The Perfect Scar

Anytime an incision is made in the skin a scar results. A goal of all cosmetic surgery and most other surgery as well is to produce a scar that is as inconspicuous as possible. If you look under the microscope at the skin where an incision has been made it is always possible to see signs of a scar. However, with the proper technique and given the right circumstances, it is possible to produce scars that are virtually undetectable.

The location of the scar is very important, and this can be controlled by the placement of the incision. In cosmetic surgery the optimal locations of incisions have been well worked out although special circumstances may warrant modification of the approach.

Sometimes surgical approaches that have been used for many years become viewed as less than optimal as ideas and approaches change. A good example of this is facelift surgery. Initially the incision in front of the ear was continued up into the hair line, to hide the scar in the hair. However, one result of this approach was the elevation of the tuft of hair in front of the ear, as the skin was elevated. This would leave a bald spot which was very aggravating to some people, especially those who had thin hair in this area to begin with. If a second procedure eventually became necessary, and the same approach was used, the bald spot became larger. With the MACS-Lift as well as with some other variants of the facelift, the incision is now made around the tuft of hair so its position is maintained.

Another factor in reducing scarring is the skill of the surgeon. The best scars result when there is no tension on the skin margins and the edges of the wound are slightly everted. Other factors can contribute to the creation of a less than optimal scar. These include infection, bleeding and impaired healing capacity of the patient. Smokers are well known to be at much higher risk for problems with healing.

Finally there are steps that can be taken after surgery to enhance the appearance of a scar. Incision sites should be kept moist and for some areas silicone gel sheeting or spray has been shown to be useful, although the mechanism is not completely understood.

Gerald N. Bock MD

Stockton, CA

Californai Skin Laser Center