Scars: What to Expect After Plastic Surgery [Part I: Controllable Factors]

As a plastic surgeon in the Scottsdale area, one of the questions I often hear from patients is: “What will my scars look like?”

Obviously, scars will be a concern for patients having extensive surgery, such as a tummy tuck or a breast lift, but patients having less invasive surgery, such as liposuction or breast augmentation, still worry about their scars.

The truth about scars is that there are some aspects the surgeon can control, while other aspects cannot be controlled. Keeping that in mind, the first part of this two-part blog series will discuss the controllable factors, and the second part will discuss the uncontrollable ones.

Controllable factors mostly have to do with surgical technique and postoperative care. During surgery, it is important for the surgeon to be as gentle as possible with the tissues. Rough handling of the skin, overuse of cauterization and imprecise incisions can certainly cause extra scarring. In addition, poor suturing techniques, the types of sutures used and how carefully the sutures are placed can affect scar healing.

When I perform a procedure such as a tummy tuck in the Phoenix area, I am extremely meticulous about how I handle tissue in order to cause the least amount of trauma possible. I also take time during the closure to make sure the tissues and skin line up as cleanly and smoothly as possible. Finally, for all but the smallest surgeries, I do multiple layers of suturing with dissolving, under-the-skin sutures to avoid any stitch marks in the skin. I use longer-lasting deep sutures to take tension off the skin-surface sutures, which reduces the possibility of scar spread.

Controllable factors after surgery include minimizing the risk of infection, scar massage, using ointment in the early period and using silicone sheeting or steroid injections if necessary to flatten scars. For my patients’ follow-up visits after surgery, I always see them personally to evaluate the scars and advise them on what can be done to minimize the visibility of scars.

It’s important to understand that scars fade over time. As you heal, your scars will become less visible.

One final idea I would like to share is that patients can take part in their own healing process to minimize scars. It is very important to follow post-op instructions, including these recommendations:

  • Do not exercise too soon. This can put strain on the tissues.
  • Avoid smoking after surgery. Smoking impairs wound healing.
  • Avoid UV exposure or tanning of scar areas for a full year to minimize scar darkening.
  • Massage your scars for a few minutes each day to help them soften. Products such as Mederma®, which are marketed specifically for reducing scars and stretch marks, are fine, but studies have not shown a huge improvement in long-term scarring. If patients want to use these products, I do not discourage them as long as I know exactly what they are putting on their scars. Some products, such as topical vitamin E, have been shown to cause more harm than good.

In Part 2 of this blog series, I will discuss factors related to scarring that are outside our control.

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