The skin as an organ is designed to keep out the environment, and therefore has an enormous amount of immunologic cells. When the skin is injured with a surgical procedure or if there is significant tension placed on the skin, there is an increased recruitment of these cells leading to more inflammation which could result in a thick, red scar. As a revisionary specialist, who focuses on ways to minimize scars, I utilize several techniques to prevent trauma to the skin.
A very common cause of poor scars is unnecessary trauma to the skin at the time of surgery. One of the big “no no’s” that I see frequently in patients seeking revisionary treatment is aggressive use of electrocautery. The cautery device that all surgeons use during surgery is necessary to control bleeding; however, when it is used on the skin, as opposed to the deep subcutaneous tissues, is creates a thermal injury otherwise known as a burn. This sets in motion a massive cascade of inflammatory cells leading to thick scars.
The problem is that to the naked eye (surgeon’s eye), you can’t see that injury when applying cautery to the skin, but microscopically there is a definite thermal injury (burn).
Another common cause of tissue trauma is excessive retraction on the skin. I have incorporated several techniques to minimize injury to the skin. The first is to train your assistants to be gentle with tissues as a habit. The use of a Keller funnel to place breast implants minimizes the retraction and tissue trauma associated with putting in breast implants and allows a smaller incision to be utilized. I also routinely use “tissue protectors” during liposuction to prevent the mechanical injury associated with the cannula repeatedly moving back and forth through the skin.
The best opportunity to have a well healed and beautiful incision is at the time of surgery. By minimizing trauma to the skin, there is less inflammation. This creates the best environment and opportunity to have that “perfect scar”.