Scars and Scar Revision After Plastic Surgery
In the last two weeks, I have encountered three of my own patients in Santa Barbara with scar results after surgery that illustrate the capriciousness of the healing process.
The first was a patient who had a facelift by me a couple years ago. She diligentlly followed our post-op instructions regarding her facelift scars. Behind both ears, she developed a thickening scar into which I injected a steroid, a pretty standard treatment. I did it a couple more times, and the scar just kept getting bigger until I decided to revise it (cut it out and re-close it). She did well for a while, but the scars slowly started again to where now they are bigger than ever, and in fact now are most consistent with keloids. The term “keloid” is often misused, as most thick scars are hypertrophic scars. Keloids actually can grow beyond the bounds of the wound, almost like a benign tumor of sorts. I will likely have to treat these more aggressively with the use of another medicine, or even enlist the help of a radiation therapist to give some very low dose radiation to the scars after another revision. The odd thing is that this woman does not remotely fit the ethnic profile of a keloid-former, who is most commonly black.
The next patient was a patient who had breast augmentation in Santa Barbara by me nine months ago and shortly thereafter moved away unexpectedly and came back recently. Her follow-up with me was therefore minimal, and she really didn’t do anything I told her regarding post-op scar management. Her scars were thick, and I revised them last week. I will follow her closely, as I may have to inject steroid into the healing scar. She has a hysterectomy scar that is also thick, and I’ve injected it, and may need to do a scar revision on it too.
The third patient was also a breast augmentation patient who I operated on three months ago, who also unexpectedly travelled abroad soon after her surgery. She, however, did do the recommended post-op scar management regimen. Usually at three months, especially in a young patient, the scars can be a little red and slightly elevated. However, I could hardly see hers (they were inframammary), and I don’t think I have ever seen three-month scars that discreet! I can’t claim any credit for this – I closed her skin at surgery just like I do with everyone else, and she used Scarguard, a product that many of my patients use on their scars. Why hers healed so unusually quickly and discreetly, I don’t know.
So this just illustrates that although post-op scar management is important, scars can be unpredictable, and age, race, surgical procedure, and post-op scar management products are no guarantee of a certain result.
Douglas J. Mackenzie, M.D., F.A.C.S.
Santa Barbara, CA