The common causes of poor scarring after surgery and how you can heal beautifully
If there is an incision, there will be a scar. Although advancements in surgery have made leaps and bounds over the past century, “scar-less surgery” is a medical frontier that has yet to be conquered. In plastic surgery, patients need to consider if the scar that results from a procedure is worth the trade-off of enhancing their appearance. For most, it is. If fear of scarring has been holding you back from pursuing cosmetic surgery, you must understand that much can be done to prevent poor healing. Let’s take a closer look at what causes sub-optimal scarring after surgery, how you can avoid it, and what you can do to improve your chances of healing beautifully!
Common Factors that Contribute to Poor Scarring
Genetics
If you have never had any surgery before and are unsure of your skin’s response to healing, take a look at your family members who have. How your skin heals from an incision or any kind of trauma can be genetic. Some people are genetically predisposed to what is called keloid or hypertrophic scarring. If this thick, raised type of scarring runs in your family, you will want to share this information with your surgeon.
Skin Color
The darker your skin coloring, the more prone you may be to raised scarring (keloid or hypertrophic). If your skin is higher than a level III on the Fitzpatrick Scale, you are at a higher risk of this type of scarring.
Too Much Tension / Tight Closures at Sutures
An important decision that plastic surgeons make with every surgery they perform is how tight is tight enough to achieve great results when excising skin and closing an incision. This decision varies from patient to patient depending on the current health, condition, and elasticity of your skin. Skin that is pulled too tightly to close an incision runs the risk of poor scarring due to tension.
Surgery Over Joints or Mobile Areas
If there is lots of natural movement at your surgery site, the chances are that any scarring will have the propensity to widen. An example of this is brachioplasty scarring – this area is notorious for widened, more noticeable scars due to the difficulty in preventing movement of the arms post-operatively. This is especially true with incisions over joints. It is imperative that you closely follow all movement, activity, and lifting restrictions your surgeon advises after surgery to avoid this. The more stress you place on the areas of incision, the more likely it is that your scar will widen.
Surgical Technique
Your plastic surgeon, when possible and surgically appropriate, will attempt to close incision sites at deeper layers of tissues so that they bear the majority of the closure’s tension. She will also handle tissues very delicately, especially at the edges of incisions, as not to crush fine blood vessels that enhance your healing.
Sutures
Depending on what area of your body you have surgery performed on, different types of stitches may be used. Most breast and body procedures are closed with deep absorbable sutures that do not need to be removed. On the other hand, facial surgeries are generally closed with very fine, permanent sutures that need to be removed in five – seven days to avoid “track marks” or suture marks.
Sun Exposure
Exposure to sunlight excites our skin’s melanin, or pigment and can cause scars to darken if left unprotected. It is essential to wear a physical sunscreen (contains zinc and titanium dioxide) over scars and keep them covered with protective clothing for the first year after surgery to avoid this.
Medical Problems
Certain health-related conditions such as diabetes, obesity, history of radiation, and poor nutrition may put patients at risk for postoperative infection, which can lead to hypertrophic (raised) and pigmented scars in the future.
Medications
Certain medications such as Accutane/Isotretinoin (a drug used to treat severe acne and which thins the upper layers of the skin) and steroids can put patients at an increased risk for pathologic scarring after surgery. Accutane users must wait at least six months after being off their prescription to have an elective procedure.
Steroids prevent inflammation, a necessary component to healing an incision. Because of this, they can make an incision more susceptible to opening and infection. Discuss stopping the use of steroids with your prescribing doctor before surgery, as abrupt cessation of steroids can be dangerous.
Tips for Preventing Poor Scarring After Surgery
Pressure Tape and Silicone Sheeting
Your plastic surgeon will advise you on the use of surgical pressure tape for the first six months following your surgery. This tape can prevent the incision site from pulling and growing longer or wider.
Silicone Sheeting is advisable if you have a history of hypertrophic scarring. These sheets reduce collagen production in scars, thus preventing excessive growth of scar tissue. Scars are flattened, softened, redness is reduced, itching may subside, and the size of the scar may be reduced.
Massage
Light massage and pressure may help prevent poor scarring by decreasing scar tissue build up. Regular and careful manipulation of tissue may also reduce itching and redness during healing.
Regular Use of Sun Protection
The daily use of a Physical Sunscreen with an SPF of at least 30 will help prevent darkening of surgical scars.
Compression
Compression on the area of incision can not only prevent tension along an incision site, but it can also reduce collagen formation over time and help realign collagen fibers for better healing. This may be achieved with an external splint or even certain compression garments.
Improving the Appearance of an Existing Scar
Prevention of poor scarring is the ideal route to take in any circumstance, but there are several ways that you can improve the appearance of an existing scar. These strategies will depend on what bothers you about your scar, such as the color, size, or thickness.
Scar Revision Surgery
In some cases, your plastic surgeon may recommend surgery to improve the appearance of a scar. If your scar has widened significantly due to swelling or tension after surgery, she may excise this scar 6-12 months after your initial surgery to allow for the opportunity to heal again with a better outcome.
If a keloid scar has formed after surgery, your surgeon may also recommend having this scar re-excised. Sometimes steroids are injected into the site, but this also has risks including hypopigmentation of the skin and death of the fat beneath the skin, causing an indentation. In severe cases, she may also enlist the help of a radiation oncologist to treat the incision site with radiation the day of surgery and a couple of days after surgery to prevent reoccurrence.
Laser Treatments
If a scar has darkened over time, aesthetic laser treatments such as IPL (Intense Pulsed Light) can help lighten pigmentation. Laser resurfacing may also be recommended to address moderate irregularities in the texture of a scar.
Although a certain degree of scarring is inevitable, the contour changes of plastic surgery almost always outweigh any dissatisfaction that stems from scarring. The trade-off for renewed self-confidence is one that most patients are happy to make.
Your surgeon will take every step possible to ensure that your incisions heal comfortably and beautifully after your surgery!
Has a fear of scarring been holding you back from pursuing plastic surgery? Schedule a consultation with an Edina Plastic Surgery plastic surgeon to discuss the improvements to your face and body you would like to see and the potential scarring that may be associated with each. The more you know and understand about post-surgical scarring, the more empowered you will feel to make the decision that is right for you. Call (952) 925-1765 to schedule!
