Plastic surgery involves incisions through the skin and how the skin scars and heals is one of the great unknowns that continue to challenge patients and plastic surgeons alike. Even we physicians are at a loss at times, in trying to figure out the variability we see. Some patients heal with barely a line visible afterwards, whereas others struggle even after multiple touch ups and revisions. And there can be some areas within the same incision that heal better than others, all on the same patient. It can be such a frustration for patients and on more than one occasion I have had patients point to a lumpy and bumpy scar, being very quick to blame the previous surgeon. But there are multiple factors that can play a role and unfortunately there is not one great secret that holds the key for all.
No doubt that the physician's ability has a lot to do with scarring. Incision size and location certainly play a part as do careful skin closure techniques. But it has been my experience that almost all board certified plastic surgeons have had more than enough training to acquire basic suturing skills. I have seen some poor scarring as a result of over-activity shortly after surgery that either causes the skin to separate or puts enough tension on the skin to widen the scar. Some areas of the body seem to scar worse than others. Thicker skin, like on the back or chest can scar worse, or areas over a joint like the knee or elbow. Environmental factors such as sun and water can also play a role in delayed healing or color change. Poor nutrition, steroid use, and certainly smoking can alter the ability to form an acceptable scar.
But there is probably no greater influence than the patient’s own genetics. Some people just simply do not scar well. Some patients seem more reactive to certain suture material than others and we do know that darker skinned individuals are more prone to very thickened and wide scarring. Unfortunately, a patient may have a barely noticeable scar from a C-section, only to develop an unsightly scar from a tummy tuck.
Treatment of scars is still a work in progress and great efforts are being made to find the one best approach. For now, hydration, massage and protection seem to make the biggest difference. Silicone sheeting and scar gel products are the most widely used at present, over older treatments of Vitamin E (which has never been shown to help) or vegetable-based topical products. And of course…time. Many scars can look very worrisome at 3 months, only to be barely noticeable at one year. I like to give plenty of time for the body to “do it’s thing”, and then re-group at close to one year. As a last resort, I always offer to my patients the option of surgical scar revision, and as many times as needed until a satisfactory outcome is obtained. This is usually done in my office under local anesthesia, and at no charge, and I am more than happy to try as many times as a patient wants until we get the bests result possible for that individual.
So until more science lends a hand, the term “Scarless Surgery” will remain the oxymoron that it is! If you would like more information on scarring after plastic surgery, please contact Scottsdale Plastic Surgeon, Dr. Corey for an individualized consultation. We proudly serve patients in Scottsdale, Phoenix, Gilbert, Mesa, Chandler, Tempe and other nearby areas throughout Arizona.