- Cosmetic Surgery
- Minor Ops
Thursday, May 2, 2019
Mr. Bryan Mayou Consultant Plastic and Reconstructive Surgeon was featured in ES Magazine in a beauty feature about effective scar management. From gels, creams, laser therapy, radiotherapy and micro-needling through to stem cell treatments and scar revision surgery, there are many options to treat scars, dependent upon the type of scar, severity and the patient. Below Mr Mayou gives an insight into scar management options:
As plastic surgeons, we pride ourselves on leaving as little evidence of our surgery, in the form of a scar, as possible. Much of that skill is in the preparation for surgery by choosing the right patient, right area of the body and right direction and length of the scar. The execution of repair must be delicate with the right choice of technique to avoid complications such as slow healing and infection. We use dissolving sutures to avoid stitch marks, but where permanent sutures for careful positioning or strength is essential that they are removed early.
Treatment does not finish with healing. We follow up with The Cadogan Scar Management, which is a range of non-surgical treatments with silicone and Icon Fractional laser for the early scar and laser, peel and micro-needling for the more mature.
We are however often presented with the problem of a bad scar as a result of a burn, trauma or poor result of surgery. This is a challenge for which we add surgical options to the non-surgical range. This includes revision cutting out unacceptable scars, skin grafting and skin flaps to bring in better quality tissue and releasing tension.
The breakthrough in management has been stem cell treatment. This has revolutionized our management of scars we thought were untreatable. Fat, which naturally contains stem cells, can be used as it is or better still as a source of stem cells. The fat is sucked out from elsewhere and processed using the Lipocube to extract the stem cells. This concentration can be injected under the scar or added to fat to hugely enhance its natural potential.
The biggest challenge is keloid and hypertrophic scars. But our understanding is changing fast.
As wounds heal, collagen is laid down to give strength and as it matures much of the collagen is resorbs leaving just the collagen of a fine scar. However, in 2% of Caucasians and 11% of Africans and Asians, the collagen does nor resorb. Instead, it continues to grow. It can be considered to have become a benign tumour. It is red, raised, itchy and painful. This is a keloid. Most occur after injury or surgery. In a few people, the injury is so minor that no one knows where the keloid came from. Maybe it was a scratch or a spot that set it off. Acne can be a real problem for keloids, leaving keloids growing all over the back and chest. Some areas of the body are more prone to them than others. The centre of the chest and the tip of the shoulder are the worst. Fortunately, the face is fairly safe, but the neck is getting tricky.
A similar, milder version of the keloid is the Hypertrophic scar. These scars are more common and we see them in Irish and Scottish Celtic skin. We associate hypertrophic scars with red hair. Red hair, red scars. The wound overheal like the Keloid, but after a month or two settles spontaneously to become a reasonable scar.
The treatment of these very difficult scars requires determined treatment delivered by a determined doctor. We have silicone gel and Icon Fractional laser for early problems. Established keloids require other treatments. Steroid injections into the scar itself work well, but the dosage and frequency are important. If the steroid leaches into normal tissue, it can cause this tissue to atrophy leaving a depression and red capillaries. We often see patients, who say they have had steroid injections, but it hasn’t worked. We can use the same steroid injections and make it work. The doctor needs skill and determination and the patient needs faith and determination.
Radiotherapy, usually combined with surgery is a good treatment, but one needs a keen radiotherapist, delivering very superficial treatment.
It is so much better to avoid the problem.
The Cadogan Clinic has recently introduced a genetic test, which can determine from a sample of saliva, whether you might be one of these poor scar formers. This is the only clinic in the UK where this is available. A positive result probably would not stop the proposed operation taking place, but it would mean that we would be ready to commence The Cadogan Scar Management in order to reduce the consequences.
The first line of treatment is the application of silicone sheet or more commonly silicone gel.
The next line is the Icon laser treatment and later steroid injections and radiotherapy.
We are often proactive and arrange for the superficial radiotherapy immediately after surgery well before any collagen is laid down.
For a consultation to discuss scar management please call 0808 250 2636.