Does plastic surgery leave scars? This is a very common question from patients considering elective plastic surgery. The short answer is yes. It is not possible to create an injury to the skin without leaving a scar. Scars may vary however in terms of quality and visibility. As a plastic surgeon, an important part of every surgery is designing scar placement in a way which may make the scar less obvious over time. It is also important to educate patients on ways to optimize early healing and scar management as maturation occurs.
There are several factors which may result in a less conspicuous scar. These factors relate to surgical technique as well as appropriate wound care and scar management post-operatively.
Scar formation may be affected by the following factors:
Meticulous wound closure
Surgically created scars have a better chance of leaving a less conspicuous scar than traumatic injuries. Surgical scars are created with precise instruments as opposed to traumatic mechanisms, such as abrasions and crush injuries which leave more irregular wound edges and damaged soft tissues. Traumatic wounds may also have higher risk of complications during early healing, including delayed wound healing and infection. Layered closure may be performed during surgical closure in certain body regions. A layer of deep “dissolving” stitches may be placed in regions of greater tension and thicker skin. This may lower the risk of scar widening over time by reducing tension on the wound during early healing.
Design incisions to follow natural skin creases
An important part of plastic surgery is designing incisions and resultant scar placement along “relaxed skin tension lines”. These lines generally refer to natural skin creases, which are parallel to wrinkle lines. For example, mole removal along the smile line region is designed parallel to this natural structure. This results in a less conspicuous scar over time. At other sites, scars are placed at natural junctions between different body units. Facelift surgery is a good example to explain this point. Incisions are placed along the junction between the ear and cheek, which become more difficult to see as scars mature. During breast augmentation, implants are often placed through an incision within the fold below the breast. This also becomes less visible over time.
Removal of skin stitches at a set time
As opposed to deeper stitches which are buried and dissolve over time, skin stitches are removed at a set time post-operatively. This lowers the risk of developing permanent marks (“track marks”) along the incision line. I generally remove facial sutures at 5-6 days post-operatively. Sutures are generally removed from other body sites at 10 days following surgery.
Patients often ask about resorbable (“dissolving”) sutures. I generally do not place these stitches through the skin surface. They often create more inflammation as they are resorbed. In certain cases, the stitches may resorb too quickly, which may cause the wound to widen or dehisce (partially or completely open up). More prominent scarring may then result. In other cases, resorbable sutures may fall out too late, which may leave more prominent stitch marks near the incision.
Optimize scar management
It is important to emphasize scar management as scars mature and fade. Although there are many different products on the market to treat scars, evidence-based research is lacking. I advise patients to apply sunscreen daily (SPF 30) for one year following surgery as scars mature. If immature scars are exposed to significant UV rays, hyper- or hypopigmentation may result. This means the scars may become permanently darker or lighter than adjacent skin. Even on cloudy days and during winter, scars may still be exposed to background UV light.
Sunscreen has many advantages:
Reduced risk of skin cancer development
Delayed signs of facial aging
Scar massage may also be effective in thinning scar tissue as well as reducing scar sensitivity. It may expedite scar maturation through mechanical forces by rubbing the scar several times daily as maturation completes.
So does plastic surgery leave scars? Despite the hopes of many patients that plastic surgery is scar-less surgery, this is unfortunately not true! But the good news is that there are many techniques relating to surgery, wound healing, and scar optimization that may lead to less conspicuous scars over time.
Please contact us if you have any questions relating to this blog or would like to schedule a consultation.