Cosmetic Surgery Tips and Tricks
Tips to getting the best scar outcome after surgery
Leesburg | Loudoun | Ashburn | Virginia
Sometimes, despite the best conditions, scars will develop and appear abnormal. The goal of your plastic surgeon should be to create the best possible conditions for you to have the best appearing scar after your surgery. The general principles of creating the best possible scar include:
- Gentle handling of the tissue during the surgery
- Surgically creating conditions where there is little to no tension on the scar
- Placing deeper skin sutures that take the tension on the superficial skin
- Placing more superficial subcutaneous or external sutures that get the skin to kiss
- Protect the immediate skin closure with surgical tape
- Applications of medical grade ointments that are lubricating and contain Vitamin E , Silicates, and or sunblock.
- Application of silicone sheets that can lubricate and apply pressure
- Profractional Laser treatment to address any irregularities to blend the tissue
- application of a protective surgical tape on your incision for the first 1-2 weeks after your procedure. The surgical tape protects the incision from the outside environment while also maintaining a lubricating environment for your scar.
- Apply a lubricating scar ointment ( we use biocorneum) for the next 1-3 months. Ideally the ointment contains vitamin E, silicates, sunblock, and a gentle steroid. Our preference is biocorneum because it contains all of these elements in an easy to use pump applicator.
- Apply a silicone sheet for the 1-3 after surgery. Many patients will just use the sheet at night and use the ointment during the day.
- Steroid injection into the scar if it remains raised after 6 months
- Profractional laser remodeling if it remains raised or conspicuous after 6 months.
Patients will often wonder what is so special about how plastic surgeons create better scars than other types of doctors including dermatologists, their primary care doctors, or emergency room doctors that took care of their lacerations.
The equipment available to each type of doctor is the same. The difference is the understanding of plastic surgeon of how to create the right conditions for the ideal evolution of scar healing.
In general, the surgical principles include :
Creating conditions with less tension. Decreased tension is created by
- Elevating the tissue on each side and bringing the tissue closer to each other.
- Orienting cuts along normal tension lines. If a cut is on an extremity for example, there is normally less tension if the cut is oriented along the axis of the extremity. Or if it is in the face, placing the scar in line with the wrinkles.
- Avoid circular incisions. This appears to be the main problem seen after dermatology biopsies. Circular shave incisions are faster and more lucrative than creating a linear excision.
- Create zigzag incisions where possible. Zigzags distribute tension more evenly than even linear incisions.
- Placing deep dermal skin sutures that absorb over a period of about 4 weeks. Deep sutures take the tension off the superficial skin
Scars are never guaranteed. Scars, even under the best of circumstances may not heal consistently. Variables that affect how your scars will heal include:
- genetic predisposition to healing. Red heads and patients with dark skin for example will not heal as consistently as patients who are white caucasians who are blond.
- sun and environmental exposure. UV exposure, exposure to toxins, or dry environments are all detrimental to optimal scar development.
- scar care after your surgery will make a big difference in creating optimal scar development. Efforts to keep you incisions lubricated with protective tape initially followed by lubricating ointments, vitamin E, silicates, or sun block will help. Silicone sheets help scar healing by applying a lubricating environment to the scar while also applying gentle pressure on the incision.
Your plastic surgeon performed a perfect surgery. The goals now are to protect the healing around the surgery and creating the least conspicuous scar possible.
Steps you should take to create the best scar for you include:
application of a protective surgical tape on your incision for the first 1-2 weeks after your procedure. The surgical tape protects the incision from the outside environment while also maintaining a lubricating environment for your scar.
Apply a lubricating scar ointment for the next 1-3 months. Ideally the ointment contains vitamin E, silicates, sunblock, and a gentle steroid. Our preference is biocorneum because it contains all of these elements in an easy to use pump applicator.
Apply a silicone sheet for the 1-3 after surgery. Many patients will just use the sheet at night and use the ointment during the day.
See the above questions and answers about scars. In brief:
Both doctors and patients will often mistake a bad scar for a keloid.
A keloid is actually a medical condition that is often genetic in nature. Certain ethnic groups are predisposed including patients of color and patients with Irish backgrounds. Keloids tend to be thick, raised, and will often develop a cauliflower appearance. Because it is a genetic condition, if a keloid develops on one part of the body, any additional cuts in other parts of the body will also be predisposed to developing additional keloids. Because it is a genetic condition, cuts anywhere on the body will be predisposed to developing a keloid
Hypertrophic scars are simply bad scars.
Hypertrophic scars are simply bad scars that can show some features of keloids. They can be raised, thick, and itchy. They, however, do not appear to be genetic; and having a hypertrophic scar in one area dis not predispose you to having hypertrophic scars in other areas.
Raised or hpertrophic cars depends on the degree of hypertrophy.
Significantly large, wide, or thick scars will usually need to be cut out and re-sutured with meticulous attention to decreasing tension, placement of deep dermal sutures, and special attention to approximating the superficial skin with small sutures
Less significant scars that are only slightly raised can be addressed with injection of a steroid directly into the scar. Steroid injection will flatten the scar by decreasing the inflammatory process as well as break down some of the thickened abnormal collagen. This can be performed with or without remolding the scar with a profractional laser.
Even less significant scars that are already flat, but appears too visible in contrast to the surrounding skin can be addressed by using a profractional laser to blend the scar to the rest of the surrounding tissue.
Red or wider scars can be addressed by applying a topical steroid and bleaching agent with moderate success
The car can also be blended to the surrounding skin to some extent with a profractional laser.
Particularly wide scars will benefit from surgical excision if it can be performed with minimal tension.
Zig zag scars are commonly referred to as a Z-plasty. I use them for forehead lifts, incisions where I foresee a lot of tension, or over joints such as shoulders, knees, and elbows where tension can usually be expected.
The zig zag pattern improves the appearance of scars because zig zags are less conspicuous than straight lines or circles. Zig zags also redistributes the tension in multiple direction. And as expressed previously, less tension predisposes to better scars than scars under more tension.
Every cut will show a scar.
With this fact in mind, the objective of the plastic surgeon is to create the best appearing scar and the best hidden scar possible. Plastic surgeon will try to hid the scars in normal body creases, inside clothing landmarks, and inside the hair lines.