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Post Operative Scar Management

One of the most commonly asked questions in the course of plastic surgical consultation is, is this going to scar? And the answer is yes it is going to scar because that's how our body heals. Whether we make an incision in the brain or the heart or the bowel or the skin or the fat it all heals the same way, by scar formation but in cosmetic surgery the appearance of the scar is very important because people are looking for an enhanced appearance. So we're very much more tuned in to scar formation than we would be in other parts of the body or for different types of procedures. Scar formation has many different components as to the cause. Some people have a genetic predisposition to scarring, so it's important for us, when we see a new patient, to ask them, do you have any other scars I can see to see how you heal? That's usually a pretty good indication. Sometimes patients with darker skin are afflicted with what's called keloid formation, which is a particularly bad type of scar. The keloid is a scar that continues to build up scar tissue beyond the confines of the wound and in that case, it's very good to know coming into it because certainly the patient is at risk for that type of formation afterwords. It might be good, in that situation, to not operate at all. That would be the surgical technique, one of the most important things in surgery is, do no harm. Another mandate we have is, to handle the tissue gently. By nature surgery is an injury. We feel the injury is beneficial, if it's done properly but if we handle the tissues roughly we can create more tissue damage and more scaring so gentle handling of tissues is very important. The location of the scar and the orientation of the incision are very important also. Those things are taken into consideration when we perform any type of surgery. The next thing we think about is wound healing after we've made that incision. It's very important for us to close that wound as perfectly as possible so that when we leave that operating room we have a fine line scar set up. As time goes on, if any type of infection occurs or any kind of wound separation, we're going to have a less than desirable scar. Preventing those problems is very important, not only for the surgeon, but for the patient and the post operative management and adherence to the instructions we give after the operation. Finally, the other problems we see when we do see a scar that's starting to widen or thicken, we can inject that occasionally with a steroid. This type of injection doesn't give the patient the look of a person on steroids, it only affects the wound but in many patients it can thin that scar to some degree and settle it down. If that happens and we see the scar responding to steroids, we might consider a scar revision in the future, knowing that that patient does respond to the steroids and if we create a new scar that we don't like we can start the steroid injections early or maybe start it right at the conclusion of the operation to help prevent a scar. We have a new product today that we offer to many of our patients after surgery, that's called Embrace. Embrace is a system that is intended to take away the tension of the wound so that it can heal with more of a fine line scar. It's an additional cost to the patient, we offer it to the right patients after surgery. When I say the right patients, some parts of the body don't lend themselves to the Embrace system but typically a tummy tuck or some type of breast surgery would be a good candidate for that. In summary, as we look at post operative scar management, the most important thing is to start selecting the patients properly. If we have a patient who always has a bad scar develop despite the best efforts of the surgeon, it might be wise to not perform that operation. The next thing is the performance of as perfect an operation as we can. We strive for perfection, we can't promise that but if we handle the tissues gently and think in terms of decreasing the trauma to the wound then we can hopefully decrease scarring. Post operatively, we'll do everything we can to prevent any type of infection or wound breakdown but if that does occur and after healing is obtained and if the scar is undesirable, we could consider a scar revision. If a patient has a thickened scar as we mentioned earlier, we can start with some steroid injections and if they do respond to the steroid injections we would regard them as a reasonable candidate for revision with the understanding that we would start the injections shortly after the revision. The most important thing that the patient can do is follow our directions to help maintain a clean, healing wound and hopefully prevent any type of wound healing problems. If you’d like to schedule a consultation, fill out the contact form on this page - https://www.surgicalimages.com - or call (402) 390-0100. 8900 West Dodge Road, Omaha, NE 68114 4508 38th Street #120, Columbus, NE 68601