Care of the Surgical Incision

The thyroid gland is a butterfly-shaped endocrine gland that is normally located in the lower front of the neck. The thyroid’s job is to make thyroid hormones, which are secreted into the blood and then carried to every tissue in the body. Thyroid hormones help the body use energy, stay warm and keep the brain, heart, muscles, and other organs working as they should.

Your incision will be located on the front of your neck. It is often possible for your surgeon to place the incision in an existing skin crease. As the scar heals, it will appear to be part of the crease and thus camouflage it.

This is largely dependent on how big your thyroid is and how extensive a surgery is required for removal. You may ask your surgeon how long they expect your incision to be. In general, most incisions will be between 1.5 to 3 inches long.

This is also surgeon dependent. You may have a gauze pressure dressing around your neck. Your doctor will give you instructions on when to remove it. You may have stitches in the incision that will need to be removed in 5-7 days, or you may have dissolvable stitches that do not require removal. If your incision has been closed with dissolvable stitches, you will likely have either skin glue or paper tapes (Steri-Strips) covering the incision.

You may have a drain in your incision, which is usually removed after 24 hours.

You can shower the day after surgery, or after any gauze dressing is removed, if present. While the surgical area can get wet, you should avoid getting excess water or moisture on the incision or vigorously scrubbing the area. Make sure to pat the area dry if it does get wet. Do not submerge the incision under water (swimming, for example) for at least 2 weeks or until instructed otherwise by your surgeon.

Scars usually take about 12–18 months to fully mature. During that time, they go through a remodeling process. Many scars that are unattractive in the first few months may greatly improve over the course of a year. In the first few months, they may be pink and raised (hypertrophic) and then soften, flatten and lighten over the remaining 9–10 months. Scar tissue is not as strong as normal skin, and therefore, depending on location, direction and tension, it may widen over time, no matter how carefully the wound was closed. Some scars may even remain permanently thick (hypertrophic) or form an excessive amount of scar tissue (keloid) despite best efforts to minimize scarring.

There are many ways to treat a scar: the most important things to remember are time, sun protection, and massage.

• Time: Since scars naturally improve over 12–18 months, you may just need to be patient.
• Sunscreen: It is very important that all scars be protected from the sun. Scars that become sunburned will remain red and unsightly for a long time, and perhaps even permanently. It is very important to use sunscreen on all scars, especially new, immature scars. Sunblocks which contain Zinc Oxide or Titanium Dioxide are preferred as these physically block the sun rather than rely on chemicals to absorb UV radiation. Also, since they are not chemicals, they tend to not irritate healing incisions.
• Massage: Gentle massage can help flatten the scar tissue, creating a smoother appearance. You can use Vitamin E oil, cocoa butter, skin cream or more expensive brand-name products (such as Mederma) to lubricate the skin during massage. However, none of these moisturizers have been proven to improve scars. It is more likely that the pressure from the massage itself helps to flatten the scar. Remember to massage your scar daily for at least 2 months.

In general, massage can begin about two weeks following surgery. By this time, any stitches should have been removed and any remaining dressing or Steri-Strips over the incision can be removed.

If using a moisturizer such as Vitamin E oil, cocoa butter, or scar cream, place a small amount onto the scar. Rub in a circular motion with your fingertip. Use steady pressure along the entire length of the scar. The area may be sensitive to touch at first. Slowly increase the amount of pressure with massaging.

There are several other treatments to consider, although not all will be appropriate for every scar, nor are they necessary for your scar to heal well.

• Silicone Rubber: Silicone rubber is one of the most effective forms of scar therapy. Silicone products help raised (hypertrophic) scars flatten and lose their redness faster than untreated scars. We don’t fully understand why silicone improves scars, but studies have shown that using silicone is better than leaving scars untreated. Silicone sheeting, tape and gel can be purchased at many local pharmacies. You can also find silicone products online. Look for products which are made mostly of silicone. All of these products should give you similar results. A variety of products are available:
  • Silicone sheets (such as those from Biodermis, Rejuveness or Spectra film) or silicone tape (such as Mepitac or Safetac available from Amazon.com) have a light adhesive backing, can be cut to the correct size to cover the scar, and should be worn daily for 3-4 months.
  • Silicone gel (such as Kelocote or Spectragel) is a thick, clear gel that comes out of a tube and may be preferred for scars on the neck. It should be applied twice daily for 3–4 months. Longer periods of time may be needed if the scar remains red and elevated.
• Lasers: Scars that remain pink and raised may respond to pulsed yellow dye laser therapy. The light is absorbed by blood vessels in the scar and may result in softer, lighter scars. At first the scar will appear darker due to bruising caused by the rupture of the blood vessels. This bruising will fade over 2–3 weeks. It may take at least a full month to see if the laser treatment has been effective. Several treatments may be needed for best results. Lasers are usually reserved for scars that are still pink after 12–18 months.
• Steroid Injections: Kenalog (triamcinolone) is a longacting local steroid injection that works to soften and may help to shrink hypertrophic or keloid scars. It takes at least one month for the steroid medication to be completely absorbed, so injections are usually spaced 4–6 weeks apart. A series of injections may be needed for best results. Your doctor will decide if these injections are a good choice for you.