Scar quality is important to us and to our patients. Our approach is to manage scars before they become a problem so that patients don’t need to worry about them in the future.
All patients undergoing surgical procedures with us are eligible for this treatment, but this will be of particular interest to patients who could potentially have larger scars in areas of the body where they could be an issue. In particular after breast surgery, abdominal reduction and face lifts.
All patients also receive post-operative wound care and advice under the supervision of our Tissue Viability Nurse, Sabina.
We cannot guarantee a perfect scar, but we give your body the very best chance, and as soon as the wound is healed we institute specific Cadogan treatment:
Silicone gel or sheets: this treatment came to us through burn management and is the only topical agent Burn Surgeons have proved helpful in reducing scars. We use Kelocote which contains a Sun Protection Factor.
ICON Fractional laser treatment: a new laser designed to mature scars and reducing redness and size and remove any surrounding hyperpigmentation, and is our preferred laser treatment for scar management.
LED light: a blue light which promotes the skin healing process by interacting with cells, stimulating them to produce new collagen and elastin, both of which are helpful in the treatment of scars.
Some patients may be advised to also undergo:
PRP: healing factors (platelet rich plasma) are taken from your own blood and injected them under the scar to promote healing and tissue rejuvenation.
Micro-needling: Also known as collagen induction therapy, this involves using fine needles to create hundreds of tiny, invisible puncture wounds in the top layer of skin. These micro injuries are virtually painless and stimulate the body's natural wound healing processes resulting in increased collagen and elastin production, tissue regeneration and skin repair.
Steroid Injections: A highly effective treatment for lowering and taking inflammation out of established active scars and for those at risk of developing keloids.
Irradiation for keloids: a treatment via superficial radiotherapy to prevent keloids from forming post surgery. In the case of existing keloids, they can be excised and the new wound treated with irradiation to prevent a new one from forming.
Repair cream (Ticalfate, Cicaplast): a useful adjunct, but given for patient comfort rather than efficacy.
Damage to the epidermis, or outer layer of the skin, will heal without scarring. However, as soon as an incision enters the deeper layer of the skin then scarring is inevitable. The wound heals by the production of collagen, which in fact is scar tissue. We aim to achieve sound healing with a minimum amount of collagen formation. A new, young scar is pink and sometimes raised or hypertrophic and with time will fade to a mature white. We aim to reduce the time of maturation.
There are a number of people who produce scars which do not mature, but continue growing and become keloid. Patients with darker skin, or much paler skin and red hair, are more likely to produce poor scars. They will usually have some previous experience of this. Such patients can still undergo surgery, but have to be treated with special care.
The Cadogan Clinic has a specific After Surgery Regime available to all patients and is of particular importance for patients with long scars in important areas, such as a face lift, breast or abdominal surgery. We are also able to treat patients who have a problem with poor scars. We believe that prevention is the proper response and have made specific treatments available, such as the Icon Laser combined with a bespoke treatment plan depending on the patient needs.
Our Surgeons can influence the quality of the scar by choosing the optimum position and orientation. For instance, a vertical scar in front of the ear will be a good scar, while a transverse scar across the cheek will be a poor scar. Our Surgeons aim to keep the scar as short as possible and to repair the wound with appropriate stitches. Any conventional stitch through the skin will need to be removed early to avoid stitch marks. In many areas of the body the Surgeon will choose use dissolving suture materials under the skin, thus avoiding stitch marks altogether.
Any signs of slow healing or infection are treated promptly by our expert team. Prolonged redness or raised keloid scars are treated early, as well as patients with olive or darker skin may develop extra pigmentation around the scar, called post-inflammatory inflammation (PID).
Patients with chronic disease need to be in the best possible condition ahead of surgery. For instance, diabetes should be well controlled to avoid infection, anaemia should be treated to speed healing. Nutrition should be good. Obese patients tend to heal poorly and suffer more infections, whilst under nourished patients may be short of vitamins need to assist healing and recovery.
Our patients are generally fit and well-nourished and are unlikely to be deficient in vitamins or other elements and need not adjust their diet. Smoking is always bad for healing and patients undergoing face lifts, breast reductions and lifts and abdominal reductions should stop smoking three weeks before surgery. If smokers are also over weight then the risk is greatly increased.
Scars tend to be sun sensitive although healing is not delayed. It is patients with olive or darker skin who need particularly to avoid sunshine or to use a factor 50 sunblock. All our patients should be using the silicone dressing supplied to them which incorporates a sun factor (Kelocote SF).
Exercise will tension the wound and should therefore be reduced within the first two weeks, however some patients will be prepared to sacrifice the quality of the scar in order to maintain exercise. These will include our professional athletes who need to be back within days. Patients who wish to go back to the gym early should discuss this with the Surgeon before so they can accommodate and adjust the type of suture material used.