Dr. Ernst N. Kaplan
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ABOUT SCARS AND HEALING AFTER SURGERY

All surgeries leave a scar, but plastic surgery techniques minimize the appearance. The scar is made inconspicuous by hiding the incisions in creases, hair or hidden locations. All scars follow a typical sequence of healing that takes about one year until full healing and the final result can be seen.

  • During the first week after surgery the surgical area begins healing by providing new blood vessels for tissue nourishment and collagen for healing.
  • After 2-4 weeks there is sufficient collagen scar for wound strength.
  • Sutures at the surface are removed at about one week to avoid forming stitch marks; but sutures deeper under the skin remain.
  • During the first month after surgery the scar and blood vessels slowly increase causing the scar to look red and raised, and to feel firm and slightly tender.
  • After 2-3 months the scar and blood vessels begin to resolve causing a paler and smoother appearance.
  • After 6 months to 1 year the redness from healing blood vessels has resolved and the scar has softened and flattened.
  • There are various circumstances that are more likely to create a heavy scar. One of my roles as your plastic surgeon is to create the circumstances to give you the best possibilities of achieving an inconspicuous scar. These factors are:
    • Age- The worst scars are in teenagers and healthy growing individuals. Older patients will have better scars.
    • Ethnicity- Dark skin people form heavier scars than lighter skin people.
    • Sex- Women will have somewhat heavier scars then men (probably because of female hormones).
    • Location- The eyelids and the face form inconspicuous scars. The chest and abdomen form heavier scars. The extremity scars are moderate.
    • Shape - Curved or zig-zag scars heal better than straight scars.
    • Position- Flat surfaces heal better than scars that cross a concave (depressed) or convex (raised) area.
    • Tension- Scars that are in the same direction as the pull of a muscle will be heavier than a scar that is perpendicular to muscle pull.
    • Infection- Infection destroys tissue and causes of bad scars
    • Blood collections- Excess blood in the healing area (hematoma and severe bruising) cause additional scar.
    • Inadequate blood flow- Poor blood flow causes slow healing and possible wound separation. This mainly occurs in tobacco smokers, diabetics, hypertension and other health conditions.
    • Inflammation –Reaction to suture material or other foreign bodies causes additional scar.
  • After surgery, special treatments to reduce scars may be used. These include:
    • Pressure dressings and taping
    • Antibiotics
    • Splints and activity limitations
    • Cortisone injections
    • Silicone sheeting
    • Massage
    • Sun avoidance or protection
    • Vitamins and other creams.