Second chance
Scars cannot be prevented, but can be placed in the best possible way
The fact that an operation leaves a scar cannot be prevented, however when making an incision I do take the forces on the skin into consideration. The less force is applied to the skin, the better and the finer it will heal. I will always assess the way a scar will form beforehand.
Reoperation
Effects of complication or a dissapointing result can be corrected or improved bij means of a reoperation. The surgery can vary from a simple (scar) correction to a full re-do of the previous surgery.
1. Scars
Scar formation
The healing process will actually only start after the sutures have been removed. The scar will first turn red and swollen as a sign of increased blood flow and the creation of connective tissue. During the following months it will turn thinner and smoother, whereby the red color changes to purple and then gradually fades. The scar now enters the so called ‘calm phase’. Scar formation is coherent to age and the type of skin: in children the reaction to scar tissue is stronger than with elderly people. A more dramatic reaction to scar formation is also seen in reddish haired people.
The location of the scar is of substantial influence on the scar formation. Scars that result from an eyelid correction show a mild reaction and enter the calm phase relatively soon, however, scars on the shoulders or the sternum often show an intense reaction, that can have a long duration. If possible I will refrain from making a scar at these places.
Taking care of scars and positive influence
You can positively influence the way a scar will develop by soothing it, at least 4 weeks, preferably longer. Keep the scar clean and do not use any cream if there are still remaining sutures. After the removal of all sutures and after the wound has fully closed, then you can apply cream or for instance body lotion. To use a special scar cream is not necessarily needed.
Fading of a scar
Fading of a scar actually means that it becomes lighter of color, soothes and becomes less noticeable. A scar will clearly show when it is red or purple. Later the color will fade and will even be lighter than the surrounding skin. This process takes at least one year. This is the reason why in case scar correction is needed it does not make sense to do this within the first year.
Scar tissue pain
Aggressive, red and swollen scar tissue is painful because of the swelling and increased blood flow. The more the scar tissue soothes, the more the pain will fade away. It is not normal when the pain lasts. In case of severe pain when touching the scar, possibly the skin nerve is captured within the scar tissue. This occurs especially in wrists. This does not heal and needs to be operated.
Treating problematic, swollen scar tissue
This is scar tissue that remains red and swollen for over a year. The first thing you could do is to massage the scar on a daily basis. Besides that you could use a special scar cream, I usually prescribe a cream based on silicone. It has been proven that putting pressure on a scar will have a positive effect. That is the reason why with burn wounds special clothing is used that will put pressure on the wounds and that the elasticity of the shape wear panties has a healing effect.
Problematic scar tissue that itches and is painful can be injected with corticosteroids, so called scar tissue reaction inhibitory hormones. The scar tissue will reduce in size soon after injection, but will be irregular and cosmetically unattractive. The best option is to let the scar tissue heal and reduce by itself.
2. Scar tissue correction
To try and improve a scar cosmetically does not always make sense. For example, a scar as a result of a major abdominal operation will hardly improve after scar tissue correction. Improvement can be achieved in case of pulling scar tissue or where the scar causes a crease or a dent. A scar can be more obvious because of the way it catches the light, in this case a scar tissue correction will make an improvement. Sometimes a correction will change the perception of a scar.
It is important to consider carefully if a scar tissue correction should be done, because the process of healing, maturing and fading, that can take years, will start from the beginning.
3. Reoperation
In case a scar tissue correction is not adequate to achieve the required result, then in some cases more extensive surgery, a reoperation, can provide an improvement. This operation can vary from a simple correction to a full re-do of the previous operation.
With the abdominal wall correction the correction often concerns a scar that is placed too high, or asymmetrical, a wide scar after complications with the wound, or a scarred belly button.
A reoperation after a breast reduction can be due to asymmetry, insufficient reduction, nipples that are placed too high or wide scars caused by wound complications.
Reoperations after breast enlargements are due to asymmetry, breast implants that are too small, the phenomenon that is called 'double bubble', capsular contracture, dents, noticeable edges or leakage.
After a nose correction a reoperation is not uncommon. Insufficient reduction of the nasel ridge especially the part just above the tip of the nose, irregularities on the ridge of the nose, skew angles, a nose tip that is too wide or too narrow are examples of reasons to opt for a reoperation.
Insufficient improvement of the angle of the upper part of the ear, or the earlobe, or sharp edges of the cartilage are reasons for patients to request a second ear correction.
Asymmetry after an upper eyelid correction is often related to a slightly lower position of one of the eyebrows. Additional one sided skin removal will not help in that case. A scar that is positioned to high on one or both sides is difficult to correct.
The initial lower eyelid correction, removal of the bags under the eyes, can be insufficient, this is a relatively simple reoperation. A more complex reoperation is required with a pulling eyelid that does not recover from itself.
In case of the forehead lift the reason for a reoperation is in common because of an insufficient lift after the initial surgery. In most cases the same complaint arises with facelift operations that require a re-do. Besides that patients request corrections of the scar tissue and ear lobe.
The decision to do a reoperation will be taken by both you and me after careful consideration. It is important to give you a realistic view on the possibilities and the results that are to be expected.
Dr. Erik J.F. Timmenga
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