color of all types of scars, including new and old post-surgery scars, keloids and  hypertrophic scars. Here are some of the best ones in the market:

• Kelo-Cote Scar Gel is a lightweight, self-drying scar reduction ointment that helps flatten, soften, and reduce all types of scars.  This helps the scar and surface of the skin surrounding the scar become smoothed, soothed and enhanced.
• Scar Fx Silicone Sheet works well on any type of new and old scar, and can be can be easily cut to fit any scar shape or size.   This natural, soft, flexible silicone is an inexpensive approach for making your scars softer and smoother in as little as 8-12 weeks. Comes in 1"x12" or 1"x22" sizes.
• Scar Esthetique Reduction Cream contains more ingredients that promote scar healing and scar reduction than any other scar cream on the market - silicone, arnica montana, antioxidants, copper peptides, Vitamin C, D & E, Retinyl A, and many other ingredients that have been shown to be effective for reducing scars.
• Biodermis Ultimate Breast Surgery Scar Kit is ideal for reducing scars from breast surgery, including breast augmentation, breast reduction, breast lift, and mastectomy.
• Talsyn Scar Cream is highly effective in improving the scar appearance of surgical scars and incisions, skin lacerations, keloids, hypertrophic scars, even burns, and abrasions. With results seen in as little as 2-4 weeks, this cream has been clinically proven to facilitate healing, improve the appearance of the scar, reduce redness and skin rigidity, improve circulation, and ensure proper wound healing and skin regeneration.
• Microneedle Skin Roller is a clinically-proven solution for smoothing scars of all types and dramatically reducing wrinkles. The treatment from this skin roller helps to promote new and finer skin regrowth therefore camouflaging unslightly scars, wrinkles or even hyperpigmentation.
• Biodermis Abdominal Scar Reduction Silicone Strip helps reduce body scars of all types by flattening, softening, smoothing, and blending the scar with the surrounding healthy skin, especially for tummy tuck  or buttock augmentation procedures. Comes in large strips, or in a 6-pack of squares and small circles.
• Wound Be Gone Scar Gel can be used while your wound is still healing and has yet to close to dramatically accelerate wound healing and prevent scar formation.  It is a unique combination of highly effective “moist healing” and a patented active ingredient which is critical for quick healing without unsightly scars.

Scar massage can help a lot as well. Then there are recent trials that show an increased temperature will significantly increase collagenolysis (the process that decreases scar tissue) So heat application e.g. by paraffin wax can be a potent improving measure.

When sourcing for scar reduction or healing creams, look out for these common ingredients which are known to help with scar recovery/healing: arnica, bromelain extract, vitamin E, vitamin K, sillicone, copper peptides, collagen, honey, aloe vera, allantoin, Coenzyme Q10, onion extract, seaweed or algae extract, etc.

Know your options

Over the counter or homeopathic scar products are easily available. However, sometimes what works for someone might not work just as well for you. It is important to understand that with as with all surgery, scarring is unavoidable.

If there is excessive keloid scar formations or irregular scars, you may want to opt for scar revision surgery. But then, it's making another scar to remove one. The most effective treatments we experienced include keeping the scar clean and free of infection, massage, and topical application of wound healing creams. These creams will usually decrease inflammation and minimize pigmentation.

If you have a history of bad scars, you must tell your surgeon. Ideally, your surgeon will use techniques to minimise scarring and place them in inconspicuous sites that won’t be too visible. After surgery, keeps scars away from sunshine until they have faded and moisturise scars regularly. If you are realistic about your expectations, chances are that you would be very happy with the final outcome.