Plastic surgery for scars

Every so often a patient asks me about a cosmetic surgery and says, “Will there be scars?” There seems to be an idea out there that if you go to a plastic surgeon for cosmetic plastic surgery you will not have any scars. In fact, some unscrupulous plastic surgeons even advertise “No-Scar Surgery”—very bad of them.

Any surgical procedure, cosmetic or not, will leave behind scars. One of the main reasons you might go to a plastic surgeon is that we are trained in techniques to minimize and hide scars along the body’s natural lines, as well as to revise or improve bad scars through special techniques.

Types of scars in cosmetic surgery

There are four main type of scars. The differences are poorly understood but related to the rate of growth and orientation of collagen fibers in the scar.

Normal scar

This scar is a thin line, the same color and texture as the surrounding skin with no unevenness.

Atrophic scar

This is a scar that is wider than the initial incision. It is flat, usually lighter in color than the surrounding skin and has a thin texture. It looks like a stretch mark. In the case of an atrophic scar, there has been too much tension on the wound and it has reacted by spreading. This scar is commonly seen around joints.

Hypertrophic scar

This scar is a thick, elevated and darker-colored scar. Commonly, it itches and is painful. Its cause is unknown but thought to be related to the number of sebaceous oil glands in particular areas of the body in some patients, e.g., under the breasts, in the pubic area and near the breast bone. Hypertrophic scars are more common after trauma.

Keloid scar

This is a scar that grows beyond the initial incision. Keloid scars are dark in color, painful, large and unpredictable in their growth patterns. Some cosmetic patients have a genetic predisposition for healing with keloid scars. Keloids commonly occur as a result of traumatic injuries.

Who gets what type of scar?

There are some guidelines and studies that show that some groups of patients have different responses to scars based on skin type and color. In my experience, though, an individual’s prior experience with scar healing is the single most important factor, by far—not the color of the skin or particular skin type.
Patients with dark skin
These cosmetic patients are at a higher risk of developing keloids or hypertrophic scars. The rate of keloids in African-American, Chinese and Hispanic patients is between 4% and 16%.  Most patients do not develop them—only some do.
Patients with light skin
The lightest-skinned patients are those with red hair. They have a higher rate of atrophic scars and red scars during the healing process. Cosmetic surgery scars take longer to become less noticeable in these patients.

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