Features of scars formed after various cosmetic surgeries

The author examined 964 patients who had undergone cosmetic surgeries at the Center for Plastic and Reconstructive Surgery. The examination periods in all cases exceeded 12 months from the day of surgery. As a result, the most characteristic differences in scars formed in various anatomical zones were established. In particular, it was established that the width of the scar is directly dependent on the healing conditions of the corresponding area of the wound. The most important characteristic of these conditions is the tension on the suture line.

Face and forehead skin tightening

In 189 patients who underwent face and forehead lift, measurements of postoperative scar width were taken at the following points:

• on the scalp (along the central line and at a distance of 8 cm on each side);
• 2 cm above and 0.5 cm below the level of the tragus;
• in the area where the main fixing sutures are applied at the top of the flap behind the ear.

As a result of the study, the following patterns were established:

• in front of the auricle (with a transition to the inner surface of the helix), where the conditions for wound closure were ideal, a filiform thin normotrophic scar was formed, noticeable only upon careful examination;
• the widest normotrophic scars were formed behind the auricle in the area of greatest tissue tension during tightening (unfavorable conditions for wound closure);
• behind the line of greatest tissue tension during facial skin tightening, as well as within the scalp (favorable conditions for wound closure), the width of the scar averaged (1.5±0.37) mm with its normotrophic nature.

Only one observation noted the formation of hypertrophic scars along the entire length of the scar. The patient was bothered by itching, the color of the scar remained crimson-red. Subsequently, the intensity of the symptoms gradually decreased.

In another 7 patients (4%), hypertrophic scars were observed in the area behind the ear along the hairline. Their prevention is to give the incision line a non-linear shape (with a triangular protrusion).

Plastic surgery of the anterior abdominal wall

A total of 122 patients were examined who underwent the following types of plastic surgery of the anterior abdominal wall: tension-lateral (35 patients), vertical (10 patients) and classical with wide separation of the skin-fat flap from the surface of the muscular-aponeurotic layer (77 patients).

Measurements of the width of the scars were carried out along the lower horizontal scar at the level of the midline of the abdomen, as well as at a distance of 5 and 15 cm in both directions.

The best scar quality indicators were noted in patients who underwent tension-lateral plastic surgery of the anterior abdominal wall, during which the edges of the skin wound were sutured with little or no tension (favorable or ideal conditions for wound healing). All scars were normotrophic in nature, and their average width was (1.5±0.37) mm in its central part and (2.5±0.22) mm at a distance of 15 cm.

In the case of a classic type of surgery, these indicators were approximately the same and averaged (3±0.42) mm. After central abdominoplasty, the width of the scar averaged (4±0.34) mm at points 5 cm above and below the navel.

Thus, in the absolute majority of cases, the average width of the scar exceeded 2 mm during plastic surgery of the anterior abdominal wall. This was primarily due to the fact that the very nature of the operation allows for the creation of favorable conditions for wound healing. However, when a wide area of skin is removed, the scar subsequently experiences significant tension associated with the stretching of the anterior abdominal wall during trunk extension and after eating. This leads to a moderate widening of the scar, the quality of which can be improved by a repeat operation (scar excision with suturing), performed 6-12 months after the first intervention.

Breast lift

In 105 patients who underwent breast lift, scar width measurements were taken at the following points:

• at four equally spaced points on the periareolar scar;
• in the center of the vertical scar running from the areola to the submammary fold;
• at two points of the submammary scar.

The most significant average width of the scar was observed in its vertical section, where it was (3.3±0.23) mm. The width of the periareolar scar was on average (1.7±0.36) mm. The inframammary scar was thinner and its width was on average (1.3±0.14) mm.

The above features were due to the fact that due to constant stretching of the vertically located scar (with the patient's body in a vertical position), it widens considerably and, as a rule, exceeds 3 mm. There is every reason to believe that over the years the width of this scar may increase even more. The periareolar and inframammary scars, which are under less stress (favorable conditions for wound healing), were also significantly less wide.

Liposuction

The data presented indicate that for this type of operation the problem of scars is insignificant.

Scar correction

The main types of operations aimed at correcting scars are scar lengthening, their excision and replacement of scar-altered tissue with a full-fledged skin flap.

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