Scars And Treatments
Steve Fallek (Plastic Surgeon & Medical Director, Face Focus Medical Spa, New York City) gives expert video advice on: How is a plastic surgery scar different then any other scar?; Will I have a permanent scar after plastic surgery?; How do I get rid of my old scars? and more...
How is a plastic surgery scar different then any other scar?
There's really no difference between a plastic surgery scar and other scars. As plastic surgeons we certainly take more time and have better technique in terms of making scars as small and as beautiful as possible. We're also very good at hiding the scars, making sure that they're in places that can be concealed. A plastic surgery scar and a regular scar are really no different.
Will I have a permanent scar after plastic surgery?
When I see a patient, they always say, “You're a plastic surgeon. There'll be no scar.” I always respond, “There is no such thing as no scar.” Anytime there is an incision or cut in the skin, there's going to be a scar. What we as plastic surgeons hope to achieve is to make those scars as small, minimal and unsightly as possible. We're also very good at hiding the scars in places that you may not see. However, there's always some sort of scar with plastic surgery.
What treatments are there for new scars in plastic surgery?
There's been a lot of research recently into laser treatment for young scars. By young scars I mean scars that are within a year or two old, they are either pink or red, and they don't have the mature, light quality of the older scars. Some of the lasers that we're using now may be effective on newer scars. You need to check with either your plastic surgeon or your laser surgeon to determine whether or not you may be a candidate. Right now it may require a couple of laser treatments really to improve those scars. Most scars take about a year to mature. I'm never too concerned about redness after plastic surgery, and that usually resolves rather quickly.
Can plastic surgery remove a keloid scar?
A keloid is a thickened or raised scar which usually extends outside of the boundaries of a normal scar. It's more common in African American or dark-skinned patients. Normally, I will see patients who say, "Oh, a keloid," and I look at their skin, and in fact they don't have keloids, or they're just not healed well. Keloids are more of an issue in dark-skinned patients, and really require a more aggressive treatment, and treatment even before removing a keloid.
What will vitamin E do for my scar?
There is no clinical proof that vitamin E works for a scar. I have many patients that say "Oh, I hear vitamin E works," but there is no clinical proof, and about 20% of patients have a reaction to vitamin E. If you are going to use vitamin E, I suggest buying vitamin E caplets and massage it into the scar. Again, there is no proof that vitamin E works, but there is clinical proof that massaging the scar, and I mean vigorously massaging that scar, will improve the texture and appearance of the scar. It is probably not a bad idea to take a multivitamin if you are concerned about a scar. You don't need to load up on the vitamin C, but vitamin C and Zinc are probably good things to have if you are concerned about scars. Take them orally rather than applying them to the skin.
Do lasers work on eliminating scars?
There's a lot of research going on these days by laser companies in terms of trying to improve a scar, and there's really no definitive answer about whether or not lasers will improve scars. Some of the earlier or immature scars, whether they're red or pink, may show improvement with laser treatment. Some of the older scars, where they're white or soft, probably won't benefit from laser treatment. You need to be careful before somebody says, “Oh yes, I'll just laser that off and take care of it.” In any regard, it will probably require 3 or 4 treatments of the laser to show any improvement to the scar.
Do scar treatment creams work?
There are a variety of skin treatment and scar creams that are out on the market. There hasn't been any good evidence that they really affect a normal, healthy, healing scar any differently. You really need to be careful about spending money on some of those scar creams. For some of the thickened, raised or hypertrophic scars, there have been some studies that show that silicone gel sheeting or other treatments do work. However, for a healing, straightforward scar, I would leave it alone. Make sure you stay out of the sun rather than spending a lot of money on a scar treatment.
Will the sun affect my scar?
The sun can either lighten or darken a scar for anywhere up to a year after surgery. I always tell my patients it's important to keep those scars or incision sites hidden from the sun. If you can't wear clothing, the best thing is SPF 30 or higher. You really should be applying that vigorously and making sure that those areas are covered. The sun can either lighten or darken the scar and that's really what we have to avoid.
How long will it take my scar from a plastic surgery procedure to heal?
We usually tell patients that it takes about a year for there to be final results from any plastic surgery treatment. Usually the scars will heal rather quickly - within the course of a couple weeks to one or two months - but you may not see final results for up to a year.
What is "Fraxel" and how does it work?
Fraxel is one of the newer types of lasers that is available, and it gives an isolated beam of energy interspersed with normal tissue. It's claiming to be as effective as other lasers on scars but without the prolonged redness, and studies are showing some good results. You need to check with your doctor before having Fraxel treatment on scars.
What is "Thermage" and how does it work?
Thermage is one of the newer machines that are available. It's been available for about two or three years, and it works by applying a radiofrequency energy to the face. Their claims are that the Thermage and the energy affects the collagen in the face and heightens the skin. Some of the other machines had some difficulties and Thermage has been updating their machine. Results have been mixed amongst plastic surgeons.
What is "smart lipo"?
Smart lipo has been in the media recently. It was developed by one of the laser companies. Smart lipo is where the end of a liposuction canula, or the end of a device, is inserted into the skin and then liposuction is performed after. According to the manufacturer it is supposed to make liposuction easier. Long-term results and studies have not been done in this country yet, so I remain skeptical until I see those results.