Plastic surgery restores form and function through reconstructive procedures, cosmetic enhancements, and body contouring.
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The procedure starts with careful planning. Before giving any anesthesia, the surgeon draws the incision lines on the skin. This helps check the natural tension lines while the skin is still in its normal state. The design whether it’s an ellipse, Z-plasty, or W-plasty is drawn very precisely.
The area is then prepped with a sterile solution (Chlorhexidine or Betadine) and draped. Maintaining a sterile field is critical, even for minor procedures, to prevent bacterial colonization that could ruin the delicate closure.
Local anesthesia is the standard for most revisions. The surgeon injects a mixture of Lidocaine (numbing) and Epinephrine (vasoconstrictor). The injection is performed slowly to minimize tissue distortion and discomfort. Epinephrine is crucial because it reduces bleeding, providing a bloodless field for microsurgery.
For larger revisions or anxious patients, oral sedation or intravenous twilight sedation may be used. The goal is complete patient comfort while maintaining the safety profile of an outpatient procedure.
The scar is excised with a fresh, sharp scalpel. The surgeon cuts through the full thickness of the dermis to remove the fibrotic tissue. Ideally, the excision is “beveled” or angled to create edges that fit together perfectly.
Tissue handling is atraumatic. The surgeon uses skin hooks or fine forceps to manipulate the skin edges, avoiding crushing the delicate tissue. Crushed tissue dies and creates scarring. This “no-touch” or “minimal-touch” technique is a hallmark of plastic surgical precision.
To close the wound without tension, the surgeon must mobilize the surrounding skin. This is called undermining. Scissors are used to separate the skin and fat from the underlying muscle fascia for a distance around the wound.
Undermining frees the skin from its deeper attachments so it can move easily to cover the wound. This step helps prevent the new scar from becoming wide. How much undermining is done depends on where the scar is and how stretchy the skin is.
Before closure, the wound bed must be arid. The surgeon uses bipolar electrocautery to seal small blood vessels. Unlike standard cautery, bipolar energy is focused between two tweezer tips, preventing thermal damage to the surrounding skin.
It’s very important to prevent a hematoma, which is a collection of blood under the skin. A hematoma can put pressure on the wound, raise the risk of infection, and harm the healing skin. The surgeon makes sure all bleeding is stopped before stitching the wound.
The strength of a scar revision lies in the deep sutures, not the top ones. The surgeon places absorbable sutures in the deep dermis and fascia. These stitches hold the wound edges together and bear the mechanical tension of the closure.
These deep stitches take the tension off the skin’s surface. The skin edges should almost meet by themselves before the final stitches are put in. This tension-free closure is the key to getting a thin, barely visible scar.
The skin surface is closed with fine, non-absorbable sutures (like Nylon or Prolene) or a running subcuticular (under the skin) stitch. The goal is precise alignment of the epidermal edges to prevent a “step-off” deformity.
The wound edges are slightly everted (pushed up into a ridge). As the wound heals and the scar contracts, this ridge will flatten out to become level with the skin. If closed flat initially, the scar often widens and sinks.
In Z-plasty procedures, the triangular flaps are cut, lifted, and physically swapped. This transposition lengthens the scar and changes its direction. The surgeon must handle the tips of the flaps with extreme care, as they have the most precarious blood supply.
The flaps are stitched into their new interlocking position. This transforms a straight line into a zig-zag, confusing the eye and releasing the contracture. The geometry must be exact to ensure the flaps fit like puzzle pieces.
In some cases, surgical glue (cyanoacrylate) is used to seal the surface, creating a waterproof barrier. Steri-Strips or tension-offloading tape are applied across the incision to provide external support.
These adjuncts serve as a splint for the skin, minimizing micro-movements that can stimulate scar formation. They also protect the incision from environmental bacteria during the initial phase of epithelialization.
After the procedure, the patient is monitored for 15-30 minutes to ensure they feel well and there is no immediate expansion of the dressing (signaling a hematoma). Ice packs are applied to minimize immediate swelling.
Since most patients are awake, recovery is rapid. Detailed instructions for wound care are provided, and the patient is discharged. If on a limb, elevation instructions are emphasized.
The first 48 to 72 hours are critical for preventing bleeding. Patients are instructed to limit physical exertion and to keep their blood pressure under control. If the revision is on the face, talking and chewing may be restricted to soft foods to minimize facial movement.
If on the body, heavy lifting and reaching are prohibited for 2 to 3 weeks. Stretching the fresh incision creates tension, which triggers the body to lay down thick scar tissue. Immobilization promotes a fine line.
Scar revisions rarely require drains. The meticulous layered closure and hemostasis usually suffice to prevent fluid collection. This simplifies recovery, as there are no tubes to manage or empty.
The focus is entirely on surface wound care and protecting the incision from trauma. Patients are educated about signs of complications, such as worsening pain or redness, that warrant a call to the office.
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During the surgery, you will feel nothing but pressure because of the local anesthesia. After the numbing wears off, most patients report mild soreness or a stinging sensation, which is easily managed with Tylenol or Ibuprofen.
Usually, you will have a small, flesh-colored tape or a clear glue over the incision. We keep facial dressings to a minimum so you can function normally. You can usually go out in public the next day, though the tape will be visible.
Facial stitches are typically removed in 5 to 7 days to prevent “track marks.” Stitches on the body, where there is more tension, stay in for 10 to 14 days. Subcuticular stitches dissolve on their own.
Yes, typically after 24 to 48 hours. You can let mild soapy water run over the area, but do not scrub it or soak it in a bath or pool. Pat it dry gently and reapply any ointment or tape as instructed.
A small amount of spotting on the bandage is normal in the first 24 hours. Apply gentle, constant pressure with clean gauze for 10 minutes. If the bleeding is heavy or continuous, or if the area swells rapidly, call your surgeon immediately.
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