May 23, 2023
Stars Not Scars
With any surgery, it’s normal to be concerned about the scars you'll be left with and whether they heal properly. In this episode, Dr. Bass covers the different types of scars and what to do if you find yourself with an unpredictable scar during your recovery.
Two conditions which sometimes occur with scar healing are hypertrophic scars and keloid scars. A hypertrophic scar is red and thick, caused by inflammation combined with your wound healing biology and how your skin behaves. Keloid scars are the result of specific genes, growing thick, raised, and wider than the original incision or wound.
With scar issues of redness and thickening, the scar will be targeted through gel bandages, compression therapy, or lasers and energy based devices. Fractional lasers have revolutionized the treatment of scars, both traumatic and surgical. For widened scars, surgical revision is typically needed, trimming out the old scar and resewing the skin edges no sooner than 6 months after surgery.
Good scars start with good surgeries. Be cautious that you’re teaming up with a surgeon who knows how to place incisions well and treat problem scars if you’re one of the rare people whose skin reacts differently.
About Dr. Lawrence Bass
Innovator. Industry veteran. In-demand Park Avenue board certified plastic surgeon, Dr. Lawrence Bass is a true master of his craft, not only in the OR but as an industry pioneer in the development and evaluation of new aesthetic technologies. With locations in both Manhattan (on Park Avenue between 62nd and 63rd Streets) and in Great Neck, Long Island, Dr. Bass has earned his reputation as the plastic surgeon for the most discerning patients in NYC and beyond.
To learn more, visit the Bass Plastic Surgery website or follow the team on Instagram @drbassnyc
Subscribe to the Park Avenue Plastic Surgery Class newsletter to be notified of new episodes & receive exclusive invitations, offers, and information from Dr. Bass.
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Welcome to Park Avenue
Plastic Surgery Class,
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the podcast where we explore controversies
and breaking issues in plastic
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surgery. I'm your co-host, Doreen
Wu, here with Dr. Lawrence Bass,
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Park Avenue plastic surgeon,
educator, and technology innovator.
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Today we are talking about
scars and how do we erase them.
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None of us want scars and
a bad scar, least of all.
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But plastic surgery is what makes no
scars. Isn't that right, Dr. Bass?
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Well, unfortunately, a lot of
folks think that, but in fact,
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that's not true. Anytime we
cut deep enough into the skin,
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we're going to heal with a scar. You know,
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we have minor scrapes and cuts all
the time that don't leave a scar,
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but something that goes into
the deeper levels of the skin
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always heals with at least a little
bit of a scar. But, you know,
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there are good scars that are really
inobtrusive and very difficult to see.
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And then there are bad scars
that are obvious and drastic
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and attract attention all the time.
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And we get scars for a bunch
of different reasons. I mean,
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some scars come from surgery where we're
making an incision into the skin on
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purpose for some, some important reason.
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But of course there's also
trauma. There's acne scarring,
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and then there's major tissue trauma
like occurs in combat injuries
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that not only break the skin,
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but often in irregular
ways, in massive ways,
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and massively damage the
deeper tissues underneath.
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And all of that makes it much
more difficult to heal with any
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kind of reasonable scar.
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Well, let's start with
a good circumstance.
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Let's say I'm having an elective
plastic surgery. I want invisible scars.
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Is that a realistic expectation?
What can I do to get the best result?
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You're right that an elective plastic
surgery is the best case scenario. So,
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as I said, the scar is never invisible,
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but how visible it's likely
to be varies by site and
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by skin response.
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So getting the best scar
starts with good surgery that's
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low trauma and a very meticulous closure.
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The suturing, and this is what plastic
surgeons in particular excel at,
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we're really good at putting a lot of
very tiny sutures that very precisely
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approximate the edges, and that helps
us get a better scar. That, of course,
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is in the hands of the surgeon.
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But then there are things
that come afterwards.
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So a best case scenario for a scar,
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something like an eyelid incision
and some facelift incisions,
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you may actually need a
magnifying glass to see them,
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but same operation performed
by the same surgeon.
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Sometimes the scar is not going
to be as favorable because
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that individual's skin
is just more reactive.
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Face scars from elective plastic
surgery tend to be better.
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Body scars
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always tend to be a
little bit more visible.
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Sometimes they're visible
but not very prominent,
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and sometimes they're not quite as good.
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So what should I be doing
to get the best scars?
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There are a few typical things that
help and should be part of every
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surgery.
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Scar management and some effort on scar
management really ideally should be part
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of every surgery. So each
surgeon has their own approach.
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They do things a little
differently but with some
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variations. But doing something
to work on the scars after surgery
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is certainly going to help
get to the best endpoint.
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So one thing is scar preparations
that are applied starting
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typically three weeks or so after surgery.
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And these are preparations that
are applied once or twice a day.
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The three big products in the United
States that are most commonly used are
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Scarguard, ScarAway, and Mederma.
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These are all very different materials.
They're not very much like each other.
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They all help with scars and
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they're easy to do and not a risk profile
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associated with them
of any significance. So
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it's all reward with next to no risk.
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Gel bandages are another thing.
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Sort of a silicone gel patch that
is placed over an incision, again,
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typically starting several
weeks after surgery, and
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that helps the scar likewise end up
the best looking scar we can get.
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I've also read online about
a lot of different home
remedies like Vitamin K oil,
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tea tree oil, coconut butter.
Do those actually work?
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So it's possible that they're
helpful and they don't
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seem to hurt things. However
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there isn't a lot of data.
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So it's probably better to
work with the medical products
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and the medical treatments.
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A lot of the treatments
on scars come out of burn
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center research and treating major
burns and helping to get those scars
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as soft and flexible as possible.
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And so that's a more data driven approach,
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which I think is a better
way to go about it.
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Let's talk about timing a little bit.
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If my incision is sensitive or delicate,
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can I just wait a month or two
and then work on the scars?
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Will holding off for a little
while really make a big difference?
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Timing is really critically important
for scar behavior. You know,
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different things are
happening at different points
during the healing process,
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and the things that we're doing
to help with the scars are
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focused on modulating those
biological responses to
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wounding and that occurred during healing.
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So you can't redo the scar a year
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from now.
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You might have to surgically
revise it and start over.
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There are things we
can do late with scars,
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but we have much more ability to
modulate the scar and get a good scar in
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the first place if we work
early. Now, as I said,
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we're typically starting at about
three weeks because that's usually
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a point when even minor
crusting or open areas in an
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incision have sealed off.
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So scar behavior and scar treatment
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typically starts when the
incision is fully closed,
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but it has not yet matured and
added a great deal of collagen.
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It has not yet remodeled.
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Okay, let's say I had my aesthetic
surgery and the scar looked great,
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but now I'm at one month after surgery
and there's some redness and thickening.
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What should I do?
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Should I show it to my surgeon at my
next visit a month or even six weeks from
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now?
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So, as I said, you know,
timing is critical,
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and if you see a scar
heading in a bad direction,
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call your surgeon immediately.
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It's much easier to break a cycle
of misbehavior in early healing
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scar than trying to
undo a well-established
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hypertrophic scar or
widened scar any of any
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of the bad things. So
that's really important.
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And some of these bad scar
departures are really medical
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problems. Hypertrophic scars,
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which is a red thick scar that
stands up off the surrounding
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surface of the skin,
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is a product sometimes of the
amount of inflammation present,
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but also of your wound healing
biology as an individual
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and how your skin
behaves. And keloid scars,
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which not only stand up off the skin,
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but actually become wider and
bigger than the original wound,
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are the result of specific genetic
mutations that cause people
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to scar in that fashion.
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And these things need medical
treatment immediately to keep
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things to the best possible outcome.
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Could that be why we get bad scars?
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It's really a problem with
our skin type or biology?
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That's the foundation or baseline.
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So your body is going to react
a certain way to wounding
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and it's going to heal a certain way,
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and that's your genetics or your biology.
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Overlaid or intersecting with that
are outside factors. You know,
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if a scar is not well approximated,
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if it broke down because
there was too much tension,
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if there was a wound infection
or some kind of a skin injury
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aside from the basic surgery,
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like there was some crush to the
tissue from trauma or something else,
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these things can produce
partial skin loss.
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But even without any skin
loss they're more likely to
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produce a bad scar.
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So the surgeon has to take
a careful look at the scar
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and decide what the problems are,
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and that then leads you
to think how to treat it.
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Let's talk about some of these typical
problems and issues with scars.
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So scars are different from
normal skin in several ways.
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The texture of the skin is
different than normal skin.
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Typically, scars have
a very smooth texture.
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The color of the scar is
different in early scars,
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often red, it's sometimes hyper
pigmented or very dark brown.
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A late scar typically has no pigment,
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so it may look whiter
than the surrounding skin.
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And the contour of the scar is different.
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The scar may be more or
less level with the skin,
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or it may be raised up
or it may be depressed,
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and anything that's raised up or
depressed is going to be much more visible
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and make the scar more obvious.
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I didn't realize the specifics.
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Why are these differences
important to understand?
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So as I said earlier,
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what's wrong with the scar is going
to tell us what treatments are needed.
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So a widened scar,
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a scar that instead of being paper
thin or a millimeter thin might be
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a half an inch or an inch.
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There's no way to get that scar
narrower without a surgical revision.
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So a surgical scar revision,
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which is typically delayed for six months
or more until the scar has matured,
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involves going back,
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trimming out the old scar in a
small procedure and resewing the
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skin edges.
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And the hope is that doing that
where that's the only thing
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happening, you're just
doing a scar revision,
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not some kind of a big
operation underneath your
chance of landing up with a
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better scar is, is good.
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And we only do surgical scar revisions
when we think we're likely to be better
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and obviously visibly better.
So if we think we're, you know,
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you could always end up better, the same,
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or worse anytime you do a scar revision.
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So we'd only like to go ahead if
we think we're likely to be better
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and make a real obvious change.
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For other issues with the scar
issues of redness, thickening,
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we're more likely to chase the scar with
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injection therapies, the gel
bandages that I mentioned,
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compression therapy or with some
of the lasers and energy based
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devices.
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As usual. Let's take these one at a time.
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So gel bandages and compression
are things that are very
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commonly used. Silicone gel bandages,
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both because of the occlusion
and a mild degree of compression,
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they provide help model a
scar softer and flatter,
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help the scars lose the
redness more quickly.
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An early scar typically looks red,
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and in a typical middle aged adult it
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takes six months or so in round numbers
for the scar to lose the redness
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become a white scar.
Teenager might take longer.
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Someone who's elderly might
do it a little more quickly.
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Their body calms down and stops
the healing process sooner.
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But those are averages and
each individual is different.
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So that's the first step.
It's the least invasive,
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it has the least risk and
will get us where we want.
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Next, we go to injections. And you know,
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what's happening in a
scar is that fibroblasts.
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The healing cells are adding collagen,
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and that's important at first to
get strength in, in the repair.
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But like Goldilocks and the three
bears, it has to be the right amount,
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not too much, not too little, just right.
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If the process doesn't turn off,
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once the scar is closed and strong,
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the quality of the scar
will continue to degrade,
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and we need to inject
anti-inflammatory medicines
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into the tissue of the scar
itself to try to stimulate the
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body, to break the cycle of
inflammation and healing.
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Now that the scar is closed,
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these medicines are
typically either steroid,
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anti-inflammatory medicines or
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anti metabolite,
anti-inflammatory medicines,
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or some combination of the two.
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And treatments are typically done
once every four to six weeks for
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several injections in the hopes that
that will break the cycle and get
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the scar to calm down.
Finally, we go to lasers.
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And
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these are lasers that do two
different kinds of things. One,
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lasers that target vascular in the skin,
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so they knock back some
of the blood supply,
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which slows down metabolically
the healing response and can
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00:15:37,631 --> 00:15:42,230
break the cycle of hypertrophic
changes. These are typically used early.
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Most commonly it's the pulse dye laser,
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00:15:46,111 --> 00:15:51,110
but sometimes IPL and other
kinds of vascular lasers are
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also used.
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00:15:53,770 --> 00:15:58,230
And then both early and
late to remodel the scar
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get its softer, flatter,
and get it to lose redness.
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00:16:01,791 --> 00:16:06,550
We use either ablative or
non-ablative fractional lasers.
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00:16:06,551 --> 00:16:11,510
Lasers that put little pinpoints
of light in that can often
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00:16:11,511 --> 00:16:14,270
go quite deep into,
let's say a thick scar.
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00:16:15,610 --> 00:16:19,990
And that gets some tissue
removal that allows the scar to
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00:16:20,000 --> 00:16:23,070
remodel in a flatter, smoother,
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00:16:23,620 --> 00:16:26,710
better matched configuration.
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00:16:27,410 --> 00:16:31,590
And it likewise can help
knot back some redness,
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particularly with the
non-ablative options.
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00:16:33,830 --> 00:16:38,570
All right, I have another
scenario for you this time.
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00:16:38,571 --> 00:16:40,730
Not as pleasant as
elective plastic surgery.
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00:16:41,530 --> 00:16:46,290
Let's say it was icy out and I fell
down the stairs and smashed my face.
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00:16:46,630 --> 00:16:49,330
Now I have all these cuts,
scrapes and a big bump.
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00:16:49,510 --> 00:16:51,010
How is that going to be treated?
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00:16:51,950 --> 00:16:54,110
These are not surgical scars,
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00:16:54,111 --> 00:16:58,070
but traumatic scars and they're much
less likely to heal. Well, of course,
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00:16:58,071 --> 00:17:02,510
we didn't get to manufacture
the incision or the scar.
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00:17:02,510 --> 00:17:04,710
It was an unexpected injury.
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00:17:04,711 --> 00:17:09,670
So this is probably best evaluated
by a plastic surgeon and managed
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00:17:09,671 --> 00:17:14,590
early in the healing process
to get the best result because
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00:17:14,680 --> 00:17:16,390
as we said, timing matters.
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00:17:16,680 --> 00:17:20,550
So showing up six months or
a year later with a bad scar,
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we can still do a lot of things for that,
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00:17:22,711 --> 00:17:27,470
but we'll do better early
in the game and early
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00:17:27,960 --> 00:17:30,670
as the abrasions and the
open areas are healing,
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00:17:30,720 --> 00:17:35,590
we often apply ointment
or medicated ointments
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00:17:36,000 --> 00:17:40,950
or occlusive dressings that
keep the area moist and that
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00:17:40,951 --> 00:17:45,870
can create a lot of
remodeling and smoothing and
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00:17:45,980 --> 00:17:50,080
a quicker point to get that closed.
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00:17:50,730 --> 00:17:54,080
So the sooner an area is closed,
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00:17:54,780 --> 00:17:58,920
the less time the body is
going to be upregulating or
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00:17:59,000 --> 00:18:02,880
spiraling up on the level of inflammation.
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00:18:02,881 --> 00:18:07,760
And the longer a wound is open or
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00:18:07,761 --> 00:18:12,360
the longer the body is trying
to slough off dead or damaged
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00:18:12,361 --> 00:18:13,140
tissue,
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00:18:13,140 --> 00:18:17,720
the more inflammation is going to
be produced and the greater the
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00:18:17,721 --> 00:18:20,960
likelihood of things like
hypertrophic scarring.
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00:18:21,610 --> 00:18:24,960
So early it's ointments,
medicated ointment,
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00:18:24,961 --> 00:18:29,800
seclusive dressings to
protect the area and seal
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00:18:29,801 --> 00:18:31,440
it off soonest.
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00:18:32,060 --> 00:18:35,440
And then we go on to the
same kinds of modalities
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00:18:36,680 --> 00:18:39,840
once that wound is closed,
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00:18:41,700 --> 00:18:45,440
the medicated application products,
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00:18:45,500 --> 00:18:49,920
the gel bandages, and then if
need be the bigger interventions.
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00:18:51,610 --> 00:18:54,850
Previously you alluded to combat
injuries and major trauma.
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What is the role of these treatments
for these devastating problems?
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00:18:59,480 --> 00:19:01,350
So all of this gets used,
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00:19:01,410 --> 00:19:06,110
but what's really been
revolutionary is the fractional
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00:19:06,111 --> 00:19:07,870
ablative and non-ablative laser.
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00:19:08,040 --> 00:19:12,950
So they've had the ability
to take thick scars
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00:19:12,951 --> 00:19:15,790
and remember, scars are
not just about appearance,
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00:19:15,791 --> 00:19:17,870
they're also about functional issues.
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00:19:17,871 --> 00:19:21,390
So if you have a really
thick scar across your elbow,
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00:19:21,450 --> 00:19:25,590
you may not be able to bend your elbow
or you may not be able to have the full
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00:19:25,591 --> 00:19:30,030
range of motion that
normally takes place so that
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00:19:30,340 --> 00:19:34,430
scar is interfering with your
ability to use your your arm.
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00:19:34,730 --> 00:19:39,230
The same is true of hand injuries
where motion is critical to having
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00:19:39,670 --> 00:19:41,950
function eyelids, lips,
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00:19:41,951 --> 00:19:46,910
things like this where a bad scar
can really disrupt the normal
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00:19:47,350 --> 00:19:48,830
function of that part of your body.
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00:19:49,370 --> 00:19:54,230
The fractional lasers have
shown a tremendous capability
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00:19:55,840 --> 00:20:00,190
to blend the scar and
improve it cosmetically,
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00:20:00,730 --> 00:20:03,230
but also to soften the scar,
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00:20:03,420 --> 00:20:08,190
make it behave more like
normal compliance skin so that
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00:20:08,191 --> 00:20:09,710
motion is restored.
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00:20:09,770 --> 00:20:14,630
And so it's played a big role
in the military and in treating
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00:20:15,420 --> 00:20:18,270
veterans who have sustained combat injury.
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00:20:19,270 --> 00:20:22,640
I have a pretty good sense of where
we are now with scar treatments.
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00:20:22,641 --> 00:20:25,200
What about the future? What
is coming down the pipeline?
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00:20:25,780 --> 00:20:30,410
There's a lot of examination
of how to optimize the device
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00:20:30,411 --> 00:20:33,890
based treatments. I think
we understand how to do it,
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00:20:33,891 --> 00:20:38,250
but I don't think we necessarily have
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00:20:38,290 --> 00:20:39,610
optimized it yet.
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00:20:39,611 --> 00:20:44,330
And so that's something that more
investigation will help us with.
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00:20:44,470 --> 00:20:49,240
But there are also a whole host of
biological things that are being
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00:20:49,241 --> 00:20:50,120
investigated.
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00:20:50,250 --> 00:20:54,720
So there are medicines that
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00:20:55,190 --> 00:21:00,040
bind and prevent RNA expression for
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00:21:00,041 --> 00:21:04,920
proteins that we know promote scarring
as part of the inflammatory process in
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00:21:04,921 --> 00:21:08,120
healing. And there are all
kinds of growth factor things
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00:21:09,850 --> 00:21:14,560
as well as platelet rich plasma
and even stem cells that are under
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00:21:14,820 --> 00:21:19,400
investigation for their potential
to help us with improved healing,
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00:21:19,510 --> 00:21:22,680
improved scarring, or
even scarless healing.
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00:21:23,920 --> 00:21:27,650
Lastly, before we wrap up, what are some
important takeaways for our listeners?
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00:21:28,480 --> 00:21:32,010
Really just to review what we've
said throughout the episode,
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00:21:32,030 --> 00:21:34,250
the first step is accurate diagnosis.
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00:21:34,380 --> 00:21:37,650
If you identify exactly
what's bad about the scar,
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00:21:37,990 --> 00:21:42,410
you can pick the appropriate
treatments to rapidly
325
00:21:42,540 --> 00:21:47,210
address it. Timing is critical,
better to jump in early,
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00:21:47,211 --> 00:21:48,530
You have less to correct.
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00:21:48,660 --> 00:21:53,610
So it's an example of a stitch in
time saves nine never truer than
328
00:21:53,611 --> 00:21:55,850
in treating problem scars.
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00:21:57,550 --> 00:22:00,210
You can make dramatic effects on scars,
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00:22:00,270 --> 00:22:04,970
but the expectation should not be that
we're going to get to an invisible
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00:22:05,000 --> 00:22:08,410
scar. I understand why people want that,
332
00:22:08,510 --> 00:22:13,330
but that's not currently within
the capability of what we can do.
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00:22:13,800 --> 00:22:18,130
It's work to chase one of these scars.
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00:22:18,650 --> 00:22:20,170
It's multiple steps,
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00:22:20,171 --> 00:22:23,970
often many steps over months,
336
00:22:24,390 --> 00:22:28,050
but if the steps are completed,
337
00:22:28,430 --> 00:22:33,250
you can reap the benefits of a great
scar, which you know, lasts forever.
338
00:22:34,820 --> 00:22:39,210
So the total time and number of
treatments may be significant.
339
00:22:40,800 --> 00:22:43,970
It's not ideal. We'd like to
do it in one or two treatments,
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00:22:44,030 --> 00:22:48,730
but experience has shown
that more treatments create
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00:22:48,731 --> 00:22:53,490
more refinement of the scar until
it gets to an acceptably faded
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00:22:53,491 --> 00:22:54,324
point.
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00:22:55,940 --> 00:23:00,930
So it's important to chase
that and do it because then you
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00:23:00,931 --> 00:23:04,890
get, you get to be the result and
not the scar being the result.
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00:23:04,900 --> 00:23:06,970
So you get to be a star, not a scar.
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00:23:07,590 --> 00:23:11,630
Thank you, Dr. Bass, for sharing your
insight and expertise about scars with us.
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00:23:11,631 --> 00:23:15,310
And thank you to our listeners for joining
us today to hear about how scars can
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00:23:15,311 --> 00:23:17,630
be minimized, if not totally eliminated.
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00:23:18,430 --> 00:23:21,830
Thank you for listening to the Park
Avenue Plastic Surgery Class podcast.
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00:23:22,240 --> 00:23:24,950
If you enjoyed this episode, be
sure to share it with your friends.
351
00:23:25,020 --> 00:23:28,510
Follow us on Apple Podcasts
and Spotify and leave a review.
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00:23:28,590 --> 00:23:29,830
We'll see you next time.
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00:23:31,110 --> 00:23:35,350
Thank you for joining us in this episode
of the Park Avenue Plastic Surgery
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00:23:35,351 --> 00:23:39,990
Class podcast with Dr. Lawrence
Bass Park Avenue plastic surgeon,
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00:23:40,830 --> 00:23:42,630
educator, and technology innovator.
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00:23:42,730 --> 00:23:45,520
The commentary in this
podcast represents opinion.
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00:23:45,521 --> 00:23:48,160
This podcast does not
present medical advice,
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00:23:48,260 --> 00:23:52,480
but rather general information about
plastic surgery that does not necessarily
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00:23:52,481 --> 00:23:55,640
relate to the specific conditions
of any individual patient.
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00:23:55,890 --> 00:24:00,640
No doctor patient relationship
is established by listening
to or participating
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00:24:00,641 --> 00:24:01,474
in this podcast.
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00:24:01,690 --> 00:24:06,040
Consult your physician to advise you
about your individual healthcare.
363
00:24:06,170 --> 00:24:07,720
If you enjoyed this episode,
364
00:24:07,750 --> 00:24:12,040
please share it with your friends and
be sure to subscribe to our podcast on
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00:24:12,041 --> 00:24:15,920
Apple Podcasts, Google, Spotify, Stitcher,
366
00:24:16,090 --> 00:24:18,440
or wherever you listen to podcasts.
00:00:00,450 --> 00:00:03,280
Welcome to Park Avenue
Plastic Surgery Class,
2
00:00:03,281 --> 00:00:06,800
the podcast where we explore controversies
and breaking issues in plastic
3
00:00:06,801 --> 00:00:10,680
surgery. I'm your co-host, Doreen
Wu, here with Dr. Lawrence Bass,
4
00:00:10,681 --> 00:00:14,360
Park Avenue plastic surgeon,
educator, and technology innovator.
5
00:00:14,520 --> 00:00:17,160
Today we are talking about
scars and how do we erase them.
6
00:00:18,240 --> 00:00:20,600
None of us want scars and
a bad scar, least of all.
7
00:00:20,720 --> 00:00:24,360
But plastic surgery is what makes no
scars. Isn't that right, Dr. Bass?
8
00:00:25,440 --> 00:00:29,600
Well, unfortunately, a lot of
folks think that, but in fact,
9
00:00:30,000 --> 00:00:34,120
that's not true. Anytime we
cut deep enough into the skin,
10
00:00:35,480 --> 00:00:37,680
we're going to heal with a scar. You know,
11
00:00:37,840 --> 00:00:42,160
we have minor scrapes and cuts all
the time that don't leave a scar,
12
00:00:42,400 --> 00:00:45,360
but something that goes into
the deeper levels of the skin
13
00:00:46,960 --> 00:00:51,280
always heals with at least a little
bit of a scar. But, you know,
14
00:00:51,600 --> 00:00:56,240
there are good scars that are really
inobtrusive and very difficult to see.
15
00:00:56,840 --> 00:00:59,920
And then there are bad scars
that are obvious and drastic
16
00:01:01,680 --> 00:01:03,840
and attract attention all the time.
17
00:01:05,480 --> 00:01:08,760
And we get scars for a bunch
of different reasons. I mean,
18
00:01:09,040 --> 00:01:14,000
some scars come from surgery where we're
making an incision into the skin on
19
00:01:14,240 --> 00:01:16,520
purpose for some, some important reason.
20
00:01:17,760 --> 00:01:21,520
But of course there's also
trauma. There's acne scarring,
21
00:01:22,240 --> 00:01:27,080
and then there's major tissue trauma
like occurs in combat injuries
22
00:01:29,240 --> 00:01:32,960
that not only break the skin,
23
00:01:33,840 --> 00:01:37,040
but often in irregular
ways, in massive ways,
24
00:01:37,560 --> 00:01:40,560
and massively damage the
deeper tissues underneath.
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00:01:40,800 --> 00:01:45,720
And all of that makes it much
more difficult to heal with any
26
00:01:46,000 --> 00:01:47,240
kind of reasonable scar.
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00:01:48,760 --> 00:01:50,850
Well, let's start with
a good circumstance.
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00:01:51,650 --> 00:01:55,770
Let's say I'm having an elective
plastic surgery. I want invisible scars.
29
00:01:56,050 --> 00:01:59,610
Is that a realistic expectation?
What can I do to get the best result?
30
00:02:00,870 --> 00:02:05,590
You're right that an elective plastic
surgery is the best case scenario. So,
31
00:02:05,790 --> 00:02:07,990
as I said, the scar is never invisible,
32
00:02:08,590 --> 00:02:13,550
but how visible it's likely
to be varies by site and
33
00:02:14,070 --> 00:02:15,110
by skin response.
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00:02:16,670 --> 00:02:19,750
So getting the best scar
starts with good surgery that's
35
00:02:21,390 --> 00:02:25,230
low trauma and a very meticulous closure.
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00:02:25,910 --> 00:02:30,710
The suturing, and this is what plastic
surgeons in particular excel at,
37
00:02:30,990 --> 00:02:35,670
we're really good at putting a lot of
very tiny sutures that very precisely
38
00:02:36,510 --> 00:02:40,790
approximate the edges, and that helps
us get a better scar. That, of course,
39
00:02:41,070 --> 00:02:42,590
is in the hands of the surgeon.
40
00:02:45,230 --> 00:02:50,150
But then there are things
that come afterwards.
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00:02:51,030 --> 00:02:53,910
So a best case scenario for a scar,
42
00:02:54,390 --> 00:02:58,310
something like an eyelid incision
and some facelift incisions,
43
00:02:58,750 --> 00:03:01,600
you may actually need a
magnifying glass to see them,
44
00:03:02,360 --> 00:03:05,920
but same operation performed
by the same surgeon.
45
00:03:06,600 --> 00:03:10,640
Sometimes the scar is not going
to be as favorable because
46
00:03:11,640 --> 00:03:14,400
that individual's skin
is just more reactive.
47
00:03:16,000 --> 00:03:19,320
Face scars from elective plastic
surgery tend to be better.
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00:03:20,320 --> 00:03:21,400
Body scars
49
00:03:23,120 --> 00:03:25,680
always tend to be a
little bit more visible.
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00:03:26,880 --> 00:03:29,800
Sometimes they're visible
but not very prominent,
51
00:03:30,040 --> 00:03:31,560
and sometimes they're not quite as good.
52
00:03:32,410 --> 00:03:34,720
So what should I be doing
to get the best scars?
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00:03:35,120 --> 00:03:40,080
There are a few typical things that
help and should be part of every
54
00:03:40,290 --> 00:03:41,123
surgery.
55
00:03:41,800 --> 00:03:46,760
Scar management and some effort on scar
management really ideally should be part
56
00:03:46,960 --> 00:03:51,760
of every surgery. So each
surgeon has their own approach.
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00:03:52,040 --> 00:03:56,520
They do things a little
differently but with some
58
00:03:57,280 --> 00:04:01,760
variations. But doing something
to work on the scars after surgery
59
00:04:02,920 --> 00:04:05,760
is certainly going to help
get to the best endpoint.
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00:04:06,880 --> 00:04:11,800
So one thing is scar preparations
that are applied starting
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00:04:12,600 --> 00:04:15,800
typically three weeks or so after surgery.
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00:04:17,520 --> 00:04:20,680
And these are preparations that
are applied once or twice a day.
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00:04:21,720 --> 00:04:26,120
The three big products in the United
States that are most commonly used are
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00:04:26,760 --> 00:04:30,560
Scarguard, ScarAway, and Mederma.
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00:04:31,760 --> 00:04:36,240
These are all very different materials.
They're not very much like each other.
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00:04:37,000 --> 00:04:40,920
They all help with scars and
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00:04:42,480 --> 00:04:46,960
they're easy to do and not a risk profile
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00:04:47,640 --> 00:04:49,800
associated with them
of any significance. So
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00:04:53,040 --> 00:04:55,720
it's all reward with next to no risk.
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00:04:56,760 --> 00:04:59,040
Gel bandages are another thing.
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00:05:00,880 --> 00:05:05,160
Sort of a silicone gel patch that
is placed over an incision, again,
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00:05:05,680 --> 00:05:09,160
typically starting several
weeks after surgery, and
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00:05:10,760 --> 00:05:15,600
that helps the scar likewise end up
the best looking scar we can get.
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00:05:16,670 --> 00:05:21,200
I've also read online about
a lot of different home
remedies like Vitamin K oil,
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00:05:21,201 --> 00:05:23,880
tea tree oil, coconut butter.
Do those actually work?
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00:05:25,120 --> 00:05:30,070
So it's possible that they're
helpful and they don't
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00:05:30,071 --> 00:05:32,470
seem to hurt things. However
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00:05:34,750 --> 00:05:36,350
there isn't a lot of data.
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00:05:36,960 --> 00:05:41,750
So it's probably better to
work with the medical products
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00:05:41,751 --> 00:05:43,190
and the medical treatments.
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00:05:43,300 --> 00:05:48,110
A lot of the treatments
on scars come out of burn
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00:05:48,111 --> 00:05:53,070
center research and treating major
burns and helping to get those scars
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00:05:53,071 --> 00:05:55,750
as soft and flexible as possible.
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00:05:56,490 --> 00:05:59,240
And so that's a more data driven approach,
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00:05:59,241 --> 00:06:02,560
which I think is a better
way to go about it.
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00:06:03,660 --> 00:06:05,820
Let's talk about timing a little bit.
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00:06:06,150 --> 00:06:09,220
If my incision is sensitive or delicate,
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00:06:09,640 --> 00:06:12,300
can I just wait a month or two
and then work on the scars?
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00:06:12,301 --> 00:06:15,100
Will holding off for a little
while really make a big difference?
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00:06:15,940 --> 00:06:20,110
Timing is really critically important
for scar behavior. You know,
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00:06:20,111 --> 00:06:23,950
different things are
happening at different points
during the healing process,
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00:06:24,810 --> 00:06:29,710
and the things that we're doing
to help with the scars are
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00:06:29,920 --> 00:06:34,510
focused on modulating those
biological responses to
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00:06:34,511 --> 00:06:37,030
wounding and that occurred during healing.
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00:06:38,000 --> 00:06:42,780
So you can't redo the scar a year
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00:06:42,781 --> 00:06:43,614
from now.
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00:06:44,600 --> 00:06:47,980
You might have to surgically
revise it and start over.
98
00:06:47,981 --> 00:06:50,540
There are things we
can do late with scars,
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00:06:50,541 --> 00:06:55,540
but we have much more ability to
modulate the scar and get a good scar in
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00:06:55,541 --> 00:06:59,540
the first place if we work
early. Now, as I said,
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00:06:59,541 --> 00:07:04,380
we're typically starting at about
three weeks because that's usually
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a point when even minor
crusting or open areas in an
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incision have sealed off.
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So scar behavior and scar treatment
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00:07:17,021 --> 00:07:20,260
typically starts when the
incision is fully closed,
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00:07:20,480 --> 00:07:24,860
but it has not yet matured and
added a great deal of collagen.
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00:07:25,310 --> 00:07:27,500
It has not yet remodeled.
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00:07:28,770 --> 00:07:32,940
Okay, let's say I had my aesthetic
surgery and the scar looked great,
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but now I'm at one month after surgery
and there's some redness and thickening.
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What should I do?
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Should I show it to my surgeon at my
next visit a month or even six weeks from
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now?
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00:07:43,930 --> 00:07:46,840
So, as I said, you know,
timing is critical,
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00:07:47,560 --> 00:07:50,520
and if you see a scar
heading in a bad direction,
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00:07:52,800 --> 00:07:54,120
call your surgeon immediately.
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00:07:55,080 --> 00:07:59,920
It's much easier to break a cycle
of misbehavior in early healing
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00:08:00,480 --> 00:08:04,440
scar than trying to
undo a well-established
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00:08:05,800 --> 00:08:10,640
hypertrophic scar or
widened scar any of any
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00:08:10,840 --> 00:08:14,840
of the bad things. So
that's really important.
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And some of these bad scar
departures are really medical
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00:08:19,350 --> 00:08:22,560
problems. Hypertrophic scars,
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00:08:22,720 --> 00:08:27,720
which is a red thick scar that
stands up off the surrounding
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00:08:27,721 --> 00:08:29,040
surface of the skin,
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00:08:29,570 --> 00:08:33,440
is a product sometimes of the
amount of inflammation present,
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00:08:33,460 --> 00:08:37,880
but also of your wound healing
biology as an individual
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00:08:37,881 --> 00:08:41,920
and how your skin
behaves. And keloid scars,
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00:08:42,040 --> 00:08:44,400
which not only stand up off the skin,
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00:08:44,401 --> 00:08:48,920
but actually become wider and
bigger than the original wound,
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00:08:50,100 --> 00:08:54,880
are the result of specific genetic
mutations that cause people
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to scar in that fashion.
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00:08:56,860 --> 00:09:01,560
And these things need medical
treatment immediately to keep
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things to the best possible outcome.
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Could that be why we get bad scars?
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It's really a problem with
our skin type or biology?
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00:09:10,910 --> 00:09:14,280
That's the foundation or baseline.
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00:09:14,570 --> 00:09:19,480
So your body is going to react
a certain way to wounding
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and it's going to heal a certain way,
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and that's your genetics or your biology.
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00:09:26,750 --> 00:09:30,880
Overlaid or intersecting with that
are outside factors. You know,
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00:09:30,881 --> 00:09:33,240
if a scar is not well approximated,
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00:09:33,490 --> 00:09:36,760
if it broke down because
there was too much tension,
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00:09:37,490 --> 00:09:42,360
if there was a wound infection
or some kind of a skin injury
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00:09:44,080 --> 00:09:45,960
aside from the basic surgery,
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00:09:46,110 --> 00:09:49,960
like there was some crush to the
tissue from trauma or something else,
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00:09:49,961 --> 00:09:53,920
these things can produce
partial skin loss.
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00:09:54,840 --> 00:09:59,800
But even without any skin
loss they're more likely to
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00:09:59,801 --> 00:10:01,240
produce a bad scar.
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00:10:01,770 --> 00:10:06,000
So the surgeon has to take
a careful look at the scar
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and decide what the problems are,
150
00:10:09,740 --> 00:10:12,720
and that then leads you
to think how to treat it.
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00:10:13,400 --> 00:10:17,280
Let's talk about some of these typical
problems and issues with scars.
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So scars are different from
normal skin in several ways.
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00:10:23,200 --> 00:10:27,760
The texture of the skin is
different than normal skin.
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00:10:27,761 --> 00:10:30,800
Typically, scars have
a very smooth texture.
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00:10:32,120 --> 00:10:37,040
The color of the scar is
different in early scars,
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00:10:37,041 --> 00:10:41,040
often red, it's sometimes hyper
pigmented or very dark brown.
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00:10:41,910 --> 00:10:45,360
A late scar typically has no pigment,
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00:10:45,410 --> 00:10:49,000
so it may look whiter
than the surrounding skin.
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00:10:50,260 --> 00:10:52,800
And the contour of the scar is different.
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00:10:52,801 --> 00:10:55,600
The scar may be more or
less level with the skin,
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00:10:55,890 --> 00:10:59,000
or it may be raised up
or it may be depressed,
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00:10:59,060 --> 00:11:03,800
and anything that's raised up or
depressed is going to be much more visible
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00:11:04,660 --> 00:11:07,360
and make the scar more obvious.
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00:11:08,410 --> 00:11:09,980
I didn't realize the specifics.
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Why are these differences
important to understand?
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00:11:12,380 --> 00:11:14,380
So as I said earlier,
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what's wrong with the scar is going
to tell us what treatments are needed.
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00:11:20,740 --> 00:11:22,060
So a widened scar,
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00:11:22,250 --> 00:11:26,780
a scar that instead of being paper
thin or a millimeter thin might be
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00:11:27,570 --> 00:11:30,100
a half an inch or an inch.
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00:11:32,140 --> 00:11:36,620
There's no way to get that scar
narrower without a surgical revision.
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00:11:37,380 --> 00:11:39,420
So a surgical scar revision,
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which is typically delayed for six months
or more until the scar has matured,
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00:11:45,860 --> 00:11:46,693
involves going back,
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00:11:47,420 --> 00:11:52,300
trimming out the old scar in a
small procedure and resewing the
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00:11:52,540 --> 00:11:53,373
skin edges.
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00:11:53,400 --> 00:11:58,400
And the hope is that doing that
where that's the only thing
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00:11:58,960 --> 00:12:01,160
happening, you're just
doing a scar revision,
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00:12:01,520 --> 00:12:06,320
not some kind of a big
operation underneath your
chance of landing up with a
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00:12:06,480 --> 00:12:09,760
better scar is, is good.
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00:12:11,040 --> 00:12:15,320
And we only do surgical scar revisions
when we think we're likely to be better
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00:12:16,080 --> 00:12:20,360
and obviously visibly better.
So if we think we're, you know,
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00:12:20,560 --> 00:12:22,840
you could always end up better, the same,
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00:12:23,080 --> 00:12:25,240
or worse anytime you do a scar revision.
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00:12:25,880 --> 00:12:29,360
So we'd only like to go ahead if
we think we're likely to be better
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00:12:31,160 --> 00:12:33,600
and make a real obvious change.
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00:12:34,800 --> 00:12:38,560
For other issues with the scar
issues of redness, thickening,
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00:12:39,320 --> 00:12:43,600
we're more likely to chase the scar with
189
00:12:44,400 --> 00:12:47,640
injection therapies, the gel
bandages that I mentioned,
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00:12:49,400 --> 00:12:54,080
compression therapy or with some
of the lasers and energy based
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00:12:54,880 --> 00:12:55,713
devices.
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00:12:56,370 --> 00:12:58,360
As usual. Let's take these one at a time.
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00:12:59,270 --> 00:13:04,260
So gel bandages and compression
are things that are very
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00:13:04,261 --> 00:13:07,220
commonly used. Silicone gel bandages,
195
00:13:07,570 --> 00:13:11,180
both because of the occlusion
and a mild degree of compression,
196
00:13:11,181 --> 00:13:15,500
they provide help model a
scar softer and flatter,
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00:13:15,501 --> 00:13:18,180
help the scars lose the
redness more quickly.
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00:13:18,181 --> 00:13:20,860
An early scar typically looks red,
199
00:13:22,040 --> 00:13:26,340
and in a typical middle aged adult it
200
00:13:26,980 --> 00:13:31,940
takes six months or so in round numbers
for the scar to lose the redness
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00:13:31,941 --> 00:13:34,740
become a white scar.
Teenager might take longer.
202
00:13:35,380 --> 00:13:38,740
Someone who's elderly might
do it a little more quickly.
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00:13:38,741 --> 00:13:43,380
Their body calms down and stops
the healing process sooner.
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00:13:43,381 --> 00:13:46,340
But those are averages and
each individual is different.
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00:13:46,710 --> 00:13:49,180
So that's the first step.
It's the least invasive,
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00:13:49,190 --> 00:13:53,620
it has the least risk and
will get us where we want.
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00:13:54,210 --> 00:13:57,660
Next, we go to injections. And you know,
208
00:13:57,661 --> 00:14:01,380
what's happening in a
scar is that fibroblasts.
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00:14:01,381 --> 00:14:03,940
The healing cells are adding collagen,
210
00:14:03,941 --> 00:14:07,980
and that's important at first to
get strength in, in the repair.
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00:14:09,260 --> 00:14:13,940
But like Goldilocks and the three
bears, it has to be the right amount,
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00:14:13,941 --> 00:14:16,740
not too much, not too little, just right.
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00:14:17,310 --> 00:14:19,380
If the process doesn't turn off,
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00:14:19,381 --> 00:14:22,940
once the scar is closed and strong,
215
00:14:23,480 --> 00:14:26,860
the quality of the scar
will continue to degrade,
216
00:14:27,480 --> 00:14:31,940
and we need to inject
anti-inflammatory medicines
217
00:14:32,570 --> 00:14:37,460
into the tissue of the scar
itself to try to stimulate the
218
00:14:37,461 --> 00:14:41,220
body, to break the cycle of
inflammation and healing.
219
00:14:42,540 --> 00:14:44,820
Now that the scar is closed,
220
00:14:45,900 --> 00:14:49,100
these medicines are
typically either steroid,
221
00:14:49,720 --> 00:14:53,600
anti-inflammatory medicines or
222
00:14:55,130 --> 00:14:58,540
anti metabolite,
anti-inflammatory medicines,
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00:14:58,750 --> 00:15:00,940
or some combination of the two.
224
00:15:00,941 --> 00:15:05,900
And treatments are typically done
once every four to six weeks for
225
00:15:05,901 --> 00:15:10,780
several injections in the hopes that
that will break the cycle and get
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00:15:10,781 --> 00:15:15,300
the scar to calm down.
Finally, we go to lasers.
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00:15:16,120 --> 00:15:16,953
And
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00:15:18,420 --> 00:15:22,740
these are lasers that do two
different kinds of things. One,
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00:15:25,220 --> 00:15:29,030
lasers that target vascular in the skin,
230
00:15:29,760 --> 00:15:32,870
so they knock back some
of the blood supply,
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00:15:32,871 --> 00:15:37,630
which slows down metabolically
the healing response and can
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00:15:37,631 --> 00:15:42,230
break the cycle of hypertrophic
changes. These are typically used early.
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00:15:43,910 --> 00:15:46,110
Most commonly it's the pulse dye laser,
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00:15:46,111 --> 00:15:51,110
but sometimes IPL and other
kinds of vascular lasers are
235
00:15:51,460 --> 00:15:52,430
also used.
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00:15:53,770 --> 00:15:58,230
And then both early and
late to remodel the scar
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00:15:58,490 --> 00:16:01,790
get its softer, flatter,
and get it to lose redness.
238
00:16:01,791 --> 00:16:06,550
We use either ablative or
non-ablative fractional lasers.
239
00:16:06,551 --> 00:16:11,510
Lasers that put little pinpoints
of light in that can often
240
00:16:11,511 --> 00:16:14,270
go quite deep into,
let's say a thick scar.
241
00:16:15,610 --> 00:16:19,990
And that gets some tissue
removal that allows the scar to
242
00:16:20,000 --> 00:16:23,070
remodel in a flatter, smoother,
243
00:16:23,620 --> 00:16:26,710
better matched configuration.
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00:16:27,410 --> 00:16:31,590
And it likewise can help
knot back some redness,
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00:16:31,591 --> 00:16:33,830
particularly with the
non-ablative options.
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00:16:33,830 --> 00:16:38,570
All right, I have another
scenario for you this time.
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00:16:38,571 --> 00:16:40,730
Not as pleasant as
elective plastic surgery.
248
00:16:41,530 --> 00:16:46,290
Let's say it was icy out and I fell
down the stairs and smashed my face.
249
00:16:46,630 --> 00:16:49,330
Now I have all these cuts,
scrapes and a big bump.
250
00:16:49,510 --> 00:16:51,010
How is that going to be treated?
251
00:16:51,950 --> 00:16:54,110
These are not surgical scars,
252
00:16:54,111 --> 00:16:58,070
but traumatic scars and they're much
less likely to heal. Well, of course,
253
00:16:58,071 --> 00:17:02,510
we didn't get to manufacture
the incision or the scar.
254
00:17:02,510 --> 00:17:04,710
It was an unexpected injury.
255
00:17:04,711 --> 00:17:09,670
So this is probably best evaluated
by a plastic surgeon and managed
256
00:17:09,671 --> 00:17:14,590
early in the healing process
to get the best result because
257
00:17:14,680 --> 00:17:16,390
as we said, timing matters.
258
00:17:16,680 --> 00:17:20,550
So showing up six months or
a year later with a bad scar,
259
00:17:20,551 --> 00:17:22,710
we can still do a lot of things for that,
260
00:17:22,711 --> 00:17:27,470
but we'll do better early
in the game and early
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00:17:27,960 --> 00:17:30,670
as the abrasions and the
open areas are healing,
262
00:17:30,720 --> 00:17:35,590
we often apply ointment
or medicated ointments
263
00:17:36,000 --> 00:17:40,950
or occlusive dressings that
keep the area moist and that
264
00:17:40,951 --> 00:17:45,870
can create a lot of
remodeling and smoothing and
265
00:17:45,980 --> 00:17:50,080
a quicker point to get that closed.
266
00:17:50,730 --> 00:17:54,080
So the sooner an area is closed,
267
00:17:54,780 --> 00:17:58,920
the less time the body is
going to be upregulating or
268
00:17:59,000 --> 00:18:02,880
spiraling up on the level of inflammation.
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00:18:02,881 --> 00:18:07,760
And the longer a wound is open or
270
00:18:07,761 --> 00:18:12,360
the longer the body is trying
to slough off dead or damaged
271
00:18:12,361 --> 00:18:13,140
tissue,
272
00:18:13,140 --> 00:18:17,720
the more inflammation is going to
be produced and the greater the
273
00:18:17,721 --> 00:18:20,960
likelihood of things like
hypertrophic scarring.
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00:18:21,610 --> 00:18:24,960
So early it's ointments,
medicated ointment,
275
00:18:24,961 --> 00:18:29,800
seclusive dressings to
protect the area and seal
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00:18:29,801 --> 00:18:31,440
it off soonest.
277
00:18:32,060 --> 00:18:35,440
And then we go on to the
same kinds of modalities
278
00:18:36,680 --> 00:18:39,840
once that wound is closed,
279
00:18:41,700 --> 00:18:45,440
the medicated application products,
280
00:18:45,500 --> 00:18:49,920
the gel bandages, and then if
need be the bigger interventions.
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00:18:51,610 --> 00:18:54,850
Previously you alluded to combat
injuries and major trauma.
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00:18:55,040 --> 00:18:58,210
What is the role of these treatments
for these devastating problems?
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00:18:59,480 --> 00:19:01,350
So all of this gets used,
284
00:19:01,410 --> 00:19:06,110
but what's really been
revolutionary is the fractional
285
00:19:06,111 --> 00:19:07,870
ablative and non-ablative laser.
286
00:19:08,040 --> 00:19:12,950
So they've had the ability
to take thick scars
287
00:19:12,951 --> 00:19:15,790
and remember, scars are
not just about appearance,
288
00:19:15,791 --> 00:19:17,870
they're also about functional issues.
289
00:19:17,871 --> 00:19:21,390
So if you have a really
thick scar across your elbow,
290
00:19:21,450 --> 00:19:25,590
you may not be able to bend your elbow
or you may not be able to have the full
291
00:19:25,591 --> 00:19:30,030
range of motion that
normally takes place so that
292
00:19:30,340 --> 00:19:34,430
scar is interfering with your
ability to use your your arm.
293
00:19:34,730 --> 00:19:39,230
The same is true of hand injuries
where motion is critical to having
294
00:19:39,670 --> 00:19:41,950
function eyelids, lips,
295
00:19:41,951 --> 00:19:46,910
things like this where a bad scar
can really disrupt the normal
296
00:19:47,350 --> 00:19:48,830
function of that part of your body.
297
00:19:49,370 --> 00:19:54,230
The fractional lasers have
shown a tremendous capability
298
00:19:55,840 --> 00:20:00,190
to blend the scar and
improve it cosmetically,
299
00:20:00,730 --> 00:20:03,230
but also to soften the scar,
300
00:20:03,420 --> 00:20:08,190
make it behave more like
normal compliance skin so that
301
00:20:08,191 --> 00:20:09,710
motion is restored.
302
00:20:09,770 --> 00:20:14,630
And so it's played a big role
in the military and in treating
303
00:20:15,420 --> 00:20:18,270
veterans who have sustained combat injury.
304
00:20:19,270 --> 00:20:22,640
I have a pretty good sense of where
we are now with scar treatments.
305
00:20:22,641 --> 00:20:25,200
What about the future? What
is coming down the pipeline?
306
00:20:25,780 --> 00:20:30,410
There's a lot of examination
of how to optimize the device
307
00:20:30,411 --> 00:20:33,890
based treatments. I think
we understand how to do it,
308
00:20:33,891 --> 00:20:38,250
but I don't think we necessarily have
309
00:20:38,290 --> 00:20:39,610
optimized it yet.
310
00:20:39,611 --> 00:20:44,330
And so that's something that more
investigation will help us with.
311
00:20:44,470 --> 00:20:49,240
But there are also a whole host of
biological things that are being
312
00:20:49,241 --> 00:20:50,120
investigated.
313
00:20:50,250 --> 00:20:54,720
So there are medicines that
314
00:20:55,190 --> 00:21:00,040
bind and prevent RNA expression for
315
00:21:00,041 --> 00:21:04,920
proteins that we know promote scarring
as part of the inflammatory process in
316
00:21:04,921 --> 00:21:08,120
healing. And there are all
kinds of growth factor things
317
00:21:09,850 --> 00:21:14,560
as well as platelet rich plasma
and even stem cells that are under
318
00:21:14,820 --> 00:21:19,400
investigation for their potential
to help us with improved healing,
319
00:21:19,510 --> 00:21:22,680
improved scarring, or
even scarless healing.
320
00:21:23,920 --> 00:21:27,650
Lastly, before we wrap up, what are some
important takeaways for our listeners?
321
00:21:28,480 --> 00:21:32,010
Really just to review what we've
said throughout the episode,
322
00:21:32,030 --> 00:21:34,250
the first step is accurate diagnosis.
323
00:21:34,380 --> 00:21:37,650
If you identify exactly
what's bad about the scar,
324
00:21:37,990 --> 00:21:42,410
you can pick the appropriate
treatments to rapidly
325
00:21:42,540 --> 00:21:47,210
address it. Timing is critical,
better to jump in early,
326
00:21:47,211 --> 00:21:48,530
You have less to correct.
327
00:21:48,660 --> 00:21:53,610
So it's an example of a stitch in
time saves nine never truer than
328
00:21:53,611 --> 00:21:55,850
in treating problem scars.
329
00:21:57,550 --> 00:22:00,210
You can make dramatic effects on scars,
330
00:22:00,270 --> 00:22:04,970
but the expectation should not be that
we're going to get to an invisible
331
00:22:05,000 --> 00:22:08,410
scar. I understand why people want that,
332
00:22:08,510 --> 00:22:13,330
but that's not currently within
the capability of what we can do.
333
00:22:13,800 --> 00:22:18,130
It's work to chase one of these scars.
334
00:22:18,650 --> 00:22:20,170
It's multiple steps,
335
00:22:20,171 --> 00:22:23,970
often many steps over months,
336
00:22:24,390 --> 00:22:28,050
but if the steps are completed,
337
00:22:28,430 --> 00:22:33,250
you can reap the benefits of a great
scar, which you know, lasts forever.
338
00:22:34,820 --> 00:22:39,210
So the total time and number of
treatments may be significant.
339
00:22:40,800 --> 00:22:43,970
It's not ideal. We'd like to
do it in one or two treatments,
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but experience has shown
that more treatments create
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more refinement of the scar until
it gets to an acceptably faded
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point.
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So it's important to chase
that and do it because then you
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get, you get to be the result and
not the scar being the result.
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So you get to be a star, not a scar.
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Thank you, Dr. Bass, for sharing your
insight and expertise about scars with us.
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And thank you to our listeners for joining
us today to hear about how scars can
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be minimized, if not totally eliminated.
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00:23:18,430 --> 00:23:21,830
Thank you for listening to the Park
Avenue Plastic Surgery Class podcast.
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00:23:22,240 --> 00:23:24,950
If you enjoyed this episode, be
sure to share it with your friends.
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00:23:25,020 --> 00:23:28,510
Follow us on Apple Podcasts
and Spotify and leave a review.
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We'll see you next time.
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Thank you for joining us in this episode
of the Park Avenue Plastic Surgery
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00:23:35,351 --> 00:23:39,990
Class podcast with Dr. Lawrence
Bass Park Avenue plastic surgeon,
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educator, and technology innovator.
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00:23:42,730 --> 00:23:45,520
The commentary in this
podcast represents opinion.
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00:23:45,521 --> 00:23:48,160
This podcast does not
present medical advice,
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but rather general information about
plastic surgery that does not necessarily
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00:23:52,481 --> 00:23:55,640
relate to the specific conditions
of any individual patient.
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00:23:55,890 --> 00:24:00,640
No doctor patient relationship
is established by listening
to or participating
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00:24:00,641 --> 00:24:01,474
in this podcast.
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00:24:01,690 --> 00:24:06,040
Consult your physician to advise you
about your individual healthcare.
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00:24:06,170 --> 00:24:07,720
If you enjoyed this episode,
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00:24:07,750 --> 00:24:12,040
please share it with your friends and
be sure to subscribe to our podcast on
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00:24:12,041 --> 00:24:15,920
Apple Podcasts, Google, Spotify, Stitcher,
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00:24:16,090 --> 00:24:18,440
or wherever you listen to podcasts.