Preventing keloids and scarring?
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Doctor Answers 4
Preventing keloids and scarring?
Scarring is a difficult topic as there are many variables.
Some of these variables cannot be controlled or affected, while others are.
Genetic predisposition (the genes with which
you were born) has a significant determination on your ultimate result. This
obviously can’t be manipulated.
Surgical factors such as minimal tension on the
skin, meticulous skin approximation, not running a stitch in the skin the full
length of the incision as this creates more inflammation where scar is
After surgery, using tape to prevent water loss
(TEWL: trans-epidermal water loss) for several weeks is useful. Most scar gels
or creams basically work in this way to keep moisture in and the massage of
application also helps. I give SkinMedica Scar Recovery Gel to my patient
"partners" after surgery as it works to communicate with the
fibroblast (the cell that makes the collagen for the healing) and has worked
wonderfully in my practice.
Minimizing Breast Implant Scars
Scar Management tips:
- Minimize tension on the scar. Steri-Strips and/or surgical tape are often placed in non-hair bearing areas at the time of surgery to minimize tension and keep pressure over the scar. This minimizes the stress that can pull the scar apart (dehiscence) creating a wound and delaying healing time, and can make the scar wider, or more “ropy”. In the first few weeks after surgery, I recommend the use of Embrace Scar Therapy which is an adherent silicone sheeting pre-stretched when applied so as to offload tension on the scar.
- Keep your incision site/scar clean to prevent infection. Follow your surgeon’s wound care instructions to the letter with out modification. Never apply different products then recommended without first discussing them with your surgeon. This is especially important during the first few weeks. If there are any signs of infection, contact your surgeon’s office right away and/or see your doctor or his nurse immediately. Typical signs of infection may include redness outside the immediate incision site, asymmetric swelling, and drainage, of pus, fever, chills, and “feeling sick”.
- Protect your scars from the sun. Staying out of the sun is the best advice. Minimal exposure to sunlight is prevents hyperpigmentation (permanently turning brown) and other problems that can make the scar more noticeable. Sunscreen, at least 30 SPF and an overlying make camouflage make up additionally protects the scar from the suns harmful rays. This advice is especially important the first year following your surgery.
- Use specific scar maturation products recommended by your surgeon. Patients seem to have their own opinions on this touting everything from Pure Vit E, Coco butter, to Aloe Vera, etc but most have minimal benefit other than keeping the scar hydrated. Although hydration is important there are better, scientifically studied products with greater efficacy. Most of the scientific articles written about this subject indicate that topical silicone gel or silicone sheets work the best. The best product available in my opinion is the Embrace Scar Therapy System by Neodyne BioSciences, Inc. available in many surgeons’ offices. Essentially this is an adherent silicone sheeting pre-stretched when applied so as to offload tension on the scar. For areas that are not applicable for this product (e.g. smaller areas or on the face), I prefer BioCorneum or Kelo-Cote products There are a lot of products to choose from, but silicone should be one of the key ingredients. Although Mederma, an onion extract derivative active ingredient rather than mainly silicone based may help, primarily silicone based products are better and many also contain other ingredients that may be synergistic (hydrocortisone or other steroid, Vitamin E, Sunscreen, etc).. If the reader has problems obtaining these they can call my office. Patient compliance is also critical – use often and according to directions or it will not work optimally. NEVER apply products without first discussing them with your surgeon.
- Monitor to make sure your scar is progressing optimally. Keep your scheduled follow-up appointments with your surgeon to verify that your scars are maturing as expected. Occasionally if indicated you may need a topical steroid preparation or even a series of injections (5-FU and/or Steroids) or laser treatments to treat or prevent scar hypertrophy or keloid formation (red raised scars), or other topical medicines to treat post inflammatory hyperpigmentation (brown scars) with prescription creams and possible laser treatments.
Preventing & Managing Breast Augmentation Scars
However, the incision type really depends on the type of implant being used, and, if a #BreastLift is also be incorporated.
For instance, the peri-areolar #incision is ideal for saline implants. They require a smaller incision because they are not filled until they are inside the body.
For the addition of a #BreastImplant with a Breast Lift, we have been using an approach for more than 20 years known as the #Transaxillary Breast #Augmentation. Axillary – with this incision, there are no scars on the breasts. Special training, experience, and equipment may be required for this procedure.
It is our most common and recommended site for silicone implant placement.
The partial muscle coverage will hide the implant better and help avoid visibility of any implant imperfections such as rippling. The appearance will also look more natural.
To manage scars following the procedure, I suggest #scar maturation products to my clients. Such as BioCorneum or Embrace, to name a few, are recommended. But, it's best you wait a few weeks following your surgery, to begin using them and speak to your surgeon about healing concerns.
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These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.