We offer help with the difficult decisions about how to treat skin on a day to day basis. Sunscreen and skin moisturizer advice, cleansers and lip protection are handled in a down-to-earth, no- nonsense manner. A selection of reasonably priced products for these purposes are available from the Centre, without promoting unnecessarily pricey, private name products.
All surgical procedures result in scars. One of the main skills of a plastic surgeon is in control of scar formation. We don’t do this with magical potions or lotions which make scars disappear. We can’t do surgery without scars. We do this by carefully choosing incision location and pattern, by gently handling the skin with fine, specialized instruments, and by the skillful and careful repair of surgically or traumatically created incisions and wounds. The degree to which we are successful in minimizing scars varies with a lot of factors.
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Reducing the appearance of Scars
The development of minimal incision, or endoscopic surgery, is a significant advance in reducing scars for some operations.
Much of how much you will form scars, however, depends on the location of the incision, and your racial and genetic pre-disposition to scarring. People with black African and yellow Asian skin are especially prone to excess scarring, and incisions must be very carefully planned, and less inconspicuous results have to be expected.
Normal scar formation proceeds along a rough schedule. During the first few weeks, the scar develops some strength. It usually looks a little pink when the stitches are removed, but is flat. From about three to six weeks, it becomes thicker and often redder, as it gains collagen protein, and it looks its worst during this phase. Then maturation begins, and this may take from six to eighteen months, or even longer. During this phase the scar continues to get stronger but gradually flattens, softens, and becomes pale.
Location plays a key role in the outcome. Incisions in the upper eyelids, the lips, the groin, and the armpits are especially good, while incisions in the centre of the chest, upper back and the upper outer arm are particularly prone to bad scars. The face, in general, tends to form good scars, if they are properly planned.
Unsatisfactory scars are either thicker, wider, depressed or raised, uneven or running in a different direction than the normal skin lines.
Keloids are scars which are very thick, angry looking, red to purple, and continue to grow beyond the borders of the original wound or incision. For example, I occasionally see patients with large masses of scar on the chest from minor acne pustules, and on the arm from vaccinations.
Hypertrophic Scars, on the other hand, are scars which have become thickened during the normal healing period, but do not go beyond the original wound edge. They usually settle somewhat, over a longer period than the time needed for a normal scar.
There are many misconceptions about what can be done about scars, and when things should be done. Generally, no surgery should be done to revise, or attempt improvement of the scar, until maturation has occurred. Revision is generally done to even out the level of a scar, improve the orientation relative to the normal skin lines, or narrow it.
Keloids and hypertrophic scars can be difficult to treat. Patience is usually the best treatment for thickened but non-keloid scars. Vitamin E and Aloe Vera extract may make the scar look better during the maturation phase, but studies have not shown that they affect the final result. Vitamin E may retard healing if it is used during the early post-operative period (three weeks). Many other drugs and agents have been and are being investigated but none has proved to be better than time.
Injection of thick scars or keloids with cortisone-like drugs may be helpful in many cases, but this has some side effects and should not be used for scars that are only somewhat thick during normal wound maturation. Pressure has been used for many years for burn scars, and recently has been combined with silicone sheeting laid directly on the scar. Pressure is applied by a variety of means, usually by the use of custom elasticized garments, worn twenty-three or more hours per day for months. Used alone or along with pressure, silicone sheeting has shown some success, and some surgeons now advise it routinely for certain incisions, such as breast lifts and breast reductions, and for tummy tuck incisions. It must be used twenty-three hours daily as well and many patients find this to be intolerable, preferring to allow the scar to settle on its normal schedule. A compromise which seems of some value is taping with a light paper hypo-allergenic tape. This allows showering and is well tolerated, so is the treatment I usually advocate.
In extreme cases, keloids have been treated with low dose radiation therapy, combined with the other methods described above, but with variable success.
It is unusual to have keloids result from surgery for people with light skin colour, and keloids are rare in cosmetic surgery in general. The location of incisions is carefully and electively chosen, careful technique is used, and most people who may be susceptible to keloids can be warned in advance.