Scar management

"It is easier to prevent a scar than to reduce it once it is formed. [...] Scars can take longer to heal if not managed." (Kase et al)
This is interesting.  After sleeping or resting in one position for a longer period of time post surgery, it felt like the wound/scar is "glued on wrongly". This is likely the effect of collagen formation. Doing something that aligns the collagen properly may help the healing so that the scar integrates well with the skin and prevents future contracting. An example, of a scar not integrating well with the skin is a hypertrophic scar, that has a raised, red appearance.

A few approaches (more here: scar minimization):

• Scar massage means using fingers to stretch the skin/scar vertical, diagonal, and pulling the skin in opposite directions to either side of the scar. This can be done after the surgical wound has healed anywhere between 3 and 6 weeks depending on sources.
• Mechanical pressure means applying pressure on the scar such as using a silicon gel strip,  using a spoon to push down on the safer and pull along, or using kineseo taping.
• Acupuncture
• Stretching exercises to retain the range of motion.
• Hydration means applying oils or creams, often with Vitamin E to the skin.

Scientific evidence: There is anecdotal evidence for these treatments. But does this apply in general? Scientific studies indicate that scar massage has no effect on scars (Shin et al).  Furthermore, the skin is a very efficient barrier, so creams may not be helpful either. There is a discussion on the importance of relaxation and breathing and complementary therapy approaches to scar healing, but more evidence based research is needed (Zanier et al).

There are no medical protocols for scar management. So it will come down to individual preferences.

What I liked: I have stretched from the very beginning and believe this helped the wound to heal in a way so as not to restrict movements when scar tissue is formed. Acupuncture was part of my recovery, so this may have helped. In particular, there are places where there is NO scar. The acupuncture therapists says this is along the stomach, bladder, and kidney meridians.  I exercise a lot and sweat. It is gratifying that initially numb areas produce sweat after while. I take it as a good sign for healing.
What may help:
I did not know about scar massage until 11 weeks after surgery. However I have not noticed a difference 5 weeks later. But it is something that is easy to do at no cost and won't hurt. Possibly it is helpful to start earlier after surgery. Small Kinesology taping strips vertical or diagonal feel good.
What may not help:
I am not convinced that silicon strips or creams or other commercial products are helpful. The strips cause itching when left on a few hours. They are pricey, using it daily for months and getting new strips every 2 or 3 weeks. I would not buy them again.

Appearance at 3.5 months post surgery: some small stretches where the scar disappeared (along the meridians, see above),  raised and red at other places. I am not overly bothered about the appearance as long as the scar tissue is flexible enough for exercising and stretching. They look good and I wear them proudly. There is beauty in scars!


References:
Kase et al  Kineseotaping for Lymphoedema and Chronic Swelling. Kineseo IP, LLC 2014
Shin et al.  The role of massage in scar management: a literature review. Dermatol. Surg.  2012 Mar;38(3):414-23.
Zanier et al. A multidisciplinary approach to scars: a narrative review. J. Multidisciplinary Healthcare 2015; 8: 359-363