Scars and the Art of Plastic Surgery
A scar is nature’s thread, mending broken or cut skin with a waterproof closure. A skin cut initiates a complex inflammatory process designed to manufacture that thread. Like a skilled army, specialized cells lay down a clot to stop the bleeding, while wound-healing chemicals flow to the rescue. One of those chemicals is histamine.
Histamine stretches out a blood vessel like a stocking, opening up little holes to allow special healing cells to leak out. You might be familiar with a certain side effect: Histamine can make scars itch.
Collagen-producing cells go to work like a garment factory, knitting the wound closed. Just as the factory needs electricity to run, those cells need extra energy and oxygen.
In the lungs, red blood cells load up oxygen like cargo boats, and they float down the blood vessels, handing out oxygen where it’s needed. For a wound to heal, however, the limited network of blood vessels isn’t sufficient to supply enough oxygen.
What’s a body to do?
How about… grow more blood vessels? And that’s exactly what happens. The body creates more capillaries to bring more oxygen-rich blood. The red blood inside the capillaries flows just below the scar’s surface. The result is sort of like… a blush.
That’s why scars are pink.
In the final phase of scar-making, the disorganized, heaped-up, young collagen reorganizes into its flat, mature form. (It’s like seeing a teenager grow up.)
Once the job is done, the extra capillaries are no longer needed, so they disappear, slinking off without a trace.
That’s why scars fade.
The ideal scar is thin, flat, and asymptomatic, but that takes time, up two years. (Some scars take even longer to grow up, just like some humans.)
So how do you get a ‘star’ scar?
Plastic surgeons create scars every time they cut skin. Part of the art of plastic surgery consists of hiding incisions—in folds, within hair, and along contour changes. But those incisions leave scars. (Plastic surgeons aren’t magicians.)
It’s natural for patients to hope for a perfect scar: thin, flat, and white, but not everyone heals that way. Factors that affect scarring include:
1. Genetics: You inherit your scar-forming qualities from your parents.
2. Tension: An incision closed under tension is more likely to be thick, raised, and wide.
3. Location and type of skin: Eyelid scars are typically better than back or chest scars.
4. Age: Children are more likely to develop thick scars between the ages of 8 and 16, while older people with thin skin are more likely to form fine scars.
5. Wound condition: Shredded skin edges are more likely to cause thick scars than cleanly cut ones.
6. Proper closure: Surgical technique can impact the result, though the best technique won’t overcome other factors.
7. Blood supply: Factors such as smoking can result in death of skin, leading to delayed healing, a wider scar, and the need for surgery to close the wound.
8. Infection: A wound infection can disrupt the wound and lead to a wider scar.
9. Poor diet: Inadequate nutrition can delay healing and result in opening of the wound.
10. Health: Medications, medical conditions, and previous radiation can affect wound healing, so share your medical history with your doctor.
And that’s the story of scar formation.
It’s really sort of magical if you think about it!
Potential patients may be concerned about scars after plastic surgery. Though no one can predict how an individual will heal, one’s parents’ and siblings’ scars can give an idea of inherited scarring potential. Patients can improve their chances of good scars by being honest with their doctors about their medical histories and finding an ABPS board-certified plastic surgeon trained to minimize and/or hide scarring. The chances are they'll be pleased with the results.