A lot of people criticize the supplement industry as being filled with snake oil salesmen, and indeed some are, that’s true. But who’s equally guilty – yet rarely held accountable – is the scar removal industry.

Whether it be lasers from your doctor’s office or scar treatment home remedies such as gels, creams, and patches… the truth is that almost all of these things are a total scam. Regardless of whether you’re young or old, light or dark skinned, for the vast majority these treatments offer little improvement.

Or when there is improvement on your new injury or surgical scar, the product used may be getting the credit when it doesn’t deserve to. Unless you’ve had a similar scar without treatment to compare it to, how can you be confident it isn’t the way your body naturally heals?

Take it from an expert…

No, this wasn’t something I set out to become an expert on. I wish I had no experience whatsoever for this!

But after a severe auto accident at age 18 involving extensive emergency surgeries, as well as dozens of subsequent surgeries for it in the years to follow, I have several lifetimes worth of scarring.

When you add them all up from head to toe, there are several linear feet of “clean” surgical scars and “messy” injury related ones.

Some were never treated, some were treated immediately post-op, and some much later on.

In short, there are plenty of ways to compare and contrast the effectiveness of scar treatments on my skin.

Which scar cream works best?

BioCorneum with other scar creams and gelsFrom the low end products such as a $12 tube of Merdema, to the high end like $120 BioCorneum gel, and basic remedies like vitamin E oil, I have tried them all over the years with little to no success.

What makes them especially problematic is that it’s difficult to achieve coverage of the incision 24/7. You toss and turn at night rubbing your face against a pillow, you shower and get wet, and you sweat with exercise. Even if it is a waterproof scar cream, it doesn’t seem to improve appearance, at least for me.

And scar revision surgery? You cut out an ugly scar with the hopes of creating a less-ugly one in its place. For highly traumatic uncontrolled situations (e.g. burned skin) that type of plastic surgery can make a lot of sense. Though surgically revising a stapled foot-long abdominal incision provided me with little improvement. Looked great when the sutures came out, but in the weeks and months which followed the new incision widened and turned into something only slightly less ugly than the original (however that scar revision surgery was needed regardless, to remove hardened internal tissue).

Among the topical ointments, I do admit BioCorneum is probably the best scar cream for face and other conspicuous cuts, but only if you can’t or don’t want to do gel sheets. Though the results are not ideal.

The one – and only – solution I have had significant success with is using silicone scar sheets in combination with the right diet.

How do silicone gel pads work?

Believe it or not, no one can say for sure. Some theorize it’s because of the light uniform pressure it places on the skin, others believe it has to do with keeping the skin’s surface moist since it traps moisture in. Whatever it may be, scientists can’t say for sure why it stimulates the skin cells to do what they do. But what can be said with certainty is that scar sheeting made of silicone has been used for decades with outstanding results for many.

Like the creams and gels, these also run the gamut in price.

I have never had good results with the brands you pick up at a CVS or Walmart like ScarAway strips or Neosporin Scar Solutions. Nor for the lesser known brands purchased online.

Which are most effective?

Cica Care sheet photoWhat is the best brand of silicone scar sheets? The one – and only – I have repeatedly had success with is Cica-Care by Smith & Nephew.

With the exception of a specialty pharmacy or medical supply store, you won’t find them for sale at brick and mortar stores. Though you will find them used in hospital burn centers and sold online. Regardless of where you buy them, no prescription is necessary. They aren’t cheap, but they’re definitely worth it. You can purchase them in many different shapes and sizes, whether it’s needed for a facial laceration from trauma or a tummy tuck scar from plastic surgery.

Cica-Care’s technology was developed in the 80’s by the University of Queensland in Australia. Patents have been filed, some have since expired, while others are still in force or pending (1). I have not done much research to find out exactly which patent(s) are still in force, but what I do know is that as of today, there is still nothing on the market similar to Cica Care’s silicone with its unique texture, flexibility, stickiness, and thickness.

Comparing the results of Cica Care vs. ScarAway or Mederma, etc. isn’t even worth including in this review, because I basically had no results with the other brands and types of “removal” products which for me did anything but. At least BioCorneum did a little something.

Cica Care Review: Surfing Injury

For the vast majority of the auto accident related injuries, I really don’t have documentation of before and after photos. For this recent surf injury, I do however these are not perfect photographs, rather a hodgepodge of imagery that happened to be taken throughout the following time period, mostly for purposes other than showing the scar healing (i.e. photos of hair color change). So these aren’t exactly the quality of before and after photos you would get from a product manufacturer or doctor’s office.

March 25th (day of injury)

A typical morning playing in my backyard (the Pacific ocean) resulted in a very atypical surfing injury.

An onshore wind is awful for surfing. The waves have little defined shape due to the intense wind blowing in from the west. Combine that with a somewhat large swell (8 feet) and low tide (shallow water depth), it’s no surprise that hardly anyone was out that morning, a rarity for LA’s best surf break.

This caused a particular type of freak accident which would be impossible to predict.

While on a wave, my body was flung forward – flipping me completely upside down in a vertical position – with the board underneath still shooting across the water’s surface, torpedoing directly into my eye socket.

surfboard damage from accidentThe impact was so intense, my skull broke the board.

Anyone who surfs knows these fiberglass boards can take regular beatings on rocks, resulting in nothing more than superficial hairline cracks and scratches. To actually crush a board like this is rare, to do so using someone’s head is even more so, or at least hearing about it from the person tell you themselves, because they survived it.

How I remained even semi-conscious, I do not know, it was a blessing for sure. No one was nearby to help and I was around two or three hundred feet from shore.

Not knowing if my left eye was still intact or being cognizant of really anything, I swam towards shore with my right arm, while holding the left of my face together. Fortunately after I was about half way there, another surfer was within earshot for me to shout to for help. He helped me to the sand and fortunately my house is directly ahead.

Once inside, I didn’t call 911 because by law they would have taken me to the nearest hospital, a smaller community hospital which was not ideally suited for this, in my opinion at least. Plus, surely that would have cost a fortune. Instead, I summoned an Uber to Cedars Sinai in West Hollywood/Beverly Hills area. By now it was 7 am so it also meant rush hour traffic – taking over 1 hour to get there.

before and after photo of Michael's injury and scar

1 month before / selfie in ER

If the board would have deviated a tiny fraction of an inch, or at a slightly different angle, I might not have my left eye. Although bloody, thank God the cornea, iris, and lens were apparently untouched. Only the white of the eye was bruised and bloody which is something that’s harmless and has a good prognosis for recovery, in comparison.

The concussion was intense, more on that in a minute.

Pain was awful, but I’m quite accustomed to that by now. Aside from the dilaudid administered in the E.R., I didn’t even bother with the oxycodone for home and threw away the script (I try and keep pain med use to an absolute minimum).

The mutilated skin, muscle, and ligaments were repaired by the hospital’s plastic surgeon on call that day, Dr. David Feldmar.

March 31st thru April 7th (6 thru 13 days after injury)

It’s ideal to have sutures removed as soon as possible in order to minimize new scarring from the holes of the thread. With this injury, some were removed after 6 or 7 days (which is average) while the remainder had to stay in a few days longer due to how badly the skin was damaged and the fact that the underlying connective tissue below it was also compromised.

After all were removed (approximately 12 days post-injury) I immediately began treatment using Cica-Care sheeting.

Being an expert on this stuff, for cost purposes I have always found it’s best to buy the big sheets (5” x 6”) and then cut them down into tiny strips. That way, one sheet – even if it costs $40 or $50 – can be turned into nearly a month-long supply, assuming you use each piece for 48 to 72 hours and the cut is small. You want the strip to extend at least 1/4” (3/8” is better) beyond all edges of the scar.

May 1st (37 days after injury)

picture of scar before extended treatmentThis photo was taken while changing strips. Apologies for the slight blurriness – everyone knows how the iPhone’s stupid front facing camera intentionally does a subtle blur to minimize our flaws in selfies. (I’m guessing Apple does this so if we look good using it, we keep buying their phones?)

This is after nearly 1 month of using Cica Care 24/7. That means sleeping in it, too. The only time it was removed was for showering, when it would be rinsed off, or replaced with a fresh strip.

To keep it securely affixed at all times and block UV light (very important) it was layered on top with:

clothing to block sun

Serious sun protection! Unless you want your scars to be permanently red and brown.

  • Black electrical tape, which offers complete opacity to protect the scar from the sun as well as indoor UV, which is emitted from most types of light bulbs.
  • Covering the silicone sheet and electrical tape with an adhesive bandage or medical tape. This served two purposes; keeping it securely on and covering the black electrical tape, which admittedly looks bizarre on your face (but sometimes I would run a quick errand with just the electrical tape, not caring I looked ridiculous).

May 28th (months 2 and 3 after injury)

If sewn up properly, many scars – if not most – look good right after stitches are removed. It’s during the healing process in the weeks and months that follow when they start to look like crap. The spacing between the skin stretches and excess amounts of collagen grow outward, creating a raised or hypertrophic scar. They will go from a bright pinkish red, to a reddish-brown, and eventually a permanent dark brown if you aren’t careful.

photo of wearing Cica Care silicone pad

This became the new 24/7 look for months. People you know will constantly ask why you still have a bandage on, not understanding it’s for scar reduction.

It is during these early months when it is most important to wear your silicone consistently. The Cica-Care directions say you can expect best results after 2 to 4 months, but I have always found that advice to be optimistic. Scaraway silicone sheets say 8 to 12 weeks and at least they’re more honest with the sentence that follows: Further benefits may result from extended and consistent use.” Whatever the brand may be, for best results you probably will need to wear them 5 to 6 months, maybe 7 or 8 if you’re really dedicated.

And being dedicated is the hardest part, especially when it’s on a visible part of your body. Obviously the face is the worst and this is not the first time I’ve had to use strips on it. But who cares, get used to your new look and stick with it. A few months of looking weird is better than a few decades with a prominent scar.

July 8 (month 4 begins, Cica-Care for 90 days so far)

For this particular injury, I wore the Cica Care sheets continuously for 3 months, knowing fully that I was cutting the treatment short.

After a month went by and I got some travel out of the way, I went back to wearing them another 3 consecutive months for further improvement… cumulatively, it was 6 months total. The photo below however was taken on July 8th, which was almost exactly 3 months after I began using silicone for the scars.
3 months after scar treatment began

Again, an iPhone pic makes it hard to discern detail, but most notably you can see how the scar has faded and the discoloration has greatly subsided.

October (month 7, Cica-Care for 180 days)

The improvement seen during the last half of treatment was much more minimal compared to the first half, but when it’s the middle of your face it’s probably worth the added hassle. The red/brown color was obviously fine by 90 days, the benefit of wearing these silicone gel sheets longer is mostly to reduce the hypertrophic scar tissue that’s raised.

Even though the crappy iPhone doesn’t capture it, please understand this is not full or 100% complete scar removal. Me, you, and everyone else will always be left with some remnants of it. For me it’s the cut being slightly recessed from the rest of the skin’s surface. In the right light and at the right angle its clearly visible (yet not so much on phone cameras).

scar treatment before and after photos

Before (injury) and after (6 months) of scar treatment. Sorry for obnoxious copyright – you will find many different scar products online using the same before and after photos… because they steal ‘em from blogs.

The Right Diet

So far all that has been discussed was the silicone sheets, which were only half of the treatment plan. Diet was the other.

Already being vegan, my starting point was probably a lot closer to the ideal diet then where the average American is coming from. But there were still plenty of things I had to cut. Just because one is vegan, it doesn’t mean they’re eating healthy. The vegan cheeses are mainly just refined oils. Whether it be at a vegan restaurant or something pre-made from Whole Foods, the amount of added sodium and refined oils is an inflammatory trainwreck for your body.

Again, given that this is only one of numerous post-scar episodes, I have plenty of others with less healthy diets to compare to. Based on all of it, here are the 3 most important tips I have.

1… Decrease the sodium

fancy gourmet saltI haven’t used a salt shaker in over a decade, so that wasn’t the issue. But even without that, you are almost certainly taking in high amounts of sodium from the foods you eat.

Whether it’s frozen foods, processed snacks, a jar of sauce, sriracha (my addiction), or virtually any restaurant you eat at, the amounts of added salt you get from them is insane. That’s the reason why they taste so good.

Groups at several universities including MIT, Yale, and Harvard have been looking into T helper 17 (Th17) cells, a type of immune cell which has now been associated with a number of different autoimmune disorders, including type 1 diabetes and multiple sclerosis. They have now concluded it’s likely that sodium affects Th17 cell development (2).

In one study where mice were fed a high-salt died, within 3 weeks they had a significant increase in Th17 cells (that’s bad).

“If I had an autoimmune disease, I would put myself on a low-salt diet now,” said senior study author Dr. David Hafler, a professor of neurology and immunobiology at Yale.

What relevance does this have to scarring? In some ways, the body’s response to repair a scar which causes hypertrophic scars or keloid formation “could be considered an autoimmune connective tissue disease” (3). Not in the traditional sense of the definition, but rather that for many of us, our bodies are pre-wired for healing cuts in an excessive way – by producing too much collagen at the site of the injury.

Cosmetic appearance aside, in almost all other regards, a hypertrophic response would actually be preferable, since it means the integrity of the broken skin is healed too much rather than not enough, leading to better integrity of the repaired tissue. That would be preferable in the cave man days, but not today!

Higher sodium equals higher inflammation (4). Not only does inflammation contribute to or promote a whole host of nasty diseases and conditions, but it also may have a negative impact on scarring and healing (5). More on that below.

2… Increase the antioxidants

antioxidant-rich berriesFor this injury, this was important for two reasons, since I also had a severe concussion. Increasing amounts of research have looked at antioxidant therapy post-concussion. One such study which was coincidentally released just days after this injury talks about it:

“Concussions can contribute to long-term changes within the brain and these changes are the result of cell death, which may be caused by oxidative stress,” said Brandon Lucke-Wold, a M.D./Ph.D. student at West Virginia University’s Medical School who conducted the research. “This study shows that antioxidants such as lipoic acid can reduce the long-term deficits when given after a concussion.” (6)

Funny enough, before hopping in the Uber to go the hospital, I actually took some alpha lipoic acid specifically because I knew it easily crossed the blood-brain barrier. Not only for the increased oxidative stress from the concussion, but also for the inevitable X-rays and CT scan which I knew lay ahead for me. Research has suggested that antioxidant supplementation prior to procedures such as these might benefit the radiation induced damage which results from it (7).

Concussion aside, a healthy diet involving plenty of antioxidants is ideal when your body is healing from an injury.

For me this meant cutting out the refined and processed junk and increasing my intake of foods with high ORAC values.

Not as a substitute for a healthy diet, but in addition, I am an advocate of using certain types of antioxidant supplements which diets (any diet) does not provide ideal amounts of. I’m talking about the most powerful antixoxidants, such as astaxanthin which is up to 6,000x stronger than vitamin C. I personally use Nutrex Hawaii EyeAstin astaxanthin, but there are a couple other equally reputable manufacturers, too.

3… as in, omega 3’s

prior surf injury cut skin

Here’s another surf injury I followed a similar regimen for, including scar gel sheeting for 5 months (this injury was before the one featured above)

If you’re on a typical Western diet or even the paleo diet, there’s a good chance your ratio of omega 3 vs. omega 6 intake is way out of whack.

Before modern times and today’s Western diet, it is believed that humans consumed omega 6’s and omega 3’s near a 1 to 1 ratio. Today, the average is 15 to 1 or 16 to 1. You may be consuming 1,500% too much omega 6, at least relative to what we humans historically ate (8).

For anyone who studies nutrition, this comes as absolutely no surprise.

Most meats and dairy are extremely high in omega 6’s and offer very little 3’s. The same applies to almost all of the refined oils used in cooking and for processed foods. Even olive oil, which contrary to popular belief, is not healthy (that’s too big of a discussion for this article).

Why is this a problem? Because omega 3’s have an anti-inflammatory effect, while omega 6’s are the opposite – they’re pro-inflammatory (9). This creates excess inflammation in our bodies.

Inflammation has been shown to have a negative effect on healing. There is a great deal of research out there to support this. One recent study I saw which is particularly interesting involves West African patients who had success with their traditional African remedies for keloids, remedies which just so happen to be high in omega 3’s (10). One of those, shea butter, is already a popular remedy. The boa constrictor oil? No so much.

I guess literal snake oil gives a whole new meaning to the snake oil salesman moniker for scar removal products.

For EPA and DHA rich omega 3 supplementation, I have been using Ovega 3 for years. For dietary sources, there are many whole food sources which provide high amounts. With more omega 3’s than salmon, chia seeds or flax are part of my breakfast almost daily.

The enzyme bromelain – which is unique to pineapple – has been widely studied for its anti-inflammatory effects.

The highest concentration is found in the core of the fruit and since its sensitive to heat, pasteurized juice is not a good source. For that reason, and the convenience of not needing to eat raw pineapple daily, I also took bromelain supplements.