Any time an incision is made there will be a permanent scar. As I discussed in Part I of this blog series, when I perform Phoenix area plastic surgery, I take all possible precautions to ensure that scars will heal smoothly. In addition, I advise my patients on what they can do during their recovery process to minimize the appearance of scars. Unfortunately, some factors are outside our control.
First and foremost, genetics is the greatest uncontrollable factor. Everyone scars differently. The same surgeon can perform the same surgery using the same technique on two different patients and get completely different scars. Simply put, some people heal more smoothly, while others have a tendency to form more noticeable scars.
Patients who have a personal or family history of bad scarring should be cautious about surgery. A genetic tendency toward severe scarring can affect not only the external, visible scar tissue but also the internal scar tissue.
Many people of Asian, African, Middle Eastern and Mediterranean descent are more prone to scarring. However, these are general findings, and every individual heals differently regardless of his or her ethnicity. Some Caucasians form thick, red scars while some African-Americans form nearly invisible scars.
Another factor affecting scarring is body location. Certain areas of the body tend to heal with thicker scars. The center of the chest, the shoulders and the back are notorious for bad scars because of the thick, tight skin. This is why surgeons try to avoid incisions in these areas. If, for some reason, an incision must be made in one of these areas, there is a higher risk for thicker or more noticeable scars.
Tension on a wound closure also can contribute to scarring. The more the skin is being pulled, the higher the likelihood that the patient will develop a bad scar. This is one reason why plastic surgery is so challenging; almost everything we do requires tension. Unlike a C-section or an appendectomy, where no skin is removed, breast reductions, tummy tucks and facelifts all require skin removal, which causes more tension to be placed on the wound closure.
To counteract this, plastic surgeons pay a lot of attention to layered closure and fine suturing techniques. One could argue that tension is a controllable factor. However, to a large degree, the surgeon cannot control tension. To achieve the desired result, a certain amount of tightening is required with procedures such as a breast lift or a tummy tuck in the Phoenix area.
Some other causes of scarring also cannot be fully controlled. These include wound infections, problems dissolving internal sutures and other healing challenges. If one of these problems occurs, the patient and surgeon can work together to improve the situation.
I hope I have helped explain one of the most unpredictable and important aspects of plastic surgery. I always do everything I can, both during and after surgery, to minimize scars. Most of my patients heal extremely well and are happy with their results, including their minimal scars. Although some people will develop less than ideal scars despite my best efforts, the majority of such patients are still happy with the overall results of their surgery.
The bottom line is that everyone considering elective surgery must be realistic about the possibility of having more visible scars than they would like and understand that this is a low – but real – risk.