Northern Virginia- Fairfax and Manassas
By: George Bitar, M.D. and Larry Lickstein, M.D.
Board Certified Plastic Surgeons
A cosmetic surgeon is an expert in managing scars. A great deal of education and training goes into giving patients the best scars possible, since this is a big part of any surgery. It is important to make a distinction between fresh and old scars because the handling of each is different. Many factors affect the final scar outcome such as the location and size of the scar, how the scar was obtained, the quality and age of the skin, the color of the skin, the amount of sun exposure to the scar, and other factors. People have a tendency sometimes to call any unsightly scar a keloid scar. A scar can be a poorly healed, exaggerated, or an "ugly" scar, but does not necessarily have to be a keloid.
A keloid is a very specific scar and not a "catch-all" term. When the skin is cut, the body lays down scar material to heal the cut and close it. When the cut is covered with scar material to the level of the skin, the body stops laying down scar material. In one specific abnormal circumstance, the body does not know when to stop, and keeps laying down scar material. The result is a scar that heals above the surface of the skin, and outside the boundaries of the original cut, but with scar material that is no different than any normal scar. This is a keloid scar. There are multiple surgical and non-surgical ways of treating keloids, from direct excision, to silicone pressure sheets, to steroid injections, or low-dose radiation therapy. Sometimes we use a combination of two procedures to obtain the best results.
When a patient is inquiring about a cosmetic procedure, I try to clearly describe how the resulting scar would appear. An upper eyelid lift scar heals very nicely because the skin is very thin and the tension is minimal. In contrast, a tummy tuck scar is in an area where the skin is thick and the tension is greater, so the results are not the same. When a scar is created due to a surgery, the suturing technique, material, and post-operative scar management with our special and exclusive scar management programme, are all factors to which I pay extra attention to get the best scar possible.
When someone comes to our institute complaining of an old scar that they would like to improve, they are handled on a case-by-case basis. I will assess the scar and give different treatment options that may include cutting out that scar and giving the patient a "nicer" scar, treating it with laser by a colleague, treating it with the scar tape and cream programme, massaging it, treating it with silicone sheeting, and other modalities.
Our goal is to always do our best to make our patients happy with education, examining the best and latest treatment options, and keeping the expectations realistic. Scars can be improved, but they can never be erased.
Preparing for the Procedure
An initial consultation is set-up where we discuss your options, and whether you are a good candidate for a scar revision. All our appropriate patients get the special scar management programme, if it is available, since it is imported. Because this is an in-office procedure, preparation is minimal. Patients are encouraged to stop medications that cause bleeding, such as aspirin, or aspirin products (Motrin or Ibuprofen), a week before this procedure. Mild to moderate pain is alleviated with local anesthesia.
The Scar Revision Procedure
The procedure takes about 30 – 60 minutes depending on the size and location of the scar. For very large scars, I will elect to do the revision under general anesthesia or heavy sedation in the hospital operating room, and not in the office operating room. If a patient is a good candidate for the procedure, a local anesthetic is applied. The scar is excised and closed in a meticulous cosmetic closure. Sutures used can either be absorbable sutures, or may need to be removed, depending on the scar. Your options will be discussed before the procedure.
The length of the scar usually cannot be changed with a scar revision, but here are other aspects of the scar that can be improved with a revision:
- Width: a scar can be made narrower.
- Elevation or depression from the normal skin surface: it can be leveled with the skin surface.
- Color: may be lightened with either a laser or with time alone. It usually takes a scar about a year to two years to fully mature and show the final outcome.
- Irregularity; a scar obtained in a car accident or a bad cut with uneven edges or an irregular shape may be revised to look more pleasing to the eye.
The Scar Management Program
We are proud to offer a special scar management programme. It is special because it has been clinically proven to work, since it addresses scar healing on many levels. In order to understand why this scar tape and cream system is effective, it is important to understand that it’s effectiveness lies in giving support, hydration, and enhanced healing:
- Support: tension on a scar creates a thickened, widened scar, or both. Support of the scar prevents an exaggerated scar. Use of paper tape has proven to decrease stretch forces on the scar.
- Hydration: Keeping a scar moist while it heals creates less scar formation. The scar tape and cream programme that we use has a plant extract that helps in scar hydration.
- Enhanced Healing: The cream in the programme that we use has inherent scar healing characteristics that have been well studied. It promotes balance between Type 1 and Type 3 collagen, which enhances wound healing.
You will be given this tape and cream programme after surgery when appropriate, to apply on the scars to make them heal as best as possible.
Our office will provide you with a detailed post-operative instruction sheet that will be individualized to your needs.
For more information about this procedure call our office and speak to our friendly staff member at 703-206-0506 (MD, DC, and VA).
Information on this web site is for information only. Do not use the information to diagnose or treat your plastic surgery or cosmetic surgery problems. Please contact your plastic surgeon with all questions and concerns.