Understanding Scarring With Plastic SurgeryAugust 28, 2015
Nearly 100 million people acquire new scars every year in the developed world alone, primarily as a result of elective operations. Scars vary greatly, depending on several factors, individual and racial patient features, type of skin, location of incisions, and skin subject to tremendous tension for a prolonged period of time, patient age, the nature of trauma, and the conditions of wound healing. Any number of these factors frequently determine aesthetic impairment and may be symptomatic, causing itching, tenderness, pain, sleep disturbance, anxiety, depression and disruption of daily activities. These problems are more troublesome to the individual patient, particularly when the scars cannot be hidden by clothes.
Virtually all tissue in the body, when injured, will repair with a scar. Scarring is the body’s natural way to heal an open wound or cut. The growth of new tissue and collagen closes and seals the wound while cleaning out dead skin and blood cells begin to form a scab. Hypertrophic scarring is characterized by wide, raised scars that remain within the original borders of injury. When a scar appears firm, elevated and continues to grow extending beyond the original borders it is called keloid scarring.
Ways to reduce scarring
- Discuss with your surgeon the planning and placement of incisions for your surgery
- Be dedicated to care for the area of incisions by keeping clean and dry to avoid any infection
- Closely follow the instructions of your surgeon throughout the entire healing and recovery process
Several treatment and prevention methods for surgical scarring are available today. Among these methods, silicon has typically been considered a standard noninvasive approach. Silicon sheets and topical silicone gel have been reported to reduce scarring because of reducing tension. Silicon has been produced in several forms, including silicone cream compounds; silicone oil or gel, with additives such as Vitamin E. In addition, for some patients, corticosteroids and massage therapy are used when indicated.
Your surgeon will decide on what scar and healing program is right for your specific needs in order to obtain an optimal outcome. Scar and healing management is an ongoing process over a course of at least 3-6 months after surgery that is managed by your surgeon.
My approach as a plastic surgeon and post bariatric patient
As a plastic surgeon, post bariatric patient (Gastric Sleeve performed in May 2012) and also as an after weight loss plastic surgery patient (Lower Body Lift/Circumferential Tummy Tuck, muscle repair, liposuction and fat transference to buttocks and hips), I will share with you my approach in regards to scarring, healing, symmetry and perfection in plastic surgery.
It will be completely normal in the incision areas to have some pain, tenderness, redness and oozing of blood/pinkish or clear liquid in the first stages of the healing process (1-3 weeks), as the body provides a stream of protein, amino acids, white blood cells and water to rebuild the area. After that period the incision pain is definitely less, redness will continue, becoming pinky in light skin patients and somewhat darker and a little wider in darker skinned patients. Incision/scars remain stiff with very little flexibility for about 1-2 months. As the skin dries it causes a scab as a protective barrier which falls off when the wound is fully healed. The skin maybe red or pink, but will fade to a flesh color with time. Since each patient is different, this will be the perfect time to evaluate and start the therapy I recommend for my patients' individual needs.
As a surgeon, I have developed several measures to improve the scarring of my patients with tension-free stitching as key. I use non-absorbable stitching in the very deep layers of the tissues (which will never be visible or touchable and very rarely a cause of stich reaction). After the period of fibrosis, the deep layer tissues remain in the exact position they were left, relieving tension from the superficial tissues, dermis and epidermis (skin), obtaining a result of very nice and thin scars. After the scabs fall off (approx. 4 weeks), patients are instructed to massage every scar in a firm (not hard) circular manor as this will improve the healing process.
One of a plastic surgeon's goals during surgery is the planning and positioning of the incisions so both patient and people who she/he interacts with, will not see the hidden scars.
FACE and NECK LIFT: I place the incision before the hairline in a zig-zag shape in order to become almost invisible, then I follow all of the ear creases, behind the ear lobe and before the hair line again where even short hair will hide the scar. I use an Inverted “V” shape incision to follow the jaw line under the chin eliminating a visual scar.
ARM and LATERAL TORSO LIFT: Because we interact with people face to face, I place the incision on the extended arm, in a horizontal line, where my patient will not see her/his own scar. However the incision will be seen on the back part of the arm if someone is behind the patient. I place the lateral torso incision following the natural curve of the lateral breast area hidden in the contour.
UPPER BODYLIFT/BACK LIFT: I place the incision following the brassiere line in order to be hidden under the bra and this line may be continued to the inframammary fold in cases with a breast procedure or frontal upper body lift.
LOWER BODY LIFT/TUMMY TUCK: I place the circumferential incision 6-7 cm above the genitalia, over the groin fold and right on top of the intergluteal fold (butt crack) thus improving the lower back, abdomen, thighs and buttocks hiding the scar, allowing my patients to wear with confidence a bikini, low raise jeans or crop tops.
THIGH LIFTS: Depending on the procedure, the groin incision is kind of a tricky area although it is a hidden area it may result in a conservative result, pulling down the labia or genitalia skin may slightly widen the scar. Vertical TL incision will be placed in a horizontal line in order that the patient is not aware of her/his own incision. It can be seen from the back.
How a plastic surgeon can avoid asymmetery after surgery
I am a very tough and inflexible judge with my own surgical results and one of the most important goals is that the end result will be to achieve the closest to perfection and symmetry of the scarring. At the end of the surgical procedure, myself and my team will visually examine and evaluate the symmetry of each incision at different angles. If it is determined that any area of the incision needs to be fixed, it can be done immediately while the patient is still in the operating room. Definitely the pre-op and the trans-operative planning are key to avoid asymmetries and irregularities for our patients.
It is important to talk to your surgeon about any questions or concerns you have before your surgery. Part of your conversation with your surgeon is about your surgical procedure but should include scarring issues so both you and your surgeon are clear about scars after your surgery.
Photo credit: wikimedia cc
ABOUT THE AUTHORDr. Carmina Cardenas is a Board Certified Aesthetic, Plastic and Reconstructive Surgeon. She completed her residency and graduated with honors from the Mexican Institute of Social Security, at the Hospital of Specialties in Plastic and Reconstructive Surgery. She is owner of Beauty Enhance Plastic Surgery.
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