Fun in the sun: Protecting your plastic surgery scars

Things are starting to heat up, which means fewer clothes and more time basking in the sun. The summer season typically means bikinis, board shorts and sundresses. Whether you've just had a mommy makeover or want to show off dramatic weight loss and the subsequent body contouring, the summer season can feel like walking the runway at fashion week. It is your opportunity to be proud and confident, showing your results off to the world, or at least your little slice of it.

While you shouldn't be afraid to wear what you want and flaunt your plastic surgery results, depending on the procedure and incision placement, your favorite two-piece could reveal healing surgical scars. Scars are a part of the plastic surgery recovery journey and are nothing to hide or be embarrassed about. However, scar tissue is delicate and sensitive, something you don't want to show off to the sun.

If you are ready to enjoy some fun in the sun and break out your hot summer wardrobe, keep these tips in mind from ASPS Member Surgeons Anureet Bajaj, MD, and Josef Hadeed, MD, FACS, to protect your surgical scars.

Why it's crucial to protect scars from UV exposure

Nothing feels better than stepping outside on the first warm day of the year, soaking in the sunshine and letting the rays beat down on your face. It's like the whole world has finally come alive again. Unfortunately, for plastic surgery patients, while it may feel like the right time to get out and be seen, UV exposure can damage delicate scar tissue and leave you with less-than-optimal results.

"Sun exposure on a fresh scar causes post-inflammatory hyperpigmentation," said Dr. Hadeed. "Because scar tissue is immature and lacks the normal protective mechanisms of healthy skin, UV rays trigger an overproduction of melanin. This can turn a thin, pink line into a dark brown or purple mark that may become permanent. Furthermore, UV radiation breaks down collagen, which is exactly what the body is trying to build to close the wound, leading to wider or 'pitted' scars."

Without adequate sun protection, scars can thicken, become discolored and slow healing. New scars, which can be pink or red, are particularly sensitive to UV rays, but even mature scars can darken when exposed to the sun for prolonged periods.

"After surgery, the surgical areas may be numb, which means that we may not feel the discomfort from the excessive heat as we would otherwise feel," said Dr. Bajaj. "Also, the skin may burn more easily, particularly after any type of resurfacing or energy-based procedure. Some medications that you take may also make your skin more likely to burn. As for scars, if you tan and they become darker, they may remain hyperpigmented or dark permanently. In other words, the rest of your tan will fade, but your dark scars won't."

Making scars more obvious is generally not a look that plastic surgery patients are striving to achieve. Thankfully, there are ways patients can protect sensitive skin while still enjoying the summer sun.

Picking the right sun protection

Techniques for scar management are essential after any plastic surgery procedure, particularly for patients who want to stay active, have planned vacations or want to feel confident in swimwear or summer clothing. Step one is to protect delicate scar tissue as it heals during the early phase of surgical recovery.

"Silicone sheets or silicone gel create an occlusive barrier that hydrates the scar and flattens it," said Dr. Hadeed. "Many modern silicone tapes now come with built-in SPF, which provides a double layer of protection.  I also recommend zinc-based SPF sticks for scars because they allow for precise application directly over the incision line."

Dr. Bajaj's go-to product is a high-quality mineral-based sunblock. There are two types of sunscreens in the United States – mineral and chemical. Mineral sunscreens use zinc oxide or titanium dioxide to create a physical barrier against harmful UV rays. These sunscreens can be excellent for sensitive skin and scar tissue. Chemical sunscreens typically reduce the amount of UV radiation that penetrates the skin by absorbing it and releasing it as heat. The active ingredients in chemical formulas can include oxybenzone, avobenzone, octisalate and octocrylene.

Why the preference for mineral over chemical for scar tissue?

"My preference is for mineral-based sunblock because it is an actual barrier," said Dr. Bajaj. "They are also much better for sensitive skin. Many of the newer products don't leave that white coat that we traditionally associate with mineral-based sunblock."

Dr. Hadeed also said he prefers mineral-based sun protection, especially when you have fresh scarring.

"Mineral sunscreens sit on top of the skin and reflect UV rays like a mirror," said Dr. Hadeed. "Chemical sunscreens absorb into the skin and convert UV rays into heat. Heat can cause vasodilation, which may increase redness and swelling in a fresh scar. Mineral blockers are also less likely to irritate sensitive, newly healed tissue."

Not only do patients need to consider the formula, but they also need to choose the right sun protection factor (SPF), which measures a sunscreen's ability to protect skin from damaging UVB rays.

Both surgeons said that, at a minimum, patients should select a sunscreen with an SPF of 30.

"I recommend a minimum of SPF 30, but SPF 50 is the 'sweet spot' for surgical patients," said Dr. Hadeed. "Beyond SPF 50, the incremental protection is minimal, but it provides a safety margin for patients who may not apply a thick enough layer."

Ideally, patients also want a formula that is "broad spectrum," meaning it protects the skin against both UVB and UVA radiation. In the past, many labels only provided information about UVB rays, the rays that cause sunburn. UVA rays are also dangerous and are associated with premature aging.

Getting dressed for scar protection success

Don't think that you are off the hook just because your sundress or swimwear covers your surgical scars.

"Patients often assume that if a scar is under a bikini or a lightweight T-shirt, it is safe," said Dr. Hadeed. "This is a misconception. A standard white cotton T-shirt only has an ultraviolet protection factor (UPF) of about 5. I advise patients to look for UPF 50+ clothing. If they are wearing a swimsuit over a tummy tuck scar, they should still apply sunscreen underneath the suit, as UV rays can penetrate many thin, wet fabrics."

The light or gauzy materials prevalent in summer clothing are not enough to protect unseen surgical scars from the sun's brutal rays. Likewise, even on cloudy days, patients should take care to use sun protection.

"Even if something is not directly exposed to the sun, we still need to protect it," said Dr. Bajaj. "That means when we are indoors or on cloudy days.  That means daily sunscreen and scar protection is a must."

Numerous stylish clothing and swimwear options now offer SPF protection, but you don't have to invest in a new wardrobe if you wear sunscreen under clothing and follow a few basic rules. Generally, darker colors and heavier fabrics are better at shielding the skin from UV rays. Clothing with a tighter weave also means fewer "holes" for the sun's rays to pass through. Blended fabrics also tend to offer more protection than 100-percent cotton clothing.

Summer scar protection quick tips

Sun protection isn't the only thing patients should be mindful of as summer heats up. Dr. Hadeed shared a few tips to help patients successfully navigate the summer while their surgical scars heal.

"Healing tissue requires systemic hydration," said Dr. Hadeed. "If the patient is dehydrated from the summer heat, their skin elasticity and healing capacity drop. Also, if a scar does get sun-exposed and begins to darken, consult your surgeon immediately. Early laser treatments – like IPL or pulsed dye lasers – can sometimes reverse the pigmentation before it sets."

Dr. Bajaj also reminded patients to be mindful of their sun protection routine.

"In general, the most important thing to do after surgery is remember that skin post-surgery is more sensitive and more likely to burn," said Dr. Bajaj. "This means being diligent with sun protection. Many of us will apply sunblock in the morning and then neglect to reapply after 90 minutes or after getting in the water. The sunscreen will become less effective as it degrades, which means that you MUST constantly reapply."

To recap some of the best tips to help protect your plastic surgery investment this summer, doctors recommend:

• Using a mineral-based sunscreen
• Choosing a sunscreen with a minimum SPF of 30, with 50 SPF being ideal
• Protecting fresh scars with a silicone scar sheet
• Remembering to reapply sunscreen throughout the day, especially if you are swimming, exercising or heavily sweating
• Put sunscreen on scars not directly exposed to the sun, or wear protective clothing
• Stay hydrated

Feel free to show your plastic surgery results to the world, so long as you avoid showing off to Mr. Sun! Your skin will thank you.

To find a qualified plastic surgeon for any cosmetic or reconstructive procedure, consult a member of the American Society of Plastic Surgeons. All ASPS members are board certified by the American Board of Plastic Surgery, have completed an accredited plastic surgery training program, practice in accredited facilities and follow strict standards of safety and ethics. Find an ASPS member in your area.