Created on 25th September 2008
Mr Peter Arnstein, consultant plastic and reconstructive surgeon at the BMI McIndoe Surgical Centre, explains everything you need to know about scarring and healing following a cosmetic surgery procedure
Plastic surgeons are the experts at creating the best possible operation scars. However, every surgical excision will produce a scar - there is no invisible mending, but with careful technique and placement of the scars in the natural crease lines, the impact can be minimised. However, even in the best hands events can conspire against good healing. Many cosmetic operations involve removal of surplus skin - breast uplifts and reductions, facelifts, tummy tucks, arm lifts - which of course means stitch lines which are under tension. This in turn can lead to stretched scars or even gaping wounds. This is more likely to occur if the skin is thin and elastic and even more so if medicine is taken which inadvertently effects skin quality and healing ability such as steroids and anti-cancer treatments.
Wounds can gape and stitches give way if too stressed, i.e. if a patient coughs without firmly supporting the wound with a hand after a tummy tuck, but that may be resutured or alternatively left to heal over a few weeks with a view to improving surgically a few months later.
Infections of wounds are uncommon in cosmetic surgery - ask about the infections rate at the hospital you are considering using. Again this can lead to a breakdown of wounds and a poor result.
Rarely the skin can die from lack of blood supply (necrosis). Again, usually due to excessive tension. This may be compounded by cigarette smoking which reduces the blood supply by constricting the blood vessels, poisoning the red cells with carbon monoxide so that they can't carry oxygen - essential for healing and tissue survival. Areas particularly at risk are the nipple on breast reductions (approximately 1 in a 100) and the skin above the pubic hair region in a tummy tuck.
However, some scars have a natural tendency to become red and lumpy, taking a couple of years to pale and flatten (hypertrophic scars). Much more troublesome still are keloidal scars which continue to thicken with time and are often itchy and occasionally painful. Keloids are very difficult to treat successfully.
Persistent scratching or abrasion of scars such as the under wiring in a bra cup on the scar on the fold under the breast following reduction or augmentation, tends to make them red and irritable. Using a soft sports bra, or protecting the scar with a band aid for a few weeks will allow it to settle down.
Scarring may be improved by massage with vitamin E containing creams; a cheap alternative such as E45, diprobase or Nivea may be as good. Application of silicone gel such as Dermitix or Silgel are considered by many to be useful. Regardless, time is the great healer and patience is almost always rewarded by improvement.
Mastopexy
There are various patterns of scars left following mastopexy depending on the technique, which in turn depends on the amount of tightening of lift and skin removal required. There is of course discomfort after almost any operation, but this is minimised by local anaesthetic put into the wounds by the surgeon during the operation and taking painkillers as required - asking for them early reduces the overall amount you will need. Bruising and swelling subsides over the first two or three weeks, as will the inevitable tiredness associated with any operation. It is very uncommon for nipple sensation to reduce with mastopexy, but more likely when combined with augmentation.
Breast augmentation
The scars with breast augmentation are usually very discreet. If properly sited in the breast folds, scars usually heal to a fine white line and only rarely are they red or troublesome. Each scar is about 5cms long depending on the implant size and type - the firmer cohesive gel implants need a larger scar than the soft gel ones. However, discomfort is usually minimal, perhaps a bruised feeling for a few days. The breast, themselves are tight and a little swollen for some six weeks, thereafter softening and dropping to a more natural shape.
Blepharoplasty
Expect black eyes after blepharoplasty, which can be quite dramatic at times. Clear your social diary for up to three weeks, by which time the worst will have gone, especially if you sleep with your head up on extra pillows or with the bed head raised and avoid bending down.
Some surgeons use dissolving stitches but if the stitches do have to be removed this is done between five and seven days after the operation. Occasionally small lumps can develop along the stitch line - these generally disappear over the next few months. If they persevere your surgeon can easily remove them under local anaesthetic subsequently. Normally makeup can be used two weeks after the operation - useful disguise for the scars and any residual bruising.
Abdominoplasty
This is an excellent operation for women whose post-pregnancy tummy fold sits on their lap when they sit down. However, it is a substantial operation, but generally very successful. The scar extends across the bikini line from hip to hip and usually heals well, although is always visible. Marked bruising is uncommon, the lower abdomen will remain swollen for several weeks before the final flatter stomach and thinner waist appear. Wounds can gape and often leak fluid which can be awkward, still healing over three to four weeks or so. Puckering of the scar line over the hips (dog ears) may require revision - a simple procedure under local anaesthetic - a few months on, to get the best results. A semicircle of skin above the pubic hair almost always remains numb although its size will diminish over the years. There is a tendency to develop a stooped posture after the operation which leads to back and neck ache. Standing straight will do no harm beyond feeling tight across the abdomen and will avoid the backache.
Conclusion
Although all surgery carries some risk - the surgeon who has ‘no complications' is either lying or doesn't operate - there are ways to ensure the safest path for you.
Approach your General Practitioner for advice - they are generally much more aware of the value of cosmetic surgery to the well being of their patients nowadays and often can recommend a plastic surgeon with special interest.
Phone the helpline desk of a reputable hospital known to specialise in cosmetic surgery.
Check the surgeons credentials on the Specialist Register and British Plastic Reconstructive Aesthetic Surgeons (BAPRAS). Ask the hospital about infection rates (all are audited), sterile instrument supply, emergency care, medical and anaesthetic cover, specialist surgical and medical teams and ask to speak to previous patients. Resist any pressure to proceed with surgery until you are entirely confident.
Aesthetic surgery by its nature must be as safe as possible. You owe it to yourself to ensure the best result for you - take your time and choose carefully.
CSMUK
