Plastic Surgery Scars: Simple Techniques to Fade Visible Reminders of Surgery

One of the most common concerns among plastic surgery patients is scarring.  "I really want a facelift [or breast augmentations or a tummy tuck or...] but will there be a scar?" Unfortunately, I must answer, "Yes."

All significant injuries scar.  Whether the result of horrifying accidents or of precision scalpels, breaks in the skin will heal with scars.

A plastic surgeon's goal, then, is to minimize surgical injury to maximize the likelihood that the scar will heal favorably.  Nevertheless, patients occasionally have untoward results.  The following patient from the East Coast emailed me for my opinion:

Hi.  I had surgery about 11 months now, and my scars are still real red and purple.  What is the cause for this?  And around my belly button I developed some blood blisters that left nasty scars.  This area remains very hard and numb.  How can this be corrected.  My plastic surgeon can not give me answers to why this happened.

This kind of patient needs compassion first.  She has invested a lot of time, energy, thought, and money into her plastic surgery, and she needs to know that I want to help.

However, she also needs to know that medical science is still limited.

Let me try to explain how her scar probably came to be the way it is. I always think of scarring as the result of three factors:

1) A patient's genetic heritage (her parent’s legacy)
2) The skill and technique of her surgeon (the surgeon's job)
3) The diligence of the patient in post-operative care (her own job)

1) Obviously, we cannot change our DNA, and we cannot choose our parents.  Genetic modification of scars is not currently possible, but research is on-going.  It is unfortunate but true that, in some families, scars are just bad; this is something that some patients are stuck with.

2) I am certified by the American Board of Plastic Surgery (which, by the way, is the only Board recognized by the American Board of Medical Specialties to certify plastic surgeons).  I, therefore, can guarantee that I always use the finest plastic surgery techniques, instruments, and suture material.  Hopefully, this patient's surgeon was well-trained and had been honored with certification by the American Board of Plastic Surgery.

3) This leaves “her job.”  The care of an incision does not end in the operating room!  She can make a difference with those red areas and with those thickenings.  She should not lose hope!  To ensure the best possible appearance of your scar, she should diligently…

a) Perform scar massage.  Ideally, I ask my patients to start massage two weeks after surgery (see Scar Massage Technique below).

b) Practice sun avoidance.  She shouldn't be afraid to go outside, but she should wear long clothing, a hat, and sunscreen—at least SPF 30.

If the scars are recurrent or she had had a history of unfavorable scarring (such as keloids or scar hypertrophy), of course no plastic surgeon can guarantee that the scar will fade to a fine, colorless line. However, I might also recommend…

c) silicone gel sheeting

If the scar begins to thicken within the first 1-2 months after surgery, I would consider…

d) corticosteroid (“cortisone”) injection
e) pulsed-dye laser treatment


Scar Massage Technique:

1) Starting 2 weeks after surgery, apply lotion to all scar areas.
2) Massage the lotion in, applying enough pressure with the pads of your fingers to make the car area lighten in color.
3) Massage in three directions (for 20 seconds each):
• Circles
• Vertical (up-and-down)
• Horizontal (side-to-side)
4) Do this 3-4 times per day.

Lotions:
1) You can use any lotion that will make your skin soft.
2) You should avoid perfumed lotions.
3) You don't necessarily need to use lotions containing antibiotics, vitamin E oil, aloe vera, or cocoa butter.
4) My favorites are inexpensive moisturizing lotions, such as Eucerin, Neutrogena, or Vaseline Intensive Care.

To summarize, I think that scars can be helped!  For those readers with unattractive scars, start scar massage, sun avoidance, silicone gel sheeting, cortisone injections, and (possibly) pulsed-dye laser treatments.  My algorithm is not necessarily the only protocol that works; assuming a physician is certified by the American Board of Plastic Surgery, I am sure that he has the experience and the knowledge to institute an appropriate plan.

Comments

[LOLY]

I had a blepharroplasty on june .The surgeon did the incision on the natural fold of the eye. The result was poor. After the surgery my eyes were very much the same the eyelids were droppy. So he performed a second surgery. This time he made a cut in a 45 degrees angle up to the eyebrows ...leaving a red scar that can even be seen when the eyes are open. It s been a month and a half since the surgery and I cannot cover that with make up or eyeshadow is still visilbe and red . What can I do to get rid of that scar. Everybody asks me what happened... Its normal to do this type of cut.. I understand It supposed to be done in the line of the natural fold of the eye. Thanks for your advise Loly

[Michael Pickart]

Dear LOLY,

You sound awfully frustrated! I am sorry that you have had an unfortunate result.

First, be patient. The redness of scars can take 6*12 months to resolve. Feel free to cover the scar with make-up, but resist the urge to have a 3rd surgery or to receive laser treatments.

Second, get a second opinion from a Board Certified Plastic Surgeon. Go to www.plasticsurgery.org, and search for an expert by ZIP code. Your story is a little confusing; the series of procedures and the outcome are not typical.

Third, be aware that you have alternatives. All is not lost! There is hope.

Sincerely,
Mike Pickart

Michael C. Pickart, M.D., F.A.C.S.
Pickart Plastic Surgery, Inc.

428 Poli St.,#2C, Ventura, CA 93001
(805) 648-4567 | fax (805) 641-0811

To: info@pickartplasticsurgery.com
Subject: [Pickart Plastic Surgery Blog] LOLY submitted a comment to Plastic Surgery Scars: Simple Techniques to Fade Visible Reminders of Surgery
Date: Fri, 18 Dec 2009 16:21:46 -0800