Best Scars After Surgery

Basics About Scars:

Scars occur in our bodies after any cut or injury. Scar is an essential component of repair of injured tissues in human bodies. Scars are thus inevitable whenever there is a damage to the skin, like in cuts and bruises. It occurs in the incisions made during surgery, even in cosmetic surgery. There are ways and means of minimising this scar formation. Fine surgical skills of the surgeon play a vital role to minimise scar formation, so results will vary from surgeon to surgeon. Your own body reaction is also a big determinant of the final scar formation. There are other determinants of scar formation as well, and all these are discussed below.

An inevitable question arises in the mind of many patients, and maybe yours as well: "I understand that my body will heal with a scar, but my mind is not ready to accept any scars. Can you do something to erase all scars?" There is no one right answer to this question - it can be both yes and no, depending on the factors that determine the answer. Best plastic surgeons like Dr Srinjoy Saha take multiple steps to minimise scars with a high success rate. Let us first focus on telling you about what achieves good results in minimising or removing scars in a very scientific, systematic, well-laid out way.

What Determines Scar Formation?

1. Skin Type: 

There are 6 different varieties of skin types in human population, known as Fitzpatrick classification in medical terms. Developed by Thomas Fitzpatrick, a Harvard dermatologist in 1975, this system classifies 'complexions' and their 'tolerance to sunlight'. It focuses on skin potential for 3 things - irritation, burns and hyperpigmentation.

Skin Type
Skin Color
Characteristics
I
White; very fair; red or blond hair; blue eyes; freckles

Always burns, never tans
II
White; fair; red or blond hair; blue, hazel or green eyes

Usually burns, tans with difficulty
III
Cream white; fair with any eye or hair color; very common

Sometimes mild burn, gradually tans
IV
Brown; typical Mediterranean Caucasian skin

Rarely burns, tans with ease
V
Dark brown; Middle Eastern skin types

Very rarely burns, tans very easily
VIBlack
Never burns, tans very easily

Fitzpatrick skin type I have greater tendency for skin irritation and burns after sunlight exposure. On the opposite side, Fitzpatrick skin type VI have greater tendency towards hyperpigmentation and tanning following exposure to sunlight. Scar formation is less in skin types I and II. On the contrary, Types V and VI are bad scar formers. It is an unfortunate reality that most Indians belong to Fitzpatrick skin types V and sometimes VI, the two types associated with developing pathological scar formations. More fair skinned Indians have skin type IV, who also scar easily.

2. Genetic Predisposition to Scarring:

Does your immediate family consisting of your father, mother, brother(s) and sister(s) have a tendency towards scarring badly and heavily? If they do, you may be at risk of forming a bad scar as well. If they do not, it may be assumed that you may not form a bad scar, but there are no guarantees here. Genetic mutations are known to happen, and some people have been found to scar badly even when they do not have any bad scar formers in their immediate family.

3. Your Race:

Some races are more likely to form bad scars than others. People of African descent are known to be more prone to developing keloids and hypertrophic scars, which consists of excessive overgrowth of scar tissues at the site of injury. In India, similar tendencies are found in different tribal populations.

4. Your Age:

People within the age group of 15 - 55 years have been found to have more noticeable scars. In childhood, scars tend to heal better than in adults. In older age with lax skin and tissues, scars tend to get concealed within the wrinkles and creases, which may be more obvious in younger skin. Skin healing is worse in advanced age, however. Skin becomes thinner, less elastic, forms less collagen as you age older. Sun exposure, exposure to environment, smoking and lifestyle issues also play a role in worsening skin healing with advanced age.

5. Your Personal Traits and Underlying Diseases:

Some people are more blessed in having genes that make them heal quickly, magically, and with minimum scar visibility or formation. If you are one of them, a well done surgery with appropriate wound closure techniques will be sufficient to result in imperceptible scars. On the flip side, there will be some of you more prone to forming bad scars no matter what. Those who suffer from diseases like diabetes or connective tissue disorders also tend to heal badly and slowly. If you belong to such unfortunate category, you will need more precautionary measures than just good surgical closure for better results. Even after all these, there may still be very few people however, in whom results may not be satisfactory even after undergoing all possible treatments. Do not let these thoughts dissuade you. Scientific studies all around the world has shown that an overwhelming majority of people have good results with hardly visible scars if they follow a good scientific protocol for minimising scars. So you may have a good expectation of results after sticking to all necessary scientifically-proven processes for successful scar minimisation. Dr Srinjoy Saha follows all these proven processes thoroughly during his surgery and beyond to help you minimise scars and/or in making your scars imperceptible.

6. Incision and Closure Techniques:

Deeper and longer your surgical incision, greater is the likelihood for scar formation. Larger incisions are also more exposed to stress, which may result in slower healing and bad scars. During surgical wound closure, there are many scientifically validated and proven techniques to minimise scars. Skilled plastic surgeons like Dr Srinjoy Saha create cleaner incisions and performs wound closure without any tension, creating flaps when necessary, healing wounds more easily and making potential scarring less noticeable. He can masterfully hide the location of your scars by placing incisions along  natural lines and creases of your face and body, and make incision cuts as invisible as possible. He performs these techniques meticulously, strategising every surgery and paying great attention to details, to achieve the best results possible for you.

What Do I Need to Do to Get Better Scars Before My Surgery?

Do you know about the BEST thing you can do to help yourself? CONTROL certain factors that you have the power to prevent bad scars BEFORE the surgery. Some of these may be simple for you, while others may need some effort. But if you do control them, it will help you enormously in getting the best results possible. Here is a list of those things:

a. Stop Smoking:

Rule of thumb before plastic surgery - STOP smoking for at least 1 week (Preferably 2 weeks) before surgery and at least 1 week afterwards. Smoking is notorious to delay healing of wounds and increase your risk for scars. It is your responsibility to be honest with yourself, stop smoking and get best possible results following  your surgery.

b. Eat Good Food:

Eat balanced diet with high protein component. Proteins make up the building blocks of new tissues during your healing process. Adequate amounts of protein in the form of dairy products, soybean, cheese, egg, chicken, fish, pork, sea-food and others are vital.

c. Drink Adequate Water:

It is vital to stay well-hydrated. You will know if you are well-hydrated when your urine is colourless or light in colour. Not drinking enough water can make you dehydrated. In severe dehydration, fluid-electrolyte imbalances occur, resulting in poor healing. Mild dehydration will make you feel thirsty and less healthy overall.

d. Stop Drinking:

Alcohol dehydrates both body and skin, decreasing overall health and resulting in poor wound healing. While your wound is healing, please avoid alcohol, heavily caffeinated drinks, and highly concentrated fruit juices or other such drinks which may dehydrate you.

e. Control Your Weight:

Obese and even overweight people have serious issues with wound healing, resulting in wound dehiscence (opening up of the surgical wound) and bad scar formation. Too much of fat underneath the skin results in lesser blood supply to the wound edges and bad wound healing. Taking steps to an active lifestyle, hitting the gym, having controlled diet, regular exercises etc may be a good idea to get the best possible results after your surgery.

What Can I Do To Get Better Scars After My Surgery?

There are plenty of things you may do to get better scars after your surgery is over. Here is a list:

a. Rest:

Adequate rest to the healing part is vital for proper wound healing. Exhaustion slows down healing. If you are asked to take rest for two weeks, please follow that advice. Avoid thinking that you know better and start working out after 1 week. Ignoring doctor's advice will not be in your best interests.

b. Stress on Your Incision Lines:

Any type of stress on your incision line that stretches or puts tension to that area should be avoided at all costs. Avoid as much of movement to that area as possible during the initial healing phase (2 weeks) by stopping lifting, bending or any such movements. If you want better scars, you also need to be careful to NOT stretch your incision lines with continuous movement during the next 3 months. Stress on wound margins pulls the incision apart, delays healing, stretches scar and leads to hypertrophic scar formation.

c. Proper Wound Care:

Proper wound care is the single most important determinant to good wound healing and to prevent bad scar formation. Regular cleaning and proper dressing to care the wound, avoiding injury to incision site, preventing infection, and other general incision care techniques are essential to healing well with less scars. 

d. Identify and Treat Wound Infection Quickly:

It is important to identify signs of infection of the wound quickly and seek medical help. Signs of wound infection include (1) expanding redness around the wound, (2) yellowish or greenish coloured pus or cloudy wound drainage, (3) red streak marks spreading out from the wound edges, (4) increased swelling, tenderness or pain around the wound and (5) fever.

e. Proper Treatment of Underlying Diseases:

Many underlying illnesses slow and impair healing. Diabetes, Thyroid problems, Connective tissue disorders, Auto-immune disorders, and many such underlying diseases are notorious to delay wound healing, open up wounds and cause poor scars. Diagnosing and treating theses illnesses before your surgery is vital for good outcomes. For example, if you have diabetes and it is not controlled well before your surgery, there is a high chance of having a rocky post-operative period with swinging levels of blood glucose and a bad wound healing with a high chance of wound infection and poor scars. However, if your blood glucose levels are well-controlled for several weeks before surgery, you will have a good chance of a smooth post-operative period, good wound healing and better scars.

f. Sunlight Exposure:

Healing scars are extremely sensitive to brownish discolouration along the edges following exposure to Sunlight and any form of Ultraviolet light. It is in your interest to adequately cover healing scars for several months after surgery and religiously apply sunscreen ointments to avoid hyper-pigmentation and discolouration of scars. It is usually safe to start this treatment after the incision has healed completely and all sutures have been removed. Investing in a good sunscreen with high sun protection factor of spf 30-50 will ultimately benefit you.

How Can Dr Srinjoy Saha Make a Difference in My Scar Treatment?

Best outcomes in plastic surgery always happen in the hands of good, knowledgeable and skilful plastic surgeons like Dr Srinjoy Saha. He has worked on projects focusing on making incision scars invisible during his time at Harvard, US. He successfully applies these advanced learnings and technologies in his clinical plastic surgery practice in Kolkata India to provide you with best results possible. Some of these techniques may include:

1. Proper Surgical Technique: Reduce Tension. 

Reducing tension on the wound edges go a long way in preventing bad scar formation. Creating and advancing flaps, progressive tension closure techniques are amongst the various methods utilised by Dr Srinjoy Saha during your surgery to produce better scars.

2. Proper Surgical Technique: Wound Edge Eversion.

Eversion of wound edges have been found to achieve fine, flat scar in multiple split-scar randomised controlled trials. 

3. Proper Surgical Technique: Cosmetic Microsurgery.

Best results for producing the finest scars in Indian population occur when microsurgical principles are employed for skin closure, especially over the face. Under high magnification, either under operating microscope or surgical loupes, microsurgery instruments and extremely fine sutures are utilised to co-apt the skin edges without tension. Dr Srinjoy Saha regularly performs this technique for patients desiring good scar over their faces, with very high degree of success.

4. Proper Surgical Technique: Incision Placement.

Best results in final scar appearance after plastic surgery occur when scars are placed within relaxed skin tension lines (RSTL) over your face and body. If your incision goes against these natural relaxed lines, employing techniques like Z-plasty ans W-plasty to break and realign these scars are helpful in achieving best results. Incisions placed within naturally-occurring wrinkles and creases of your body also result in good final scar appearance.

5.  Proper After-Care: Medicines.

Avoiding wound infection with antibiotics (if required), regular wound cleaning and dressings, and applying proper wound care regimen are essential for good results.

6. Proper After-Care: Scar Massage.

Scar massage have been found to have some efficacy in bettering scar appearance. This is an easy way of getting better results and can be done by the patient themselves. It is usually done for 10 minutes each time in the method taught to the patient, twice daily, with ample amount of prescribed ointment or lotion. Scar massage starts after the wound closes well and all sutures are removed.

7. Proper After-Care: Silicone.

Most commonly used medical silicone is polydimethylsiloxane. It is an inert polymer that is applied to scars in the form of sheets or gels.Silicone have been shown in multiple studies to reduce the incidence of hypertrophic scars and keloids. 

8. Proper After-Care: Sunscreen.

Newly formed scars are prone to discolouration when exposed to sunlight or UV light. Religiously applying sunscreen with high spf of 30-50 will help you in minimising these problems. Covering your exposed scars and using umbrellas also go a long way in producing better scar results.

9. Proper Post-operative Care: Scar Protocol.

Dr Srinjoy Saha utilises an advanced, well-established, scientifically-validated protocol combining different principles of tissue engineering, medicines and laser therapy to produce far, far better results in any existing surgical incision. It is recommended to start this protocol within 2 weeks of wound suturing and goes on upto 3 months thereafter. Briefly, this protocol combines (1) Mechano-Modulation of skin and underlying tissues, (2) Lasers (either ablative fractional or nonblative fractional laser therapy), (3) Laser Assisted Drug Delivery, (4) Molecular Therapy and (5) Scar Hydration to modulate your body function and produce the best results in scar formation possible for you.

Conculsion: Final Word for Best Scars.

Scarring after surgery can vary enormously from person to person. Employing the same surgical technique, one person may have virtually no visible scars. Another person may have some visible scars which fade over time. While a third person who is predisposed to bad scar formation can have noticeable, ugly scars after complete healing. You will need to understand that these scar results does not happen because of the fault of any surgeon. Employing proper surgical techniques minimises scar problems. Dr Srinjoy Saha is extremely knowledgeable and skilful, and always integrates surgical techniques during your surgery that will benefit you in producing best possible scars over the long term.
If you are extremely concerned about your final scars, you will need to follow proper aftercare as detailed above. Various methods of scar betterment are available, some of which are beneficial and some are not. The goal of scar betterment is improvement of final scar appearance, hopefully making it imperceptible; and not removal. Utilising advanced scientific Scar Protocol during your post-operative period will help you achieve great results during your healing period, and it is recommended that you utilise it for best results in final scar appearance.

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