Scar Revision & Lesion Excision

Your Procedure

These instructions apply to scar revision, whether the scar is replaced, reoriented, or rearranged (for example, with a Z-plasty), as well as to the removal of skin lesions, either by excision with stitches or by shave removal.

• Shave removal. There are no stitches. The spot heals like a small scrape over about 1–2 weeks. Depending on the spot, we cover it with antibiotic ointment or Vaseline, or with brown 3M Micropore tape. If the tape falls off, keep the spot covered with ointment or Vaseline so it does not dry out. Let any scab come off on its own. It may leave a flat pink or lighter mark that fades with time.
• Biopsy. A removed lesion is sometimes sent to a pathologist for a biopsy. If yours was sent, please call our office after 2 weeks to ask about your results.

Shopping List

• Prescriptions. Pick up your prescriptions well ahead of your procedure. We send them to your pharmacy at least 2 weeks in advance. Open the bag well ahead of your procedure and make sure nothing is missing. Call us right away if your antibiotics or pain medication are missing.
• Hypochlorous acid (HOCl) spray. Your antiseptic before and after the procedure.
• Hydrogen peroxide, Q-tips, and antibiotic ointment or Vaseline for cleaning and caring for your incision.
• Tylenol (acetaminophen). An alternative to narcotic pain medication if pain is not severe. Do not take NSAIDs.
• Stool softener (preferably MiraLAX). Helps with constipation from narcotic pain relievers.
• Crushed ice or frozen peas for cold compresses, always wrapped in a cloth.
• Brown 3M Micropore tape. Provided by The Naderi Center and used on the face or body, over incisions or shave removal sites. Your surgeon will tell you how to use it.
• Silicone scar gel. Available online. Your surgeon will tell you if and when to start it.

Before Your Procedure

• Starting 1 week before your procedure, spray hypochlorous acid (HOCl) on the treatment area and the skin around it 3 times a day as an antiseptic.
• Stop all nicotine (smoking, vaping, patches, gum) at least 2 weeks before your procedure; 4 weeks is preferred. Nicotine slows healing and can make a scar worse.

Day of Your Procedure

• Take two showers: one the night before your procedure and one the morning of your procedure. Each time, wash your hair well and use antibacterial soap on your face and body.
• No products. Do not apply sunscreen, moisturizer, or deodorant. If the scar is on your face, do not apply makeup, hair spray, or gel.
• Glasses, not contact lenses. Do not wear contact lenses; wear your glasses instead.
• Eat a light meal. For an in-office procedure you may have a light breakfast, such as toast and water.
• Clothing. Wear comfortable, loose clothing: easy slip-on pants, a button-down shirt, and flat shoes.
• If you are given Valium or another sedative, a responsible adult must take you home. You cannot leave alone in an Uber or taxi. An Uber or taxi is fine only if a responsible adult rides with you.

The First Few Days

• Rest. Take it easy to reduce inflammation and help the skin heal properly.
• Minimize tension on the incision. Limit movement of the area, do not stretch the skin, and leave it alone as much as possible.
• Cold compresses. Apply crushed ice or frozen peas wrapped in a cloth for 20 minutes every hour while awake for the first 2 days. Never place ice or frozen materials directly on the skin. Numb skin can get frostbite.
• Dressing. If you go home with a dressing, keep it in place until we tell you to remove it. For tape, see Incision care.
• Pain. Use your prescribed pain medication, or Tylenol if pain is mild; do not take the two together. Do not exceed 4,000 mg of Tylenol (acetaminophen) in 24 hours. Begin a stool softener when you start narcotic pain medication. Do not strain during bowel movements.
• Arnica and bromelain. Start Arnica and bromelain supplements after your procedure, not before. They help bruising and swelling fade faster.
• No nicotine for at least 2 weeks after your procedure.

Incision Care

• Showering. You may shower 48 hours after your procedure. Use lukewarm water and gentle pressure. Do not let the spray hit your incisions directly; let the water run over them gently. Do not rub your incisions; fresh incisions can open if handled roughly. Be careful of falling.

When there is no tape over your incision:

• Cleaning. Clean incisions gently 3–4 times a day with a Q-tip dipped in diluted hydrogen peroxide. Roll the Q-tip; do not scrub. Some crusting around the sutures is normal; do not pull off crusts.
• Ointment. Apply prescribed antibiotic ointment or Vaseline very gently 3–4 times a day.
• Continue your hypochlorous acid (HOCl) spray on your incision and the skin around it 3 times a day.
• Nothing else on the incision. No lotion, makeup, sunscreen, or scar gel until your surgeon says it is safe.
• Scar gel. Once your incision has completely healed and your surgeon says it is safe, you can start a silicone-based gel.

Nutrition

• Healthy eating. Continue the Naderi Anti-Bleeding, Anti-Bruising Diet for 2 more weeks after your procedure. It helps minimize swelling and bruising.
• Hydration. Drink 8–10 glasses of water a day to help healing.

What to Expect

• Swelling and bruising. Some swelling and purple-blue bruising around the incision are completely normal. Bruising is greatest on days 2–3 and then fades; swelling and firmness can take up to about six weeks to settle.
• Mild bleeding at the incision for the first few days is not unusual. Strenuous activity, straining on the toilet, sneezing, heavy lifting, and bending forward raise your blood pressure and aggravate bleeding and swelling.
• Pain and itching around the incision are normal during healing and should resolve in a few weeks.
• Sutures may be dissolvable or may need to be removed, usually about 1 week after your procedure. We will tell you which.
• Scars start deep pink. Over time the pink fades to white, the scar softens, and it becomes less noticeable. Healing varies, but it takes about a year for the scar to look its best.
• Final result. Your scar will change over time. A scar revision improves a scar’s appearance but does not make it disappear completely, and removing a lesion always leaves a scar. There is always a possibility that a scar widens or returns, that a keloid forms, or that a lesion grows back. Following these instructions helps lower that chance.

If you are ever unsure, our team is always available. Take a few clear, well-lit photos and email them to Surgery@NaderiCenter.com. For anything more urgent, please call the office so we get your message quickly.

Activity

• Sun. Protect healing skin and incisions from direct sun exposure for 3 months. Even a mild sunburn can worsen swelling and darken a healing scar.
• Driving. Do not drive or make important decisions until you have been off pain medication and any sedative for 24 hours.
• Return to work. Most patients return to work anywhere from a day to a week after the procedure.
• Exercise. Normal activity can resume a few days after your procedure, and exercise in about 2–3 weeks. Swelling may briefly worsen with exercise. Discuss limits with your surgeon; the size and location of the scar matter.
• No tub baths, jacuzzis, or pools until your incision has healed and your surgeon approves, usually about 4 weeks.

Do Not

• Do not place anything frozen directly on the skin.
• Do not soak your incision in a bath, hot tub, or pool while it is still healing.
• Do not take aspirin, ibuprofen, naproxen, or other blood thinners until your surgeon says it is safe.