At least a few times weekly I get asked whether or not someone will have a scar after a certain procedure. People are sometimes under misconceptions about how exactly Plastic Surgery works. Anything you cut, burn, or excise scars. The quality depends upon a number of factors including
- location – certain areas don’t scar as well as others (behind the ear, the medial-lower breast, the armpit, the scalp)
- tension – more tension equals wider scars. This plays a factor in the areas listed under location. Incisions across areas with lots of motion (the knee, wrist, & shoulder) all tend to be wide.
- technique – Plastic Surgeons didn’t invent good surgical technique and gentle tissue handling habits, but we tend to pay more attention to it.
- genetic predisposition – sometimes it’s your parent’s fault. A number of people display profound inflammatory responses with exaggerated scarring from anything. I make a point of discussing this with Asian and African-American women (who have higher rates of hypertrophic or keloid scarring) when discussing breast surgery.
- medical commodities – diabetics, obese patients, those with arterial disease, and gastric bypass patients all have baseline wound healing problems to some degree.
- age – the inflammatory response of normal healing varies with age. You can do experimental surgery in utero and get essentially scarless healing of a fetus. However the response in children and teens to injury can be exaggerated scars as their immune systems tend to be “peaking” during those years. Alternatively, you can do things to the face of 70-90 year olds that would disfigure younger patients and often not even find a scar.
