A scar is the visible mark on the skin left by trauma – of which surgery is one, very controlled example. A surprising proportion of many plastic surgeon’s workloads involves camouflaging, de-accentuating and at times, radically revising surgical and other scars.
Earlier in my career I had a colleague who was world-class in his field (which wasn’t plastic surgery) and performed life-saving surgical miracles on a daily basis; but by the time closing the skin came along, several hours after the start of the surgery, my colleague was less engaged. As a result, my colleague’s patients were less delighted than they should perhaps have been with his skills, because they couldn’t see those. All they could see was the scar on the skin. Until I persuaded my colleague to take an extra 5 minutes at the end of surgery, I had a regular stream of patients who were alive because of my colleague, but disgruntled nevertheless because of my colleague’s scars.
Something in the region of 70% of the process in which the body produces a finished scar is out of a surgeon’s control: factors such as where the wound is made on the body; the body’s genetic predispositions; where ladies are in their menstrual cycle when a wound is made; your nutritional state; your age; your skin tone; whether or not you smoke or passively inhale tobacco; whether or not your wound becomes infected, or receives a knock whilst it’s healing can have major effects on the final result of a scar.
Only 30% of the final result is truly a function of surgical expertise and technique. That said, there is a great deal that your surgeon can do to influence the 70% that isn’t strictly down to the surgeon and knowing how and when to do that can make all the difference.
Scars which heal nicely are not usually a source of concern for patients, so I’ll concentrate on the rest which are, broadly speaking, scars which stretch and widen or scars which become raised and lumpy – of which there are two sorts: hypertrophic scars and keloid scars
These can be the result of suboptimal surgical technique, but can also result from the wound being banged accidentally in the first few weeks of healing; or from infection during healing; or in the same way that stretch marks occur, secondary to rapid weight gain or pregnancy. Most stretched scars can be surgically revised and improved using plastic surgical expertise and fundamental techniques.
These have in common an abnormal metabolism of the protein molecule collagen which is the main component of scars; but otherwise, the genesis of hypertrophic scars and keloid scars is very different. They appear similar to the untrained eye, however, and the difference confuses many doctors who don’t specialise in dermatology or plastic surgery.
There are many treatment options for lumpy scars but the important thing is to make the correct diagnosis first and then tailor the management of abnormal scars accordingly, whilst paying careful attention individual patients circumstances.
The afro-caribbean population in the UK is especially susceptible to keloid scars and as a result, over many years, I have gained a considerable experience and expertise in the surgical and non-surgical options for treating these scars.
Treating patients with these scars can be immensely satisfying because patients have often given up hope and resigned themselves to what is often both a painful and an unsightly blemish, so I am always happy to consult with people and colleagues on how best to manage these scars.