I’m a natural redhead with the typical pale skin, what's the best option for scar treatment?

Question

I will be having a breast lift with implants in the near future and the scarring is my only holdback. I’ve even considered just asking for an implant because the scarring aspect worries me so much. I’ve seen several post-op pictures that give me hope for minimal scarring over time, but others make me question the procedure. I’m a natural redhead with the typical pale skin…what’s my best option?

Semih Yildiz, MD, FEPOBRAS · Answer

Pale skin and red hair can make early scar redness more noticeable, but it does not automatically mean you will heal with bad scars. With a breast lift, the biggest factors are choosing the correct operation, careful surgical technique, low tension on the closure, and consistent scar care afterward.

If your breast shape truly needs a lift, choosing implants alone just to avoid scars can lead to a larger, lower, or more stretched appearance and may not give the result you want. It is better to accept the shortest scar pattern that will reliably correct the sagging, rather than doing an underpowered operation and needing revision later.

Once the incisions are fully closed and your surgeon clears you, silicone gel or silicone sheets are usually the first-line scar treatment. Sun protection is very important, especially with pale skin, because UV exposure can keep scars red or pigmented longer. Avoid nicotine, keep protein intake good, and follow your surgeon's bra and activity restrictions to reduce tension on the healing incisions.

If scars become raised, itchy, thick, or stay very red, options such as steroid injections, vascular laser, or other scar treatments can be added later. Most breast lift scars look their most obvious in the first few months and then continue to soften and fade over 12 to 18 months.

Ted Eisenberg, DO, FACOS, FAACS · Answer

I feel moisture to the incision provides the best chance for optimal healing. Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author. RealSelf Distinguished Hall of Fame Inductee. Philadelphia, Pa., USA

Gary M. Horndeski, MD · Answer

The breast lift technique I recommend is The Bellesoma Method. This will reshape your breast tissue creating upper pole fullness without implants, elevate them higher on the chest wall and more medial to increase your cleavage. Vertical scars are avoided, nipple sensation (in 95%) and the ability to breast feed are maintained. Later, fat transfers can be performed if additional volume is desired.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Connie Hiers, MD, FACS · Answer

First avoid tanning your scar up to a year. Second, there are many good scar products, like Mederma and Scar Guard, over the counter to start using once the tapes or sutures are removed.

Camille Cash, MD · Answer

As soon as your surgeon clears you to do so you can begin scar treatments such as silicone sheeting.  The key is consistency.  If you use the products randomly you will not see the results.  Keep in mind that tension plays a role in scar formation.  Selecting an implant that is too big for the space could put additional stress on the incisions, influencing the resulting scar.

Mats Hagstrom, MD (license on probation) · Answer

Fair skin individuals tend to form some of the most favorable scars of all skin types. The scars tend to turn pink, or even light purple during the hyperpigmentation phase of healing.
Eventually the scars on fair skinned individuals tend to be slightly hypo pigmented (white on white)
Scars are often more visible and more unpredictable on individuals who have more pigmented skin, especially those who have a golden or olive type complexion.I typically do a scar or healing history on most patients before considering doing surgery.
I asked patients to show me any history of previous surgery, cut, scrapes, or any area of their body where they’ve had some injury.
Even looking at how acne heals overtime can be very helpful in predicting the type of scars, a patient may experience.
When I see evidence of individuals who have a higher chance of having scar hypertrophy and hyperpigmentation, I usually sit down and have a more lengthy discussion about scarring, and the potential visibility of scars in that individual.
 When it comes to scars, it’s important to differentiate scars that are hyperpigmented and scars that have hypertrophy. Individuals perform hypertrophic scars should probably be using silicone tape for many months after surgery if hypertrophy starts developing.
Silicone tape has not been helpful for hyperpigmentation and I’ve seen silicone tape make hyperpigmentation worse so I typically only use it on patients who have scar hypertrophy.
Maturation of surgical scars takes time.
Scars can continue to change and improve often lightning in color for 12 to 18 months after the procedure.
Scars typically look the worst between six weeks and three months.
At six months they typically lighten up significantly and by 12 to 15 months they typically look far far better than they did during the early postoperative.
 When reviewing before, and after pictures, it makes little sense to make any conclusion regarding what scars look like unless you have a clear understanding of the timeframe of when after pictures were taken.
Most plastic surgeons take after pictures at three and six months.
Each provider will do this differently.
Some providers will ask patients to come back at one year, but in reality many patients often don’t want to come back at one year if they’re happy with their outcomes.
 For this reason many postoperative pictures show scars that are still immature.
The body heals very differently on different parts of the body. Thin skin tends to heal very well.
Scars on the back with the skin is thick tends to heal with very visible scars.
Face and especially eyelids. Tends to heal very well with minimal scarring. 
On the breast scars around the areola tend to heal well, as does the vertical limb on a breast reduction, which includes this incision.
If a full anchor, incision is made, the scar consult be more visible at the lateral edge as the skin transitions into thicker skin of the back and torso.
Without including pictures, we can’t make an assessment.
Some patients may be candidates for having breast implants without a breast lift, and still have a fairly good outcome.
Women who have significant breast ptosis should probably not have implants. If they’re not willing to add a breast lift.
To get a quality assessment and better understanding of surgical options I recommend having multiple in person consultations with plastic surgeons in your community.
Best,
Mats Hagstrom, MD.

I’m a natural redhead with the typical pale skin, what's the best option for scar treatment?

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