Am I Going To Have A Scar? Tips From A Plastic Surgeon

By
jaryeth.basco

/ February 2, 2018

Whether I am seeing a patient after a chain saw accident in the emergency department or in consultation for a tummy tuck one of the most common questions I am asked as a Plastic Surgeon is “ Am I going to have a scar?”   The quick answer is YES.  Whenever an injury goes through the second layer of the skin (the dermis) a scar is formed.  OK, so now you know the answer no matter what injury, procedure or surgery you have it will leave a scar if the dermis is injured.

So the next question is how visible or “bad” will the scar be.  This depends on a multitude of factors.  First the nature of the injury will in part determine how the resultant scar will look.  A sharp cut with a knife or scalpel will leave a much less noticeable scar than a crush injury that results from a fall or motor vehicle accident.  Crush injuries that result in open wounds do so because the skin has been crushed or scraped to a point that is can no longer handle the force so it splits or tears. Unlike a cut from a blade or sharp object where the location of the skin cut is the only injured area, the area or injury from a crush extends for a good distance around the open wound, this often leads to poorer wound healing and a more visible scar.  Contamination of the wound with dirt, gravel or other substances can lead to infection or traumatic tattooing and therefore a more visible scar.  Age and overall health status also play significant factors in wound healing.  Children heal very quickly which is good but can lead to prolonged redness of scars or hypertrophic scarring.  Elderly people heal more slowly and with less inflammation therefore in general produce less visible scars. Factors such as smoking, diabetes, family history of keloid formation and certain medications can inhibit wound healing result in worse scarring. Also some patients just tend to produce more visible scars.  Finally location of the injury on the body can also affect the final appearance.  Injuries or wounds over joints or high tension areas of the skin can result in more visible scars due to spreading of the scar.  This is one of the reasons why incisions over joints are typically oriented longitudinally and not transversely.

The logical next question patients ask  is what can be done to improve scarring or make the resultant scar less visible. The good news is there are many things that can be done to improve the final appearance.  The first and often most important step to improved scarring is appropriate closure of the wound.  This often but not always means stitches (sutures is the medical term) .  Does it need stitches? Well depends what you mean by the word need.  Many wounds wound heal without stitches but would take much longer to completely heal, have a higher risk for infection, and leave a horrible looking scar.  So if you want the best possible chance of having the least noticeable scar the answer is often yes it will need stitches.  Placing stitches (sutures) re-approximates the edges of the wound  which helps in two ways.  If the wound is gaping then the stitches will bring the wound together so that your body does not have to fill in the area in between the wound edges and will therefore heal quicker.  The second aspect is to stabilize and realign the appropriate tissues so they heal to each other.   It’s not just the stitches though, it is how they are placed, what type of sutures are used (there are over 20 different types of suture material), and how many layers of stitches are placed. Other factors at the time of repair that have an effect on wound healing include cleansing of the wound removal of contaminants, preparation of the wound by trimming crushed skin edges as needed and many other factors.

After the repair of the wound or surgical incision healing has just begun and by providing the right environment for healing scarring can be minimized.   Wounds for the most part heal better in a moist environment which can be obtained with a variety of dressings and bandages.  Vaseline or petroleum jelly based antibiotic ointments are easy to obtain and apply, and can increase the speed of healing due to maintenance of a moist environment.

Scars mature over the course of 6 months and sometimes up to one year.  So that means final appearance can be influenced for six months up to one year. Several treatments have been shown to improve the final appearance of scars in scientific studies when used within this time frame.  One the best proven ways you can help is to protect the area from the sun.  The injury or incision site will be sun sensitive for 6 months.  Either covering the area or using a SPF 30 sunscreen daily and a SPF 50+ for intense sun exposure every day for six months will make a significant improvement in scarring.  Unprotected exposure to the sun even if just with daily activities will lead to discoloration or redness of the scar.

Silicone has been shown in research studies  when applied near continuously (24hrs a day except while showering) to an injury to significantly improve the final appearance of scars.  Silicone scar strips are great for areas where they will adhere and stay in place, most often on the torso.  They are now made with opaque backing which will block the sun if used in a sun exposed area.  The downside is that as stated they need to be in place nearly 24 hrs every day which is difficult on the face or extremities.  In these locations I prefer a silicone scar gel which is typically applied twice a day make sure the area being treated has silicone on it nearly 24hrs a day.   Unfortunately not all silicone scar gels are created equally.  Also if you do not use one that has a sunscreen in it.  You will need to add a layer of sunscreen over the silicone gel as the gels do not block UV.  I prefer Silagen scar gel with sunscreen. Silagen has been shown to adhere to the skin strongly giving 24hr coverage when applied twice daily and also contains a non chemical sunscreen safe for children and those with sensitive skin.   I recommend to apply an additional coat of SPF 50+ sunscreen and to re-apply this as directed for intense sun exposure such as outdoor sports or beach activities even when using the Silagen with sunscreen.

Finally just massaging the area of injury  with anything from cocoa butter to emu oil has been shown improve the final appearance of the scar.  It is not really the product at all but the actual mechanical force of the massaging that improves the appearance.  Massaging 2-3 times per day 10-15 min is usually what I recommend but the more often the better.

If you have done all of the above or none of the above and still are not pleased with the appearance of your scar,  don’t worry there are options.  While not all scars can be improved, most can even after they have matured.  While it is preferable to do everything possible to achieve the best outcome during the maturation period of your scar.  Lasers, dermabrasion, chemical peels and surgical scar revision can significantly  improve the appearance of scars but can never erase them.  Schedule a consultation with a Board Certified Plastic Surgeon if you wish to discuss options to improve or treat scarring.  The best way to prevent scarring is to practice appropriate safety precautions when possible.  Stay Safe .

Raymond Jean MD  Board Certified Plastic Surgeon  Main Line Plastic Surgery  www. mainlineplasticsurgery.com  484-222-0010

Cuts on the Face Closed With Stitches: Care Instructions

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Overview

A cut on your face can be on your chin, cheek, nose, forehead, eyelid, lip, or ear.

The doctor used stitches to close the cut. Using stitches helps the cut heal and reduces scarring. The doctor may also have called in a specialist, such as a plastic surgeon, to close the cut.

If the cut went deep and through the skin, the doctor may have put in two layers of stitches. The deeper layer brings the deep part of the cut together. These stitches will dissolve and don’t need to be removed. The stitches in the upper layer are the ones you see on the cut.

You will probably have a bandage.

You will need to have the stitches removed, usually in 3 to 5 days.

The doctor has checked you carefully, but problems can develop later. If you notice any problems or new symptoms, get medical treatment right away.

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It’s also a good idea to know your test results and keep a list of the medicines you take.

How can you care for yourself at home?

• Keep the cut dry for the first 24 to 48 hours. After this, you can shower if your doctor okays it. Pat the cut dry.
• Don’t soak the cut, such as in a bathtub. Your doctor will tell you when it’s safe to get the cut wet.
• If your doctor told you how to care for your cut, follow your doctor’s instructions. If you did not get instructions, follow this general advice:
  • After the first 24 to 48 hours, wash around the cut with clean water 2 times a day. Don’t use hydrogen peroxide or alcohol, which can slow healing.
  • You may cover the cut with a thin layer of petroleum jelly, such as Vaseline, and a nonstick bandage.
  • Apply more petroleum jelly and replace the bandage as needed.
• Avoid any activity that could cause your cut to reopen.
• Do not remove the stitches on your own. Your doctor will tell you when to come back to have the stitches removed.
• Be safe with medicines. Take pain medicines exactly as directed.
  • If the doctor gave you a prescription medicine for pain, take it as prescribed.
  • If you are not taking a prescription pain medicine, ask your doctor if you can take an over-the-counter medicine.

When should you call for help?

Call your doctor now or seek immediate medical care if:

• You have new pain, or your pain gets worse.
• The skin near the cut is cold or pale or changes color.
• You have tingling, weakness, or numbness near the cut.
• The cut starts to bleed, and blood soaks through the bandage. Oozing small amounts of blood is normal.
• You have symptoms of infection, such as:
  • Increased pain, swelling, warmth, or redness around the cut.
  • Red streaks leading from the cut.
  • Pus draining from the cut.
  • A fever.

Watch closely for changes in your health, and be sure to contact your doctor if:

• You do not get better as expected.

Where can you learn more?

Go to https://www.healthwise.net/patientEd

Enter Z635 in the search box to learn more about “Cuts on the Face Closed With Stitches: Care Instructions”.

How to get rid of scars – information materials from the clinic’s specialists

03.03.2023, 15:44

Scar or scar is a fibrous connective tissue that, in the process of regeneration of damage, replaces an area of ​​previously healthy skin. Deciding how to get rid of scars on the body, they go to the clinic and the cosmetologist chooses a way to solve the problem.

What types of scars are there

All scars and scars are divided into several types.

1. Atrophic. Looks like dips and dimples on the skin. Such defects appear from smallpox, chickenpox and as the consequences of acne (if the pimple was infected or severely inflamed). Striae (stretch marks) also belong to the same species.
2. Keloid. Occurs when excessive collagen production occurs at the site of injury. As a result, scar tissue grows outside the wound, even after it has healed. These scars do not change or diminish over time and look like red, firm ridges. You can get rid of them after the end of growth.
3. Normotrophic. Scars of this type are located on the same level with the skin and are formed after a minor injury, which may be a minor injury, a pimple with slight suppuration, or an incision that does not require stitches. Red in color, they brighten over time and become barely noticeable.
4. Hypertrophic. These scars appear in the case of pathological scarring, most often after surgery, or if there has been a deep cut. Causes – infection of the postoperative wound and surgery on a skin area under significant tension. There is also a high risk of their formation, when the tissues are strongly contracted when the incision is sutured. The scar is bright in color, high, later it turns pale and smoothes out.

How scars form

The wound surface is first covered with protective crusts. Under them, soft granulation tissues are formed, which are gradually replaced by connective fibrous tissue produced by fibroblasts. In the place of damage, they actively work for 3-4 months. As a result, the scar begins to rise above the skin. At the same time, blood vessels are actively formed in the tissues, from which the problem area becomes red. Later, it brightens and decreases, as the excess collagen is destroyed and the number of capillaries decreases. From this moment, you can begin to get rid of the scar.

What are the methods of removing old scars

Modern cosmetology offers various ways to solve this problem. Depending on the condition of the scar and its volume, the removal takes place in one or more stages. If you follow the rules of skin care complications do not occur.

Surgical

This method removes old scars from a burn, injury or incision. Depending on their size, the procedure is performed under local anesthesia (more often) or general anesthesia. First, the scar is cut off, the edges of the resulting wound are connected and sutures are applied with special, very thin threads. The cut is just below the level of the skin. The stitches are removed after 3-4 days. Then, within a few weeks, following all the doctor’s recommendations, they undergo a course of physiotherapy or cosmetic procedures.

Injectable

In this case, the scars are filled with lipofillers, hyaluronic acid or collagen. Before injection, the site is treated with an anesthetic and the drug is injected. Then the antiseptic is applied again. In the first days after the procedure, you should not touch the treated skin, stay in the sun and overheat. As the fillers are removed, the resulting cosmetic effect will decrease.

Physiotherapy

The method includes hardware and thermal effects on the scar. The following procedures may apply:

• phonophoresis – using ultrasound, preparations to soften scars are injected into the deep layers of the skin;
• paraffin therapy – a method of thermal exposure using melted paraffin, which provides deep heating of tissues and stimulation of metabolism in them;
• electrophoresis with lidase – electrical impulses inject lidase into the deep layers of the epidermis, which gives a quick softening effect;
• mud therapy – therapeutic mud is used to stimulate metabolic processes in tissues, which contributes to their regeneration;
• galvanization – the action is a galvanic current that stimulates regeneration;
• dorsonvalization – exposure to microcurrents to improve metabolic processes in tissues;
• diadynamic therapy – a current with a frequency of 50 to 100 Hz is applied, as a result of which tissue polarization occurs and the metabolic process improves in them.

During the procedures, the scar softens, and metabolic processes improve in its area.

Dermabrasion

Dermabrasion is a mechanical peeling method that exfoliates the stratum corneum of the skin, stimulating its regeneration and renewal. It is used to eliminate large or multiple sunken or protruding scars. The procedure is performed under local anesthesia or general anesthesia. The recovery period is about 15 days. There are four types of leather polishing:

• diamond;
• mechanical;
• laser;
• microdermabrasion.

After the procedure, use a protective dressing until crusting occurs.

Cryodestruction

Treatment of the scar with liquid nitrogen at a temperature of -196o, but does not cause cold burns. Anesthesia is not required. Rejection of frozen tissues occurs 10-12 days after the procedure, and healthy skin is formed in their place. The method is more often used if there are scars on the dense skin of the arm or leg.

Laser

Laser stimulates collagen production and breaks down old scar tissue. As a result, the scar brightens, smoothes and ceases to differ from the rest of the skin. In total, you need to go through 7 to 10 sessions, with breaks between them from 1 to 2 months. So you can get rid of fresh and old scars.

After the course, an ointment recommended by the doctor is applied to the skin where the defect was, in rare cases antibiotics and painkillers are also prescribed. You should also avoid exposure to high temperatures and ultraviolet radiation.

Advantages of laser skin scar removal

The advantages of laser scar removal are as follows:

• use on any skin tone;
• getting rid of scars of various types;
• effect only on the scar itself;
• the result is noticeable after the first session;
• scar removal even in delicate areas;
• no rehabilitation period.

When to start laser scar removal

Since after the procedure, you should protect the skin from ultraviolet radiation, in the case of removing scars on open areas of the body (face, arm, etc. ), it is worth starting this in the fall, when the sun is no longer so active . If the scar is protected by clothing, then the season does not matter. The scar itself should be free of inflammation.

Laser caesarean section scar removal

With this method, the scar is completely smoothed out. The procedure is performed after the end of breastfeeding, which is a contraindication for laser resurfacing.

What to expect after laser removal of post-acne

Post-acne is removed without a trace by laser and the face looks completely healthy. The skin becomes smooth, without dents, its elasticity increases, color improves and pores narrow. The effect is lifetime.

Modern cosmetology methods make it possible to get rid of any skin defect qualitatively, regardless of whether the face, body or limbs are affected by the defect.

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Scar treatment | MAMR

Publication date: 12/28/2020

A scar or scar is a connective tissue formation that occurs after an injury, surgery, burn, skin diseases: boils, acne, chicken pox. Scars can be drawn into the skin, be at the same level or rise above it. They have a pale shade or, conversely, a hyperpigmented color. Scars that are localized in open areas of the body, on the face, are considered aesthetic defects and bring psychological discomfort to the patient. The treatment of scars and scars includes various techniques, including those based on the principles of biomechanics.

MAMR specialists conduct practical training seminars on the methods of complex scar removal using accurate diagnostics and manual techniques based on the principles of ontogeny and functional anatomy.

How are scars formed?

Scars and scars have several stages of formation:

1) Inflammation and epithelialization

Occurs within 7-10 days from the moment of injury. Gradually, inflammation of the skin and swelling decreases, granulation tissue is formed, which brings the edges of the wound closer together. Scar tissue is still missing. Then the wound heals by primary intention, a thin, barely noticeable scar is formed. At this stage, the patient’s physical activity is limited, atraumatic sutures are applied to the wound. Daily dressings are performed using local antiseptics to avoid dehiscence of the wound surface and infection.

2) Formation of a “young” scar

Passes from 10 to 30 days after the patient was injured. In granulation tissue, collagen-elastin fibers are formed. The scar is immature, loose, easily stretched, has a bright pink color due to increased blood supply to the wound. During this period, patients should avoid physical exertion and the appearance of a secondary injury in the affected area.

3) Formation of a “mature” scar

Lasts during the second and third months after the injury. Elastin and collagen fibers grow into bundles and begin to line up in a certain direction. The blood supply to the scar is reduced, so it thickens and turns pale. There are no restrictions on physical activity, but a new injury can trigger the formation of a keloid scar.

4) Final transformation of the scar

4 months after the appearance and up to a year, the scar finally matures, the vessels die off, the collagen fibers are stretched. The scar becomes thick and pale. At this stage, his condition is already clear, and the specialist can choose the necessary treatment.

Types of scars

The choice of method for removing a scar depends entirely on its type. There are such types of scars:

• Normotrophic. At first it has a pink tint, but later it becomes pale or flesh-colored and is almost invisible on the skin. It is located on the same level with healthy skin and is practically invisible. Such scars remain after 1st degree burns, shallow cuts, scratches and abrasions.

• Atrophic. It is located below the level of the surrounding skin. Due to the lack of skin growth, indentations and visible scars appear. The skin in this area is thin and flabby due to a decrease in collagen production. It can be a natural shade or a little darker, it appears as a result of acne and after the removal of moles, papillomas.

• Hypertrophic. It has a pink tint, is located high above the level of healthy skin and is limited to the damaged area. It is formed due to abnormal growth of connective tissue at the site of injury. The skin loses its elasticity, so cracks, ulcerations, and tears may appear in this area. Partially disappears within two years after formation, responds well to treatment.

• Keloid. It is formed as a result of a pathological reaction of the body to injury. It rises strongly above the surface of the skin, has a dense structure, uneven edges and a sharp border. Differs from natural skin tone. It occupies a larger surface of the skin than the wound itself. The maturation of a keloid scar can take several years. At the site of its localization, the patient often experiences itching, burning and even pain. It is difficult to treat, a relapse may occur: a scar will appear, the area of ​​\u200b\u200bwhich is even larger than the previous one.

Before starting scar treatment, it is important to carry out diagnostics using a biomechanical algorithm, to identify which techniques will have the greatest impact on the regeneration of the skin, fascia, muscles, bone tissue and stimulate the central nervous system, causing the necessary reactions in scar healing.

Traditional scar treatment

Scar treatment is aimed at removing pronounced or prominent keloid scars. In traditional medicine and cosmetology, a number of techniques are used to make scars less noticeable and painless:

• Treatment by injection. Enzyme preparations in injections reduce the formation of hyaluronic acid: longidase, lidase, hyaluronidase. In the presence of keloid formations, steroid hormones are used, which are injected directly into the scar tissue, as a result, it becomes smoother. In the initial stages of the appearance of keloid scars, cytostatics can be used, which prevent the division of skin cells and the growth of the scar area.

• Electrostatic massage. Acts on the scar tissue with an alternating electrostatic field and causes them to vibrate. Thus, trophism and microcirculation of tissues improves, the recovery process is accelerated.

• Laser resurfacing. Under the influence of the laser beam, the tissue is heated, the cellular contents and coarse collagen fibers are dissolved. The laser penetrates deep into the skin, acts pointwise, damages only cicatricial changes and does not affect healthy areas. In addition, the laser has a bactericidal effect on the skin. As a result of heating at the level of cells and tissues, the process of regeneration starts, and “young” collagen is formed. After a course of treatment, tender fibrous tissue appears at the site of the scar.

All these methods are aimed at relieving symptoms – tissue inflammation, rough scarring, changes in skin color at the site of the scar. Elimination of other damage from scars, including changing the shape of the seam in traditional medicine, is treated with surgery. But the most effective in healing scars are manual techniques that allow you to get rid of deep scars and their complications without surgery.

Treatment with manual techniques

With the help of knowledge of biomechanics, a manual therapist understands how the patient’s body is arranged, what tissues and muscles need to be acted upon to activate skin regeneration at the site of the scar. By understanding how body parts and muscle tissue are interconnected, the therapist can use traction and stretching to stimulate the patient’s CNS and prevent the negative consequences associated with scars.

The following manual techniques are used to treat scar tissue:

• Lymphatic drainage massage. Helps reduce swelling that often accompanies scar tissue formation.

• Myofascial release. Slow movements and light pressure helps to restore the mobility of tissues in the scar area.

• Spot stretching. With the help of active movements in the joint, the tissues return to their normal position.

• Application of cross fictions. In scar tissue, collagen fibers are located in one direction, parallel to each other. Therefore, the scar differs from the surrounding healthy skin, in which collagen proteins are arranged in a random order. Friction and shifting of the skin crosswise, perpendicular to the passage of collagen fibers returns them to their normal position.

If 15 years ago it was believed that it was almost impossible to remove excess scar tissue without surgery, then with the help of knowledge of biomechanics it is really possible to completely restore the elasticity of injured tissues and eliminate aesthetic defects.