Obsessed With Tension
After genetics, the most important factor for achieving a perfect scar is avoiding tension on the skin closure; this is established at the time of the operation. The skin as an organ is designed to keep out the environment, and therefore has an enormous amount of immunologic and inflammatory cells. When the skin is injured with a surgical procedure or if there is significant tension placed on the skin, there is an increased recruitment of these cells leading to more inflammation. This can result in a larger amount of immature, bulky collagen being laid down which will cause a thicker, redder scar to form. As a revisionary specialist, who focuses on ways to minimize scars, I utilize several techniques that allow a meticulous tension free closure.
Minimal scar formation begins with a plan and engineering the surgery to prevent any excess tension on the skin. For example: when performing tummy tucks I utilize “Progressive Tension Suturing”. With this technique 15-20 sutures are placed underneath the abdominal flap, progressively advancing the undersurface of the flap down towards the pubis, so there is virtually no tension on the skin closure. Next, several sutures are placed in the deep subcutaneous tissues so the two edges of skin are already closely apposed before the final skin suturing is performed. At this point, a “micro bite” closure can be performed for a near-perfect skin closure. This same type of tissue planning also goes into breast lifts. By removing a small wedge of tissue on the lower pole of the breast, the underlying breast tissue can be sutured together, again taking tension off the skin.
The best opportunity to have a well healed and beautiful incision is at the time of surgery. By performing surgery in such a way that there is no tension on the skin, this creates the best environment and opportunity to have that “perfect scar”.