Careful Planning Of Facial Surgery Scars
Posted by Dr. Sam Rizk May, 05/10/2017 - 02:59 PM
Scars from facial aesthetic surgery should be a primary concern when choosing a facial plastic surgeon to perform your procedure. Every surgeon has his or her own style and method, and the placement and quality of the scar will be related to the procedure itself. There are many things that plastic surgeons will take into consideration when making an incision to minimize the appearance of scars. My goal is always to use the smallest and most inconspicuous scar possible for every patient.
Regardless of the specific procedure, whether it is a facelift, neck lift, brow lift or blepharoplasty, my top priority is to end up with the smallest and thinnest hidden scar because once you make an incision, there will always be a scar there. Scars last forever, and some are better than others. For example, for a facelift, I strive to place the incisions where they will not be very visible and plan the procedure accordingly. I take extra time to avoid having tension on the scar because those scars tend to heal more slowly and may end up being wider.
The quality and type of your skin also have a great impact on how well you will heal after surgery as well. The thinner the skin, in general, the better the scar may be. Genetics also plays a role. Another consideration is the location of the scar. Thicker skinned areas, like those on the body, chest, and breasts, will respond differently than more delicate facial and eyelid skin. Eyelid scars tend to heal very nicely when placed correctly because the skin is thin.
All of these factors are considered when I am carefully planning my incisions so the scars will not be readily visible. If your surgeon designs the incisions wisely and takes time to perform the surgery correctly, the hair will grow through the incision which helps to camouflage the scars so they are more difficult to notice.
It is very important to tell your facelift surgeon how you wear your hair to avoid any alterations in the hairline after surgery. When I perform a facelift, in most cases I will end my incision behind the ear and do not extend it into the hairline behind the ear. Most people do not need to have an incision that long to get a good result unless they have a substantial amount of excess skin and fat and require extensive redraping. With this modified incision pattern, patients with short hair, men or women, as well as women who like to wear their hair up or in a ponytail, will not be self-conscious about having visible scars in those areas.
Fortunately, keloid scar formation is rare from facelift and eyelid surgery. Some people will be more prone to thickened or raised scars than others, and I always take that into consideration before surgery. Another type of abnormal scar that can form is a hypertrophic scar. A hypertrophic scar is raised but is not a true keloid scar. It can be red, thick and raised in some cases, but it can be treated with intralesional steroid injections and lasers if needed. Hypertrophic scars are far more common than true keloid scars which are more prevalent in darker skin types. To avoid hypertrophic scars from occurring, I will carefully place the layers together and suture everything in place with minimal tension to deliver the best possible scars for my patients.
Advice from Dr. Rizk:
For all the above reasons, we do a comprehensive consultation and take a detailed medical history in advance to determine how each patient will heal. In darker and thicker skin types, there is always a higher risk of scar abnormalities that may require a secondary procedure in rare cases. In lighter or fair skin types, the tension on the skin is a critical endpoint to produce the best possible quality scars. The way the surgeon sutures the skin, the type of sutures used, and how deeply the sutures are placed, will also make the difference between a good result and a great result.
Before you consider a facial procedure, I highly recommend that you ask to see photographs of what facelift and eyelid scars may look like; the good, the bad, and the ugly. This way you will know exactly what to expect. At the end of the day, the type of scar and quality comes down to the amount of tension placed on the incisions, location of the scar, post-operative healing, skin type, and genetics. In many cases, this cannot always be predicted in advance which is why you should choose an experienced board-certified facial plastic surgeon who specializes in surgery of the face, brow, eyes, and neck.
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