The way scars generally heal are dependent on two main factors: 1. the technique which the surgeon has some control over and 2. how a patient heals which no one has any control over. Plastic surgeons make the effort to hide incisions in naturally occurring places to hide them such as the belly button or low in the hairline as well as making them as small as possible. In our practice, we use a needle instead of a scalpel blade to make a small, circular puncture rather than a line. Circular incisions tend to heal with a smaller overall length and still can accommodate the instruments needed for the operation . Also, the incisions are closed with fine sutures like the ones we use for facial lacerations. Finally, operating as gently as possible decreases the trauma that occurs at the incision site so that they heal better.As far as patient skin types go, the darker the skin (the higher the Fitzpatrick type) the longer the incisions tend to stay hyperpigmented or dark. In some patients, they may be dark for a year or more. Lightening agents are helpful in some cases but the key is to hide the incisions and make them as small as possible in the first place. Staying out of the sun is important as ultraviolet light can permanently darken the incision while it is in the healing phase.
