A hyperpigmented or red scar is much more noticable than a hypertrophic (raised) or widened scar.
Many things can lead to a reddened scar, including infection, wound tension, inflammation, and UV-exposure. Of these things, UV-exposure is one of the only places that a patient can intervene. If a fresh scar is exposed to significant sunlight, it tends to turn red. To make things worse, it tends not to fade back to the color of the surrounding skin. After I explain this to patients, the next question is whether they need to use SPF 75 or 100. The marketing of sunscreens is in flux at this point. In fact, there is a push to limit the advertised SPF to 50. At these high levels, there is very little difference. In fact, there is little difference in the incidence of sunburn between SPF 15 and SPF 30, if applied correctly. “Applied correctly” is the key term. Most people do not apply sunscreen in sufficient amounts or re-apply often enough. If applied incorrectly, like I do, the incidence of sunburn is decreased when SPF 30 is used, compared to SPF 15. In the end, I recommend sun-protection (SPF 30 sunscreen) to patients any time they are in the sun for atleast the first year after surgery. Good sunscreen can be expensive, and costs a fortune when you need it the most- on a cruise or at the ski resort. I still flinch at the time I had to grab a small bottle at the Hilton Head marina. Nevertheless, it is always cheaper than a scar revision procedure or any of the unproven scar creams on the market. More to come…
Due, Eva, et al. “Effect of UV irradiation on cutaneous cicatrices: a randomized, controlled trial with clinical, skin reflectance, histological, immunohistochemical and biochemical evaluations.” Acta dermato-venereologica 87.1 (2007):27-32.
Pissavini, Marc, and BrianDiffey. “The likelihood of sunburn in sunscreen users is disproportionate to the SPF.” Photodermatology, photoimmunology & photomedicine 29.3 (2013):111-115.