Doctor, how will my scar be? Will I have keloids? Undoubtedly, this is one of the most raised issues in plastic surgery offices. Even more than the shape of the operated area, the patient pays attention to the quality of the scar, inferring from it the success or not of the surgery.
However, there are numerous factors that influence healing. We can divide them didactically into three groups:
1 ? Patient Inherent Factors
Genetics: I think this is the major factor in healing. There are patients who, even with poor healing conditions, evolve to a good quality scar, while others, under the best conditions, evolve to keloids. Keloid, a thick, high-relief, usually reddish scar, is prevalent in blacks and Asians, which clearly demonstrates genetic influence.
Nutrition: Several nutritional factors influence good healing. We can mention vitamins A, B, C, copper, zinc, iron, folic acid. Anemia, hypoalbuminemia, as well as a lack of vitamins can compromise good healing.
Specific pathologies: There are some pathologies that directly interfere with the scar. Diabetes, obesity, collagen diseases, coagulation disorders and others all interfere with the healing process.
2 ? Intraoperative Factors
Under the responsibility of the surgeon, the factors related to the surgical act must be carefully controlled. They are: accurate surgical technique, quality of the wires used, antisepsis (cleaning of the operated area), intraoperative bleeding, tension in the scar (any scar under excessive tension tends to enlarge).
3? Postoperative Factors
Responsible for the patient, postoperative factors may compromise the outcome of surgery, even aided by favorable genetics.
Tension in the scar: Scarring is a complex and lasting process. It follows chronological steps independent of the patient's will and yearning. Every scar up to 2 months is not yet strong enough to be subjected to traction without widening. This is why every surgery has limitations, such as not raising the arms after mammoplasty, not stretching the abdomen after abdominoplasty, etc.
Bleeding: Active bleeding or bruising may result from postoperative efforts. This is why no physical efforts should be made within the first 21 days.
Infection: Dressing and care in dressings are essential to prevent early scar contamination.
Medicines: Some medications interfere directly with the healing process and should be avoided. Examples are corticosteroids, isotretinoin, B-aminopropionitrile, d-penicillamine, colchicine.
Finally, the combination of these factors will determine the quality of the final scar, which may be ideal (thin, flat and clear) or with unsightly variations (broad, depressed, high, thick, etc.).
Scar and Keloid Management - Andrew Vardanian, MD | UCLAMDCHAT (April 2024)
- Plastic surgery, Body
- 1,230
