LAM FACIAL PLASTICS

Dear Doctor, I was listening to your videos
One thing I did not know/wonder.
When there is a wound (any wound, not talking of any specific procedure), I remember you said that if a scab is formed, then the skin will not heal properly underneath it.
So one must not let the scab form in the first place.
When I explained that to a friend, she asked me something I was not sure my answer was right...
She asked me: how do you avoid a scab?
I told her: using vaseline or some emollient all the time
She then asked me: doesn't scab form even if there is an emollient cream on top of the wound?
And that's where I honestly was not sure what to answer.
Doctor, if an emollient is applied above a wound, will the scab NOT form, ever. Or will it form anyway, just not in the fast, "bad" way than can lead to scarring?
And if the scab somewhat formed, anyway, what should people do?
My nephew (a kid) just had a small accident and a scab has formed (I had not seen him until today) in his face (small, yet, as it is in the face, I guess trying not to get a scar is best), right where he has the wound. I told him not to pick at the scab and to keep it moist ... did I say the right thing? What should I suggest him if the scab is already there? I assume taking it off is not good... but since the best (not having a scab in the first place) is something that I can't do anything about... what should I do/tell him/my sister to make him do?

Hugs!

a scab over a small cut is not a big deal. you should just keep it dry actually and let it contract in and fall off. what i am talking about more is surgical incisions as well as widely resurfaced skin from plasma, laser, peel, etc. these should most likely not scab over for optimal healing. small scabs over a small scrape i don't think is a big deal. if someone has an abrasion or cut, ideally keep it moist immediately with an antibiotic cream so that a scab does not form. however, once it forms, you don't want to macerate or wet a dry scab. that may lead to the scab falling off prematurely. at that point when a scab has already formed, just leave it alone and keep it dry and allow it to heal by itself. is that clear?
best,
sml

Oh,very clear! thank you!!! I now know what to tell my sister and my nephew (BTW, his little wound seems to be healing fast!)

You mentioned surgical procedures, lasers, peels, as situations where one really must work hard at not letting scabs form- when you include peels in that category, I assume you mean deep facial peels? (like those one sees need bandages and the like, right?)

Or does that include medium peels?

About eleven years ago (gee, time flies) I had a series of medium-to-deep (think 40% and the last one 70%) glycolic acid peels, and I remember that the dermatologist had told me to not pick at scabs if they formed, but didn't mention I should use ointments to prevent them from happening.

Thank God I only got one "blister" or two at most each time that healed soon and the rest peeled normally.

If the doc didn't tell me to use an ointment over the skin that had just gotten a rather high glycolic peel, was that a sign of negligence on his part? Or was it ok because it was a medium all over peel with glycolic, and, say, not trichloroacetic acid or phenol or some other stronger agent or concentration?

What peels fall into the category of "watch out, avoid scabs": the ones that go deep to the dermis? the ones by some specific peeling agent (or %)? (glycolic, versus malic acid, versus salicylic, tca, etc.).

Where would a small scab over a small but deep cut fall in? My sister (yes, the mother of the one who got the little wound - they certainly had their fair share of small accidents!) had a tiny piece of glass from a broken window cut her skin. The wound was minimal in width, yet very deep, in an arm. I am not sure how it is looking now, but back when she had it, I remember it left her with a scar, small but indented. Not sure how it looks now and I guess in the arm it is not a big deal (she does not mind, I bet) - but I wonder what would have been better if she had tried to avoid a scar forming after that narrow but deep wound.

Hugs!!

You mentioned surgical procedures, lasers, peels, as situations where one really must work hard at not letting scabs form- when you include peels in that category, I assume you mean deep facial peels? (like those one sees need bandages and the like, right?)
YES.
Or does that include medium peels?
YES.
About eleven years ago (gee, time flies) I had a series of medium-to-deep (think 40% and the last one 70%) glycolic acid peels, and I remember that the dermatologist had told me to not pick at scabs if they formed, but didn't mention I should use ointments to prevent them from happening.
HMMM, VERY VERY DIFFERENT STRATEGY. WOULD ADAMANTLY DISAGREE BUT OBVIOUSLY YOU ARE OKAY.

Thank God I only got one "blister" or two at most each time that healed soon and the rest peeled normally.
I AGREE.

If the doc didn't tell me to use an ointment over the skin that had just gotten a rather high glycolic peel, was that a sign of negligence on his part? Or was it ok because it was a medium all over peel with glycolic, and, say, not trichloroacetic acid or phenol or some other stronger agent or concentration?
GLYCOLICS ARE PRETTY WEAK IN GENERAL SO I THINK HE MIGHT HAVE BEEN OKAY. SINCE I DO NOT DO GLYCOLICS (WHICH ARE TYPICALLY DONE BY AN AESTHETICIAN IN A SPA), I SHOULD NOT COMMENT FURTHER.

What peels fall into the category of "watch out, avoid scabs": the ones that go deep to the dermis? the ones by some specific peeling agent (or %)? (glycolic, versus malic acid, versus salicylic, tca, etc.).
ANYTHING IN WHICH THE EPIDERMIS IS OFF AND THE DERMIS IS EXPOSED. READ MY OTHER ANSWER ABOUT DEPTH OF PEELS. ITS NOT JUST THE TYPE AND CONCENTRATION, BUT HOW YOU APPLY IT.

Where would a small scab over a small but deep cut fall in? My sister (yes, the mother of the one who got the little wound - they certainly had their fair share of small accidents!) had a tiny piece of glass from a broken window cut her skin. The wound was minimal in width, yet very deep, in an arm. I am not sure how it is looking now, but back when she had it, I remember it left her with a scar, small but indented. Not sure how it looks now and I guess in the arm it is not a big deal (she does not mind, I bet) - but I wonder what would have been better if she had tried to avoid a scar forming after that narrow but deep wound.
OBVIOUSLY, I DID NOT SEE THE SCAR SO THIS ANSWER IS MERE CONJECTURE. HOWEVER, IF THE WOUND WAS SPLIT OPEN AND DIRTY, THEN I WOULD DO WET TO DRY DRESSINGS FOR A FEW DAYS UNTIL THE WOUND LOOKED CLEAN THEN CLOSE IT, OR IF IT WAS RELATIVELY CLEAN THEN I WOULD COPIOUSLY IRRIGATE THE WOUND AND CLOSE IT PRIMARILY WITH 2 LAYERS. IF IT WERE MORE A DEEP SCRATCH, THEN KEEPING IT JUST MOIST WITH AN EMOLLIENT WOULD BE APPROPRIATE.

Grrreat.
Wish the docs would have been as informative with my sister as you were with me when asking about her situation. Even not seeing the wound, you have "painted" all possible scenarios and explained the approach to each!

glad it was clear for you. thanks for the diligent submissions to this forum.