Posts Tagged ‘scarring’

Optimize Scars from Plastic Surgery

optimize scarsIf you’re considering plastic surgery, you’ve probably thought about potential scarring. Maybe you have scars that haven’t healed well, or maybe you’ve seen pictures, and worry that you might get the same result. While there’s a possibility of poor scarring after any surgery, the good news is that most scars created during cosmetic procedures heal well and are minimally visible.

Today, plastic surgery procedures are designed so that scars are positioned in areas that are mostly hidden. There are also surgical techniques that can give scars a better chance of healing well.

What your surgeon can do to reduce or hide scars

Position the scars well

Cosmetic surgeons take great care in positioning scars in inconspicuous areas. With rhinoplasty (nose surgery), for example, the scars are sometimes entirely inside the nose or barely noticeable between the nostrils. For breast surgery, scars can be placed underneath the breast, hidden around the areola (pigmented area surrounding the nipple) or occasionally under the arm. For a tummy tuck, the scar can be positioned low, so underwear or swimwear hide it.

Choose the right tools

The materials used to close a wound can contribute to it healing well. In some areas, removable sutures may give a better scar appearance. While in other areas, absorbable sutures (that don’t require removal) may be the better option. Sometimes, like during a face lift, for example, surgeons use surgical staples because they’re gentler on hair follicles. An experienced and skilled cosmetic surgeon will know what tools will work best for your particular situation and surgery.

Reduce tension on sutures

How a wound is closed can have a significant impact on how the scar heals. Many studies have shown that tension on healing skin incisions contributes to poor scarring. To combat this, we use techniques to control this. One common procedure is to use supportive sutures on the deeper tissues, so the tension lies well inside (where scarring isn’t visible) and the skin itself isn’t being pulled. Supportive dressings and minimizing movement that creates excess tension on the scars also helps.

What you can do to optimize scars

There are also things you can do to optimize scars after surgery.

  • Apply silicone strips, gel or ointment to your scar
  • Avoid significant sun exposure to scars during the healing period
  • Keep scars moist

Be aware, there are lots of products out there that claim to improve scars, but most don’t have much evidence to back up their claims.

If you’re prone to poor scarring

While most patients heal very well after surgery, some patients may have a genetic predisposition to develop poor scars. Although the tendency to develop hypertrophic scars (scars that heal to appear thick, elevated and red) or keloid scars (similar to hypertrophic scars, but can grow) can exist in any ethnic group, the risk is higher for individuals of African or Asian descent.

If you have a history (or a family history) of this kind of scarring, talk it over with your surgeon before embarking on surgery. They might suggest varying the procedure, using a different closure mechanism or offer adjunctive therapies to help you get the best possible outcome. And, in the case that a poor scar does develop, it can be treated with topical treatments, taping or steroid injections to improve its appearance. Or, in more severe cases, a small scar revision procedure, typically done under local anesthesia with minimal recovery, may do the trick.

Emory Aesthetic Center

Schedule your consultation today and let the skilled surgeons at Emory Aesthetic Center help you learn more about how to optimize scars after treatment.

Request an appointment

or call us at 404-778-6880.


I Want Small Scars After Surgery, But Will That Work for Me?

Surgery ScarsFrequently patients will come into our Center and say to me, “I really want (you can fill in the blank – uplifted breasts, a smooth flat tummy, a youthful neck, etc.), but I don’t want any scars, at least not big ones.” As physicians specializing in aesthetic surgery and cosmetic medicine, we totally understand and respect these desires, and in some cases patients indeed can get excellent results without the need for significant scars. However, in other cases, using a small scar approach can be quite misguided. Some of the most dramatic results that we produce are when we use bigger scars. Whether you need a procedure with a small scar or whether a larger scar is far better depends on several highly individualized factors – these factors are all about what your needs are and what you desire most:

  • How do you scar?
  • How do you and your significant other feel about scars?
  • What is the underlying issue you want to address with surgery?
  • What is the best surgery to get you the best results?
  • Are there minimally-invasive alternatives that might work for you and if so, how does it compare?

Everyone has an inherent tendency to scar, so clearly the decision to have a procedure with a larger scar is tempered by how you tend to scar. Different ethnic groups have different scaring characteristics. For instance, individuals of Asian or African descent may have a higher risk of developing hypertrophic or keloid scars while those who are lighter skinned and of northern European descent, scars tend to fade well. How you might scar also depends on where the scar will be placed. For example, scars over the shoulders tend to get thicker and are more visible, while scars of the eyelids (think blepharoplasty or eyelid lift) are almost uniformly fine and minimally visible.

It is also important to consider not just how you will scar, but how you feel about scarring. Some patients do not find larger scars distressing in the least – “Doc, I don’t really care about the scar as long as my tummy is smooth and tight”. Another patient, with a stomach that looks exactly the same, might say “Gosh. . . .I’d really like this loose skin gone, but I can’t stand the thought of a scar, even though I know it will be hidden under my panties or bikini bottom”. Most patients, however, lie somewhere in the middle. They don’t really want the longer scars, but if that scar is required to get the result they want, then they say “OK . . . it’s worth it”.

Whether a procedure will result in a smaller scar or a bigger scar depends on what it is that you are trying to fix. If, for instance, a patient wants to thin out some fatty deposits but has generally youthful looking elastic skin, liposuction, using very small incisions, or even non-invasive fat removal, may be the best choice. On the other hand, if there is significant loose skin in the area that you want treated then liposuction alone may not be right for you. Yes, it might thin out the layer of fat, but it will not tighten up the loose, hanging skin. To do that, a tummy tuck may be required to remove the excess skin, resulting in a larger scar. More often than not, what determines our recommendation to you concerning a small- or large-scar technique is dependent on the quality and quantity of your skin in the area of concern.

Minimally-invasive techniques produce little or no scar, and for those who are scar averse, these techniques can be a great option. For instance, bulging of the lower eyelids can be very well treated with blepharoplasty (eyelid tuck), but this commonly produces a scar under the eyelashes. On the other hand, limited bulging can often be camouflaged by the injection of fillers around the eyelid-cheek junction without any scars at all. In these cases your surgeon can help you think through the tradeoffs that occur with any kind of procedure. Injections don’t leave a scar but they are temporary.

Whether you need a longer scar, a shorter scar, or even no scar to get what you want, we at the Emory Aesthetic Center can help you sort through the options to figure out what is best for you. If what you want can be achieved with little or no scar, that’s great. However if a bigger scar is going to give you a far better result, then we’ll work with you to keep the scars as well positioned, hidden and of the best quality as possible using the most up to date techniques and treatments.

About Dr. Eaves

Felmont Eaves, MDDr. Eaves recently returned to Atlanta, Georgia, to head the Emory Aesthetic Center as Medical Director, having previously completed his plastic surgery residency as well as a fellowship in endoscopic and minimally invasive plastic surgery at Emory University, The Emory Clinic, and associated hospitals. Before joining the Emory Aesthetic Center, Dr. Eaves was a partner in Charlotte Plastic Surgery for more than fifteen years and served as group president from 2010-2012.

His professional and institutional committee memberships and offices include an impressive list of national, international and local plastic surgery organizations, societies, boards, task forces, advisory councils, coalitions and foundations, including having served as President of the American Society for Aesthetic Plastic Surgery (ASAPS) from 2010-2011 and Trustee (2011-Present).

Dr. Eaves’ primary areas of academic inquiry have been in minimally-invasive and endoscopic aesthetic surgery, patient safety, system and process improvement in plastic surgery, evidence-based medicine applied to plastic surgery and recontouring surgery after massive weight loss. He has received several patents for new medical devices he developed, and has made major clinical service contributions to his field. Dr. Eaves has published more than 100 articles, book chapters and book reviews on plastic surgery in peer reviewed publications, as well as manuals, videos, computer programs and other teaching aids and has coauthored the first textbook on the topic of endoscopic plastic surgery.

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Improve and Diminish Scars with Scar Revision

Scar RevisionThe scar may be a result of trauma or a surgical incision…no matter the reason, the common theme among patients who present in my office with a scar is that they wish these marks to be removed. Scars, though, cannot be simply removed. They can however be improved and hidden. There are several options that exist that can make these scars less visible. Let’s review these options and help you decide if a consultation with one of the physicians at the Emory Aesthetic Center is the right choice for you.

A scar is the body’s natural response to injury. With favorable healing, a thin inconspicuous scar may result. If however, the injury is traumatic or the healing was delayed, a widened scar may result. Worse, the scar may even thicken and become rope-like, referred to as a hypertrophic scar. When the scar extends beyond the area of injury, they are classified as keloids. Darker skin types are more prone to keloid scarring, and genetics can also play a role in wound healing.

No matter the cause, a scar will fade and improve with time. There are some commonly recommended therapies that can help the scarring process. Silicone gels, e.g. BioCorneum, can be used twice daily and hasten the perceived scar maturation. Silicone gel sheeting may also be used but can be more cumbersome for application. Laser therapy similarly may help improve a scar by reducing the redness. There is new incisional offloading product called embrace® that has shown reduction in the scar response by decreasing tension on the incision. It has been used for abdominal and breast aesthetic surgery with good effect.

If scar revision is considered a reasonable option, the timing of that revision will typically be a minimum of 6 months after injury. It is important to allow the body to heal as much as possible prior to introducing new trauma. A revision involves removing the scar and reclosing the wound so that it allows for more favorable healing. Various techniques can be used. These include wide undermining to diminish tension on the incision, z-plasty or w-plasty to lengthen and stagger the scar, and transposition to reorient the scars in more favorable locations. An abdominoplasty can even be performed to hide lower abdominal scars. Scar revisions can usually be done with local anesthesia in an office or a minor procedure room-type setting. These procedures are much less extensive than the original procedure or trauma, and recovery is minimal.

Even though a scar can never be completely erased, let the physicians at the Emory Aesthetic Center evaluate you to determine if your scar can be made less visible.

About Dr. Anderson

Erica Anderson, MDErica Anderson, MD, is board certified by the American Board of Plastic Surgery and currently holds an appointment as Assistant Professor in the Division of Plastic Surgery at Emory University. Dr. Anderson completed her general surgery residency and plastic surgery residency at the University of Colorado Health Sciences Center and associated hospitals in Denver, CO. She completed a year of advanced training in Aesthetic Surgery at Grotting Plastic Surgery in Birmingham, Alabama.

Dr. Anderson returns to Emory University after being in private practice in Arlington, Virginia. While there, she maintained a busy aesthetic and reconstructive practice and also served as Medical Director for the Wound Healing and Hyperbaric Center at Virginia Hospital Center.

Dr. Anderson’s academic and research interests are largely focused on clinical outcomes with regards to cosmetic surgery. Her areas of clinical interest are diverse including cosmetic surgery of the breast and body as well chest wall reconstruction and wound care.

Dr. Anderson is married with 3 children, Trent, Connor and Fiona, and 2 vizslas, Max and Mimi.