SCAR…A four-letter word
The scar’s response to injury effectively restores the skin’s integrity. The only problem: Scars are ugly.
Scars are good. They are the body’s response to injury, and they are intended to heal over the injured area for a complete skin cover. Part of the function of skin is to keep what is inside “in” and what is outside “out.” Skin is the packaging of the body. It is our cover, our defense. The scar’s response to injury effectively restores the skin’s integrity. The only problem: Scars are ugly.
I once had a patient who requested that I place a conspicuous scar across one of his cheeks. He wanted a “fencing scar” to look tough, I suppose. I sent him on his way for a psychological evaluation. More commonly, my patients want to avoid scars at all costs.
As a plastic surgeon, scars are always on my mind. I always find myself dealing with two types of scarring, planned and unplanned.
With unplanned scars, the result of such things as accidents, burns, and sub-par surgery, I first must discover what is wrong with the scar. Usually there are three categories of problems.
Generally, wide scars are worse. Many factors affect the width of a scar when healed, but the number one factor is tension. When a wound is pulled together with tension, the scar will widen. If a wound is located over a joint, such as the knee, they widen every time. My job, as a surgeon is to support my repair closure in the strong deep layers so that the tension is addressed beneath the skin, not on the skin itself. This way the surface scar is a fine line that escapes notice.
A scar that is raised or depressed is more noticeable. Raised scars are caused by the over-formation of scar tissue, or more simply—the healing mechanism gone haywire. There are options such as the injection or topical application of steroids. Often if a scar is raised, simply sanding it down with dermabrasion followed by causing it to atrophy with a steroid injection will help. Depressed scars are often caused by a breakdown of the tissue beneath the scar. It’s like the foundation beneath your house collapsing. Once again, surgery can be the answer. Repair of the deep layers is the best option. So we excise (cut out) the scar, loosen all of the connections of surrounding skin and repair it from the bottom up. This procedure creates a solid foundation beneath the scar to prevent future depressions.
The fix for this depends upon what color the scar is relative to the patient’s skin color. Dark scars are often lightened with a laser. Red can be faded the same way, with lasers that focus on the red. We use an Intense Pulse Light or IPL. For width, some lasers shrink tissue and topical treatments with silicone gel, making them less noticeable. For prevention, once your doctor approves, these topical silicone gel products are a great way to “buy insurance” that the new scar will heal unnoticeably. Light colored scarring is a different challenge and harder to blend in. Surprisingly, medical tattooing is often the best solution.
Planned scars refer to the incisions of face-lifts and breast surgery. It is part of my job to locate the incisions and to hide them. But there is a lot more to obtaining predictably discreet scars in plastic surgery. I didn’t become a plastic surgeon overnight, and I earned my experience with thousands of operations.
When planning my incision locations, I look for the patient’s natural folds and crinkles. Healing is generally better when incisions are located in a natural fold, and even if the scar is visible, it can masquerade as a natural fold so it doesn’t scream “plastic surgery”!
I also use the method of surgery called “a-traumatic technique.” Simply put, I handle my patients’ tissue carefully and gently. Every grasp, every touch is carefully executed, and the results of this special care show on the faces of my patients.
Lastly, I avoid suture on the surface of the skin whenever possible. We are all familiar with the crosshatched “Frankenstein scar” pattern. This scar is a result of sutures that are too large, tied too tight, and left in too long. I often close skin with a fine suture that runs just beneath the skin’s surface, which fixes all three problems. The fine line of a properly healed scar tells me I did everything right, and that I controlled all the variables I could. Some things I cannot control, like the patient’s genetic ability to heal well or follow instructions. Unbelievably, some patients misbehave after surgery. They have everything to lose, but they do too much, too soon such as drinking, smoking, and engaging in all kinds of unwise behaviors. Hopefully with pre-operative counseling, these examples are uncommon and the results reflect success!
So, if you have a scar that is of concern, consult a Board Certified Plastic Surgeon and explore your options. You don’t have to live with scaring.
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"SCAR…A four-letter word"
Dr. Andrew Ordon, MD, FACS is a Plastic Surgeon and one of the Co-Stars of the Emmy winning syndicated television series, "The Doctors.” He has two successful practices in Beverly Hills and Rancho Mirage, California and he is a founding member of the...