Bethenny Frankel made headlines recently when she announced that she had been diagnosed with skin cancer, specifically basal cell carcinoma. On her face.
As a dermatologist, I am constantly preaching the necessity of adequate sun protection. Especially on areas (like your face and hands) that are rarely covered by clothing. I will spare you another lecture about skin cancer and sunscreen – though if you are curious you can learn a lot more about how to detect and prevent skin cancer here and here.
Frankel posted a photo on Instagram after undergoing surgery to remove the skin cancer and I’m sure as people came across this there was a resounding gasp. There is an inch-long incision on her face, right underneath her eye. Not a great place for a scar!
What is a scar?
Scars form when an injury on your skin heals. As your body works to repair the wound, it creates collagen (a tough fiber in your body that gives the skin strength and flexibility) to reconnect the tissues that were broken. The process of wound healing in the skin can take up to 1 year to be fully complete. As part of wound healing, a scar commonly occurs.
It is important to know that a scar can mean many different things to different people. The reason for this is that there are many different types of scars.
- The majority of scars will appear flat. They can be red or dark brown depending on your skin type and on where they are in the healing phase. When scars are excessively red, dermatologist describing them as hyper-vascular (meaning a lot of blood vessels). When a scar is excessively dark we describe this as hyper-pigmented. The change in skin color is usually secondary to marked inflammation in the affected skin.
- When the body produces too much collagen, the scar can be raised and is called hypertrophic or keloid. These are more common in younger and dark-skinned people
- Some scars will appear as sunken or pitted which occurs when the underlying structures supporting the skin are lost. Surgical scars and scars from acne usually have this appearance.
- When the skin stretches rapidly, scarring will appear as stretch marks (which many people can attribute to excessive weight gain or pregnancy).
How can I prevent scarring?
If you have a wound, it will leave a scar. There really isn’t a way to truly prevent a scar. However, with proper wound care you can help to reduce the appearance of a scar.
- Always keep the area clean and moist. Gently wash with soap and water to keep germs out.
- Keep the wound moist – petroleum jelly works great to keep the wound from drying out and will aid in quicker healing time.
- After washing and applying petroleum jelly, keep the wound covered with an adhesive bandage and be sure to change the covering daily as it heals.
- Don’t expose the wound to sunlight and once healed be sure to use adequate sun protection which may help to reduce red or brown discoloration. Always use a broad-spectrum sunscreen with SPF 30 or higher and reapply frequently.
Over time scars will naturally fade given adequate skin care routines.
Here are some specifics details on how to manage the most common kind of scars:
- Vascular scars: These scars usually heal well with time. I always recommend sun protection, because excessive sun can enhance and lengthen the vascular healing phase of a scar. While the red is dissipating, green concealer can be used to mask a red scar. If a scar has been red for longer than 6 months, then an intervention may be necessary. Laser treatments work best for getting the red out. There is a laser called the vbeam, which specifically targets red blood vessels.
- Post inflammatory hyperpigmentation (dark brown scars): Again time is your best friend when it comes to this kind of scarring. I see these most commonly in acne patients with dark skin. Many find the post-inflammatory hyperpigmentation left behind from a scar even worse than the acne itself. The good news is that there are topical medications and topical treatments that can greatly improve these types of scars. A gold standard for treatment hyperpigmentation is a medication call hydroquinone. This is a skin lightening medication. While hydroquinone is very effective, it cannot be used for long periods of time. Overuse can even create a paradoxical darkening of the skin! Skin brighteners are an alternative to hydroquinone. They contain a blend of botanicals that work together to suppress pigment-producing cells and brighten the skin. These are few skin brighteners that I love: LumoPro-C and Lumixyl.
- Keloids/hypertrophic scars: These types of scars occur when the body makes too much collagen during the wound healing process. Some individuals are prone to keloids. If you are prone to keloids then you should inform your doctor before any surgical procedure. Treatment of hypertrophic scars can be challenging. However, there are two things that can be very helpful. The first in a medication called Kenalog, which is injected by a board certified dermatologist. This helps to flatten out the scar. You can also use silicone dressing to help with scaring. The silicone puts pressure on the scar as it is healing, making it hard for excessive collagen to form.
Is scar removal an option?
My patients often ask me whether it is possible to completely remove a scar. The answer to that question is no. There is no way to completely remove a scar. However, the appearance of a scar can usually be improved. For non-raised scars, surgery may be an option used to alter a scar’s shape to make it less noticeable. Dermabrasion, microneedling, and laser resurfacing can help to make scars ‘blend in’. Lastly, fillers can be effective to help raise sunken scars. These treatments are only temporary and would need to be repeated.
As for Frankel, she had a type of surgery called Mohs Surgery. This type of treatment for skin cancer allows for the removal of tissue one layer at a time and helps to save as much normal, healthy skin as possible allowing for a focus on functional and cosmetic results. I’m sure she has a great dermatological surgeon helping to reduce scarring as much as possible and will be prepped with all the wound care she needs to heal perfectly.