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All wounds heal with a scar. Many elements affect the severity of scarring: the size and site of a wound, the blood supply of the area, the quality and type of the skin, the direction of the scar and whether infection has occurred. Complicating factors may include medication such as steroids or anticoagulants, medical conditions such as diabetes, or smoking.
While it is not possible to remove scars completely, plastic surgeons are trained to optimise the appearance of scars, and they can often improve them and make them less obvious.
They can do this through the judicious use of tapes and steroid applications, or through surgical procedures know as scar revisions.
If you are concerned about a scar, you may discuss your options with your GP and a plastic surgeon. The surgeon will talk you through the possible methods of treating your scar and the risks, benefits and limitations of each. Most scar revisions are done under local anaesthetic, so you do not need to be put to sleep.
Scar revision may be performed for hypertrophic scars, keloid scars, skin contractures, or unsightly skin grafts.
It is important to remember that a scar takes one to two years to mature fully, and any surgical procedure will mean that the whole process of healing and maturing must begin anew.
A hypertrophic scar occurs when the body continues to produce the protein collagen when the wound has healed. The scar remains active and red, itchy and thick. It remains within the boundaries of the original incision or wound.
A hypertrophic scar may improve on its own, although it may take a year or two to do so. Usually steroid creams and injections are needed.
Sometimes this conservative approach is not sufficient, and the scar can be improved by surgical removal and regular injections of steroids, beginning from the time of the surgery, to prevent the thick scar from reforming.
A keloid scar is also thick red and itchy. It is different from a hypertrophic scar in that it grows beyond the boundaries of the original incision or wound.
Keloid scars are commonly seen on the earlobes, the shoulders and the upper chest. They are commoner in young people and in people of Asiatic or darker skin.
Steroid injections may help. Often surgical excision of the scar is necessary and steroid injections may be used regularly beginning from the time of surgery, as these scars do have a tendency to recur. In some cases radiotherapy is even indicated to shrink the scar.
If a skin deficit from a burn or trauma heals with a tight scar, ie with scar contracture, there may be a restriction of movement and discomfort.
It is possible to correct this by moving tissue around in a skin flap, or by applying a skin graft.
Unsightly skin grafts
Skin grafts are applied when there is a shortage of skin after trauma or a surgical operation. Sometimes the cosmetic result is not so satisfactory, and once the scar has matured it is often possible to revise it and improve the cosmetic appearance.
Moles and skin lesions
Benign skin lesions: moles, skin tags, lipomas and cysts
You may consider removing benign skin lesions for a number of reasons: they may be unsightly, itchy, cause discomfort by rubbing on clothes, or worry you because they are growing.
It is worth consulting your GP if a mole changes suddenly, ie grows, becomes darker, itches or bleeds. This does not mean it is becoming malignant but it should be checked.
Some lesions may be shaved flush with the skin, which may leave little or no scar.
Most lesions are cut out, and this will leave a scar. The plastic surgeon will use his skill to excise them in a manner that reduces the visibility of the scar. Some skin types or some sites are prone to thick scars: keloid and hypertrophic scars. Your surgeon will warn you about these.
Skin tags/ papillomas: Benign epithelial lesions of the skin. Very common, often occur on the neck and under the breast. They have small narrow stalks connecting them to the skin surface. Can itch or catch on clothes. Often occur in groups.
Seborrheic keratoses: Very common, occur mostly in older patients, often on sun-exposed areas of the body. Common on the face, trunk and back. They look brown and often crusty or wart-like and they may feel greasy. They often itch. They can be easily shaved or excised.
Sebaceous cysts: They are blocked glands of the skin which continue to produce sebum to lubricate the skin and so continue to grow. They occur on the face, neck or back most commonly. If they discharge, they release a cheesy white material. They are not cancerous but may become infected.
Lipomas: They are benign tumours of fat tissue. They may be very small, or can grow over years to large masses. They may be removed by excision or fine liposuction.
Prominent ears (Otoplasty)
Ears that protrude excessively can be pinned back with a simple surgical procedure.
This leaflet is about you or your child’s operation. Please read as it will help to give you an idea of what to expect during your hospital stay and afterwards. It also identifies some of the possible complications, although obviously this is not a comprehensive list. If you have any questions please ask.
Prominent ear correction (otoplasty)
You are being admitted for a prominent ear correction operation. In this operation the ear cartilage is folded back to allow the ear to sit in a less prominent position. To gain access to the ear cartilage an incision is made behind the ear.
The operation is usually performed after the age of 5 or 6 when the child may become embarrassed or withdrawn because of perceived difference from his/her classmates. The operation is performed under local anaesthetic in adults and general anaesthetic in children. For general anaesthetic the anaesthetist will see you and your child before the operation. Discuss any queries you have about the anaesthetic with the anaesthetist. If your child has had any difficulties during a general anaesthetic in the past make sure that both the anaesthetist and the ward doctor know about it.
There will be a scar behind the ear almost the full length of the ear. This may be visible from behind. Scars start off red and noticeable. With time they tend to fade. They will never vanish and in some people remain noticeable.
After the operation the ears are dressed in a large protective head bandage. This stays on for a week and is then removed in the clinic. After it is removed the ears remain tender for a week or two and contact sports or situations where they may be bumped should be avoided. Some people feel comfortable with a soft head band over the ears to sleep for a while, usually about three weeks.
Initially the ears are bruised and swollen. It takes about three weeks for the bruising to settle. The swelling will not be completely gone for three months or more.
Any operation can give problems with infection or bleeding. Simple infections settle on a course of antibiotics. Some infections require treatment in theatre. Bleeding is not unusual after this operation. Most often padding the head bandage or redoing the head bandage is all that is required. Occasionally a blood clot forms under the skin. This has to be drained and may need to be dealt with in theatre. Severe infections or blood clot against the ear cartilage can permanently damage ear cartilage leaving an ear deformity. This condition is rare.
It is possible for the springiness of the ear cartilage to cause the ear prominence to recur. If this happens a second operation may be necessary to correct the prominent ear satisfactorily.
Although this anti-ageing technique is very popular, we prefer to advise our patients to consider rebuilding the fatty tissue underneath the skin.
Miss Sassoon does not perform surgical “facelifts” at all. Her argument against the facelift procedure is based on the logical reasoning that faces lose the plumpness of youth due to a reduction in fatty tissue, the face droops and merely drawing the skin tighter over the face is both costly and unnecessary – the procedure does not last and needs re-attending to after only a few years.
Building up the face with fatty tissue offers a more natural return to youthful appearance rather than the rather severe method of drawing the skin tighter on the face. With fat cells surviving for 7 -10 years, this also benefits from being a more long term anti-ageing treatment.
It is not a common operation compared to surgical facelifts – the surgeon reconstructs the face from the inside out, but it does offer a natural looking solution.
This technique is not suitable for smokers.
Fillers – an alternative to surgery
A much simpler and readily available procedure is one that uses dermal fillers to plump out the face and achieves a more natural look. Non surgical and just as effective although it only lasts months. It is non-permanent and a quick procedure with minimal risks. See non-surgical/liquid facelifts for more information.
Blepharoplasty (Eyelid Surgery)
As one ages the skin loses its elasticity and muscles slacken.
For the eyelids this entails an accumulation of loose skin which collects as folds in the upper lids and deepening creases in the lower lids. At the same time there is slackening of the muscles beneath the skin allowing the fat, which cushions the eyes in their sockets, to protrude forward to give the appearance of bagginess.
Blepharoplasty is a surgical procedure to remove excess skin and muscle from both the upper and lower eyelids along with underlying fatty tissue. Blepharoplasty can improve drooping skin and bagginess. It can also improve vision in older patients who have hooding of their upper eyelids.
Blepharoplasty surgery is customised for every patient depending on his or her particular needs. It can be performed alone, to the upper, lower or both eyelid regions, or in conjunction with other surgical procedures of the eye, face, brow or nose. Eyelid surgery cannot stop the process of aging. It can produce a more alert and youthful appearance and diminish the look of loose skin and bagginess in the eyelid region.
I carry out upper blepharoplasties under local anaesthesia, but combined upper and lower blepharoplasties under general anaesthesia in the operating theatre. In a typical procedure an incision is made following the natural lines of the eyelids: in the creases of the upper lids and just below the lashes in the lower lids. The incisions are extended slightly into the crow’s feet or laughter lines at the corner of the eyes. Surplus fat is removed along with excess skin and sagging muscle.
Following surgery the patient is asked to sleep sitting up slightly and to rest with the head elevated a few days to reduce swelling. Cold compresses help. The sutures, and any steristrips used to support the eyelids, are removed after a few days. Sometimes steristrips are reapplied to support the lower lids for a further week or so. Make-up can be applied after a couple of weeks. It is not unusual for the eyes to feel tight after surgery for a few days because of swelling and because of the skin removed. If the eyes feel dry eye drops can be applied. Sometimes the eyes may actually be watery after surgery because the tear ducts may be swollen and not drain as readily; this can last a few weeks. There will be some bruising, which can readily be disguised with make-up and dark glasses. The scars will be pink for a few months but settle down eventually.
Risks of blepharoplasty
Every surgical procedure carries a certain amount of risk and it is important that you understand the risks involved. Although the majority of patients do not experience the following complications, you should understand the risks, potential complications and consequences of blepharoplasty
Bleeding. It is possible to have a bleeding episode during or after the surgery. Do not take any aspirin or anti-inflammatory medications for ten days before surgery as this may contribute to a greater risk of a bleeding problem. Hypertension (high blood pressure) that is not under good medical control may cause bleeding during or after surgery. Accumulations of blood under the eyelids may delay healing and cause scarring.
Blindness is extremely rare after blepharoplasty. However it can be caused by internal bleeding around the eye during or after surgery. The occurrence of this is not predictable.
This is very rare after surgery. Should it occur additional treatment including antibiotics may be necessary.
Although good wound healing is expected, abnormal scars may occur both within the eyelid and deeper tissues. These may be of a different colour than surrounding skin.
Dry eye problems
Individuals who normally have dry eyes may be advised to use special caution in considering blepharoplasty. Temporary or rarely permanent dryness of the eye may occur.
Displacement of the lower eyelid away from the eyeball may rarely occur. Further surgery may be required to correct this condition.