Scarring is a normal and expected consequence of every plastic surgery operation. While they can vary in size and appearance, an incision in the skin will inevitably leave a scar.
Over time and with good scar management, scars will soften and become narrower as they mature. Scar management is an essential part of preventing thick, unsightly scars from forming. There are a number of simple measures that can be put in place to prevent poor scar formation, and plastic surgeons play an important role in optimising the wound healing process for their patients.
What are hypertrophic and keloid scars?
Hypertrophic and keloid scars result from abnormal wound healing, in which the scar tissue grows excessively and forms a hard, raised and discoloured growth. Hypertrophic scars are more common, can regress with time and generally stay within the boundaries of the original wound. Keloid scars grow beyond the boundaries of the wound and do not regress. They can be painful and require intensive management.
Who is at risk of developing a keloid scar?
Some patients have a higher likelihood of developing a keloid scar based on personal factors including age, genetics and skin phototype, so it is important to be aware of these risks and have a conversation with your surgeon before your surgery. Keloids are particularly common in Asian patients, and in females more than males.
Asian skin types and skin types with a higher level of melanin and collagen formation have a greater risk of forming keloid scars following injury or trauma to the skin. During the normal wound healing process, new scar tissue is formed that is maintained by fibroblasts. The thicker dermis and high collagen density of Asian skin types results in an increased fibroproliferative response during healing, leading to abnormal scar formation and hyperpigmentation.
Where on the body can keloid scars form?
Keloids develop most commonly on the ears, jawline, neck, shoulders, chest, upper back and proximal arms. While the tendency toward keloid scarring is genetic, it is also region-specific. For example, a person may develop a keloid in one earlobe after having it pierced but not the other. Similarly, if a person develops a keloid scar as a result of a Caesarean birth it does not mean that a keloid will necessarily occur with eyelid surgery. With the exception of the jawline, keloid scars very rarely develop on the face.
How can my surgeon minimise scarring?
The surgeon should prioritise the prevention of keloid scarring and take measures to do so at every stage of the operation.
Before the operation
The surgeon will ensure that the patient is aware of the possibility of poor scarring, and of any personal factors that may make them more susceptible. The surgeon should also consider the skin incision design that will result in the least amount of skin tension after the operation.
During the operation
The surgeon should focus on taking measures that will minimise inflammation after the surgery, such as reducing the possibility of infection through rinsing, disinfection and oral antibiotics. Skin tension can be reduced during the operation through a two-layer closure suturing technique. The surgeon should also select the most appropriate sutures for optimal scarring.
After the operation (post-op)
Immediately after the surgery, tension-bearing skin tapes will be used, and compression therapy from customised garments will help to control excess fluid. Silicone therapy can also be commenced immediately through applying a silicone-based tape or gel. Silicone therapy is safe and effective in promoting normal scar maturation.
Can keloid scars be removed?
Multimodal treatment is recommended as the most effective way to address keloid scars. A growing keloid can be treated with a combination of silicon therapy, pressure therapy and cortisone injections, which can help to reduce the size, swelling, redness and tenderness of a keloid. Anti-wrinkle injections can also be administered to improve the keloid’s appearance.
If a change can’t be noticed after 12 months, surgical excision may be considered for select patients, but surgeons approach this option conservatively. This is because people who are prone to developing keloid scars may be at risk of developing another scar from the removal surgery incision. With surgical reduction alone, keloid scars have a 40%-100% chance of recurring, and this is why a multimodal approach to treatment is encouraged.
At Eastern Plastic Surgery we specialise in treating Asian patients, who tend to have a higher predisposition to keloid scarring. Dr Frank Lin takes great care in utilising preventative measures to effectively minimise the occurrence of these scars for higher risk clientele. He tailors the suture material and technique to suit each individual patient’s condition and scar location, and begins silicone scar therapy treatment immediately following the closure of the wound. The resulting scar is typically fine and relatively inconspicuous – the most desirable result for any type of surgery.