There is no way to do surgery where you cut through the skin without a scar. You can have a small scar, a well placed scar, a scar which heals well, but there is always a scar. Some scars, like liposuction, are small. Some areas like the upper eyelid scar in a blepharoplasty almost always fade to nothing. And there are some scars like a tummy tuck, which are big, and in areas more prone to scarring with issues- the midline, the hair bearing skin of the pubic area, a place of high motion and rubbing on clothing. Some of my patients have tummy tuck scars which are almost invisible, but some have areas which have elevated or pigmented. You can get great scars in trickier areas, but you need to work for it. And sometimes you need to do a revision and roll the dice again.
I have blogged about this in the past, so if you are an avid reader you may hear repetition. Scars need to not be irritated, infected, or under tension. Address spitting sutures early.
You need to deal. This means you can’t just not look at your scar and hope for the best. You need to clean it, visually inspect it (the area may be numb so you don’t “feel” if something is going on), and do scar treatments. How can you stack the deck in your favor?
Tension on a scar means the skin is trying to pull apart. That constant pulling stimulates more scar or causes the scar to widen. Your skin tone, your age, the site of the scar, and the surgical technique play a role here. Tension on a scar is why scars in areas of high motion like the knee heal poorly. Being young with better skin tone pulls on scars more. Areas of the body where the skin is tight like the lower leg are under more tension. Positioning is important. When we do a tummy tuck we bend you at the waist. We need you to stay bent for a few weeks after abdominoplasty to keep the tension off the scar.
In surgery we do many techniques to address skin tension.
I tell my patients think of your scar like a sleeping baby. Do not make the baby mad. What irritates scars?
This is where simple TLC makes a difference. I want you to look at your scar. Is it red? Does it look angry? Is there discharge on the dressing or garment? What color is the discharge? For my patients, the skin is almost always closed with a subcuticular suture. This is a suture which snakes under the skin.
ACT EARLY and AGGRESSIVELY. The longer a scar is angry, the higher the chance for poorer scar and pigment issues.
One would think infection is a big issue with surgical wounds. In my elective plastic surgical practice, it is not common to see a true infection. We do cover you with antibiotics around the time of surgery. There is redness associated with normal healing and redness associated with an infection. But infections do happen. As with all things, jump on it early.
How do you know if it is infected? If any of these occur, you should alert your doctor.
You don’t tend to have a fever with a skin infection as it is a local process. Infections cause inflammation, which can lead to poor scar healing. Many times they start with spitting a stitch
When we use dissolving sutures, which we need to do to align the deep tissue and keep tension off the skin, your body starts about a month in reacting with the suture to dissolve it. You may feel little pebbles under your skin, tiny bumps, or hardness along your suture line. This is normal. It takes months to dissolve the suture, depending on the type and caliber of the dissolving suture.
But sometimes your body thinks “Ug. That is so much work to dissolve this suture. I’m just going to shove the suture out through the skin.” When this happens you may feel a raised bump. It may be tender. It looks an awful lot like a zit. Then it does one of two things:
If you do not clip the suture, the little part sticking out can irritate the skin around it causing redness, pigment, and increased scar.
Sometimes when you have this, you may see a little “pus” when it pops through the skin. This is not an infection- it is the cells trying to dissolve the suture. BUT you can get an infection around the suture if this is not addressed.
Clean the area. Clip the whisker. (If you can’t get it, come into the office and we can do). Topical antibiotic. If redness occurs, if the area doesn’t heal or keeps draining, or if it hurts, alert our office. You may have a little skin infection or a remnant of the suture which is keeping the area from sealing.
When scars have tension, irritation, infection, or spitting sutures, this causes a poorer scar. This is seen by scars which
Avoid all the issues I listed above. Even if you are a perfect patient and are taking great care of your scars, issues can still happen. Basic scar tenets:
Scars take a full year to mature. Many issues with scars do not manifest until months out. I see patients out til 3 months- usually at 3 months if it is going wayward we can see it. FOR MY PATIENTS IF YOU ARE EVER CONCERNED, come in. I have an open door with my patients. There is no charge to come back for a visit. I take photos so we can compare what the changes are. As far as what to do? We usually let the surgery settle for a year and then evaluate what action to take.
It is rare for the whole scar to heal poorly. What we see more is patchy- you may heal part of it great, and part terribly. This is part of the risk of surgery.
Do not fret. Many times, a simple scar revision in the office under local anesthesia is successful- you aren’t healing a giant surgery, so your body is able to focus on the area. Rolling the dice again is worth trying.
There are things you can do at the scar revision which may help you heal differently this time. Liquid silicone and silicone tape have been staples of scar care (and shown more effective than Mederma or Vitamin E). But newer things are on the horizon. I just finished a scar trial using Age Zero Exosomes. Microneedling may be effective and we offer that in our clinic. For those with known keloids, Botox or steroid injections may help. Read the next blog for more details.
The information provided on this website is for general informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always seek the advice of a qualified healthcare provider for any questions regarding your health or medical condition.
