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SKIN
CARE:
We offer help with the difficult decisions about how to treat skin on a day to day basis. Sun screen and skin moisturizer advice, cleansers and lip protection are handled in a down-to-earth, no- nonsense manner. A selection of reasonably priced products for these purposes are available from the Centre, without promoting unnecessarily pricey, “private name” products.
SCARS
All surgical procedures
result in scars. One of
the main skills of plastic
surgeons is in control
of scar formation. We
don’t do this with
magical potions or lotions
which make scars disappear.
We can’t
do surgery without scars.
We do this by carefully
choosing incision location
and pattern, by gently
handling the skin with
fine, specialized instruments,
and by the skillful and
careful repair of surgically
or traumatically created
incisions and wounds.
The degree to which we
are successful in minimizing
scars varies with a lot
of factors.
The development of “minimal
incision,” or endoscopic
surgery, is a significant
advance in reducing scars
for some operations.
Much of how much you will
form scars, however, depends
on the location
of the incision, and your
racial and genetic
pre-disposition to scarring.
People with black African
and yellow Asian skin
are especially prone to
excess scarring, and incisions
must be very carefully
planned, and less inconspicuous
results have to be expected.
Normal scar formation
proceeds along a rough
schedule. During the first
few weeks, the scar develops
some strength. It usually
looks a little pink when
the stitches are removed,
but is flat. From about
three to six weeks, it
becomes thicker and often
redder, as it gains collagen
protein, and it looks
its worst during this
phase. Then maturation
begins, and this may take
from six to eighteen months,
or even longer. During
this phase the scar continues
to get stronger but gradually
flattens, softens, and
becomes pale.
Location
plays a key role in the
outcome. Incisions in
the upper eyelids, the
lips, the groin, and the
armpits are especially
good, while incisions
in the centre of the chest,
upper back and the upper
outer arm are particularly
prone to bad scars. The
face, in general, tends
to form good scars, if
they are properly planned.
Unsatisfactory
scars are either
thicker, wider, depressed
or raised, uneven, or
running in a different
direction than the normal
skin lines.
Keloids
are scars which are very
thick, angry looking,
red to purple, and continue
to grow beyond the borders
of the original wound
or incision.For example,
I occasionally see patients
with large masses of scar
on the chest from minor
acne pustules, and on
the arm from vaccinations.
Hypertrophic scars,
on the other hand, are
scars which have become
thickened during the normal
healing period, but do
not go beyond the original
wound edge. They usually
settle somewhat, over
a longer period than the
time needed for a normal
scar.
There are many misconceptions
about what can be done
about scars, and when
things should be done.
Generally, no surgery
should be done to revise,
or attempt improvement
of the scar, until maturation
has occurred. Revision
is generally done to even
out the level of a scar,
improve the orientation
relative to the normal
skin lines, or narrow
it.
Keloids and hypertrophic
scars can be difficult
to treat. Patience is
usually the best treatment
for thickened but non-keloid
scars. Vitamin E and Aloe
Vera extract may make
the scar look better during
the maturation phase,
but studies have not shown
that they affect the final
result. Vitamin E may
retard healing if it is
used during the early
post-operative period
(three weeks). Many other
drugs and agents have
been and are being investigated
but none has proved to
be better than time.
Injection of thick scars
or keloids with cortisone–like
drugs may be helpful in
many cases, but this has
some side effects and
should not be used for
scars that are only somewhat
thick during normal wound
maturation. Pressure has
been used for many years
for burn scars, and recently
has been combined with
silicone sheeting laid
directly on the scar.
Pressure is applied by
a variety of means, usually
by the use of custom elasticized
garments, worn twenty–three
or more hours per day
for months. Used alone
or along with pressure,
silicone sheeting has
shown some success, and
some surgeons now advise
it routinely for certain
incisions, such as breast
lifts and reductions,
and for tummy tuck incisions.
It must be used twenty–three
hours daily as well and
many patients find this
to be intolerable, preferring
to allow the scar to settle
on its normal schedule.
A compromise which seems
of some value is taping
with a light paper hypo-allergenic
tape. This allows showering
and is well tolerated,
so is the treatment I
usually advocate.
In extreme cases, keloids
have been treated with
low dose radiation therapy,
combined with the other
methods described above,
but with variable success.
It is unusual to have
keloids result from surgery
for people with light
skin colour, and keloids
are rare in cosmetic surgery
in general. The location
of incisions is carefully
and electively chosen,
careful technique is used,
and most people who may
be susceptible to keloids
can be warned in advance. |
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Deciding whether a Non-Surgical Procedure is right for you starts with a personal consultation with Dr. Gelfant.
You are invited to contact us at our Vancouver offices to arrange a meeting.
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