“Am I going to have a Scar?”
By Michael A. Devlin, MD on March 19, 2015
When there is a cut through the skin, the skin needs to heal. To heal, it needs to lay down new collagen, which is never as organized as the collagen you are born with. Disorganized, heaped up collagen is the definition of a scar.
So what do plastic surgeons do to reduce the appearance of scars?
We either try not to cut through the skin or do it in such a way as to reduce the appearance of the scar. Some topical treatments like chemical peels, laser resurfacing or dermabrasion, can alter the skin, but, because they don’t cut through it, rarely cause scarring.
What if a cut through the skin is necessary?
First, we handle the skin as delicately as possible taking care not to unnecessarily damage tissues. We try to preserve vital blood supply and close the wound or incision with no tension on the skin for the best possible healing.
Secondly, we place the incision where it will be as unnoticeable as possible.
The incision for a facelift, for example, uses the natural crease in the ears. We also use the natural lines of the face, what we call the relaxed tension lines—like crows feet–to blend scars in when doing an eye lift.
Lastly, we can change the direction and placement of scars with local skin flaps like z-plasties.
A z-plasty can change a straight line scar that creases the skin to a zig-zag that acts like an accordion over an area.
What if the scar can’t be moved or hidden or surgically improved?
That’s when we may try lasers, dermabrasion to sand down raised scars. Sometimes we use steroid injections to decrease itching and inflammation or topical dressings to flatten scars.
If you have surgery, you are going to have scars. There’s no real way around it. It’s up to you to decide if the improvement of cosmetic surgery is outweighs the addition of a scar.
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