Scars are something no one asks for whether they are from a plastic surgery procedure, an accident, acne or anything else. Dr Mark Vucak, Specialist Plastic Surgeon from Queensland Plastic Surgery sees quite a few patients each year for scar revision surgery which aims to improve and minimise the appearance of scars. There are several techniques, both surgical and non-surgical, that can help and Dr Vucak talks us through them.
The first thing Dr Vucak says about scars is that they are unpredictable. “Scars develop differently in different people and it depends on many factors including the site of the scar, the blood supply to the area, the size and depth of the wound, the colour of your skin, the direction of the scar, how your body heals and the Surgeon’s skills.”
Surgeon’s Skills to Minimise Scarring
Talking about your surgeon’s skills, if you are having any plastic surgery procedure it is important to consider where your scarring will be right from the beginning of planning for your surgery. You should be asking your surgeon about his technique for the surgery you will be having and where the scars will be located and whether or not you have a choice in that. You should also be asking what can be done to minimise them, if your surgeon does not already offer the information.
Dr Vucak tells us his preferences for where he likes to makes surgical incisions to minimise scarring. “When I think about making a surgical incision I always try to keep the scar as short as possible. It’s best to align it in Langer’s lines which run around your body and these lines are directions of tension and the scar will be less stretched if this is done.You can see that oblique incisions around the arm or leg are better than transverse incisions across. Likewise incisions on the face need to be in frown lines and follow the contours.Vertical and horizontal incisions on the forehead are always less noticeable than oblique or curved incisions.
“Surgeons like to close the tissues in layers and I aim to take the tension in the skin in these deeper layers. This for example is done in a facelift with tension in the SMAS layers and in an abdominoplasty with tension in Scarpa’s fascia. With the tension taken off the skin there is less pulling and the scar is better. Many scars on the face can be improved by changing the direction of he the scar and the commonest procedure to do this is with a Z plasty or flap repair. This is especially important with burn scars or scars and contractures on the hand and in web spaces where a combination of flaps and grafts may be required.
“Yesterday I used a Proveena Vac dressing on a high risk wound and that can be applied at the end of the operation over the closed suture line and the vacuum holds the skin edges together which will reduce tension in the healing wound and improve the scar. With all our surgeries I use micropore tape for three months on the suture lines. The tape can be changed once a week and shower with it on then dry with a hairdryer. The tape takes the tension and the scar is better.”
Regardless of how you got your scar/s, there are ways to improve their appearance. Most scars are never able to be made to disappear completely but there are several techniques available today that can certainly help to minimise them.
Having a second surgery to reduce scars from your first surgery
Although it might seem strange to think of having surgery to reduce an already existent scar, surgery can sometimes change a scar’s shape or help to make it less obvious. Dr Vucak says he has performed many surgeries to reduce the scars made by another surgical procedure. “The best method in most cases if the scar is thick or contracting is to excise the whole scar and start again using these techniques. It’s fair to say many bad scar come from infection in the postoperative period which leads to an inflammatory response and more dense healing. Following a reexcision the surgery is usually smaller and doesn’t usually become infected so the scar is finer. All suture lines need support to reduce tension and get a better scar. So in abdominoplasty we use a binder and keep the patient flexed to reduce tension.In a facelift we start with foam dressings and move to a chin strap the next day for support and with liposuction and thigh reduction garments are worn. These garments improve the lymphatic flow and flatten the wound as well.”
Non-surgical treatments can help minimise scarring too
- Laser resurfacing or dermabrasion
- Steroid Injections
- Filler injections – these have been getting some good results for patients in recent years but are often only temporary
- Topical treatments – gels, creams and other skincare products
- A combination of these.
Many of these non-surgical treatments stimulate collagen production and improve the overall quality and appearance of your skin at a deeper level can also help with scars.
Dr Vucak says at Queensland Plastic Surgery they also use non-surgical treatments and techniques to help minimise scarring. “Over the last few years we use high intensity LED on all wounds and start before the operation with abdominoplasty and breast reduction and continue after the operation is done. At least 6 treatments are required. In the early days microdermabrasion worked but now I use fraxel laser to get the best result with scars. This is especially good in acne. Many times I will use a small fat graft under the scar as the fat acts like a spacer and makes a new vascularized collagen matrix which improves the texture colour and vascularity of the scar making it more supple.”
So, you can see it’s extremely important to ensure the surgeon you have for any plastic or cosmetic surgery procedure is on board with taking the correct steps to minimise any scarring. Talk to your surgeon before your procedure about where your scarring will be to make sure he knows what he is doing, and what steps you will need to take after your surgery as well.
If you’d like further information on anything Dr Vucak has discussed in this blog or if you’d like to arrange a consultation with him you can contact Queensland Plastic Surgery, located in Townsville, Cairns, Rockhampton and Mackay on 1300 366 782.