I read with interest about new research published in Science magazine this month. According to a study carried out by doctors at the University of Pennsylvania in the US, scars could be a thing of the past with a new healing process. By altering the cell composition within a wound, the lesion heals as normal skin rather than scar tissue.
Scarring and plastic surgery
Although this breakthrough will not be readily available to patients for many years to come, it will be certainly be welcomed by those contemplating an elective cosmetic surgery procedure, as scarring is possibly the one unavoidable complication of a surgical procedure.
Any time that an incision is made in the skin, there will be a scar and – currently – that cannot be eliminated from the process. My aim, though, is always to ensure that any scar is no longer than necessary and positioned as discreetly as possible.
There are a number of factors that affect the healing process, including your body’s individual response and your age. Counter-intuitively, a younger patient with very taut skin can take longer to heal than an older patient with greater skin laxity. Nicotine directly impacts on the healing process, making wound healing problems and infection more likely. Facelifts and abdominoplasty (tummy tuck) are the most threatened cosmetic procedures and anyone in my care for a facelift must be a non-smoker (absolutely no smoking for 8 weeks before surgery).
So, we ask all patients to give up smoking in the first few weeks after a relatively major procedure anyway but also recommend they quit entirely for best possible scarring.
In terms of the stages of the healing process, a scar will start to improve in appearance within the first month or so, but it can take up to a year to fully fade and flatten. Over time the scar will change greatly in appearance. In the first stage, white blood cells, antibodies, growth factors, nutrients and enzymes are brought to the wound site via an enhanced blood supply of fine capillary vessels to prevent infection and begin the healing process. As a result, the scar will look bright red, somewhat swollen and inflamed.
The second stage of healing is called the proliferation phase and it’s where the body ‘rebuilds’ the wound site with new tissue. Key in this is the fibroblast cell which produces collagen as tough fibres which that bind the wound area together, tightening and strengthening it. Swelling dissipates and the blood supply slowly reduces causing the surface scar colour to fade from red to pink.
Optimal healing depends on the fibroblasts receiving enough oxygen and nutrients through the capillary vessels. Nicotine severely narrows capillaries, heavily reducing that supply, which is why smoking can have such a damaging impact on scar quality.
The final stage is called maturation and at this point the predominant collagen alters from type III to type I in a process called remodeling. The collagen fibres become more closely aligned and cross link which reduces the thickness of the scar and makes it even stronger.
The capillary blood supply almost completely disappears, resulting in the surface appearance of the scar becoming much paler, often paler than the adjacent non-scar skin.
The recent breakthrough from US scientists impacts on the proliferation or secondary phase of wound healing. Fat cells, known as adipocytes, are present in normal dermal tissue, but are lost when a wound heals into a scar. The most common cell in healing wounds are myofibroblasts and, unlike fat cells, they do not contain a hair follicle which is why they look different to normal skin.
Previously, it was thought impossible to turn a myofibroblast into a follicle-containing fat cell, but now the scientists from University of Pennsylvania have discovered how to “manipulate wound healing so that it leads to skin regeneration rather than scarring” as Dr George Cotsarelis, the lead investigator of the study, explains. By regenerating the hair follicle first, the fat cell forms and it is indistinguishable from normal, undamaged skin.
What can I do now about my plastic surgery scars?
First of all, be patient. A fully mature scar (12 months) will look quite different to the same early scar. Any decision concerning possible scar revision should therefore wait until then. The wearing of compression garments in the early stages is recommended where practicable. There are also a number of scar treatments available, such as creams and silicone gels and sheets, but if your scar is healing well it is probably best left to heal naturally. Some studies have shown that laser therapy can improve the appearance of scars, but typically the best results are achieved when the scar is still relatively ‘new’.
In terms of the steps you can personally take to ensure your scar heals well, I would recommend you use high factor (50+) sun block on it to avoid sun exposure that can either lighten or darken a scar compared to the surrounding, pigment-rich skin. A healthy, varied diet will provide all the nutrients the body requires for good wound healing. And, of course, avoid smoking!