Features of scars formed after various cosmetic operations

The author examined 964 patients who underwent cosmetic operations at the Center for Plastic and Reconstructive Surgery. The timing of the examination in all cases exceeded 12 months from the date of the operation. As a result, the most characteristic differences in scars formed in different anatomical zones were established. In particular, it was found that the width of the scar is directly related to the healing conditions of the wound site concerned. The most important characteristic of these conditions is the tension on the seam line.

Face and forehead lift

In 189 patients who underwent a facelift of the face and forehead, measurements of the width of the postoperative scar were carried out at the following points:

• in the scalp (along the central line and at a distance of 8 cm in each direction);
• 2 cm above and 0.5 cm below the level of the tragus;
• In the zone of application of the main fixing sutures at the apex of the flap behind the ear.

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

• anterior to the auricle (with the transition to the inner surface of the curl), where the conditions for closing the wound were ideal, a filiform, thin normotrophic scar was formed, visible only after careful examination;
• the widest scars of the normotrophic type were formed behind the auricle in the zone of the greatest tension of the tissues during a tightening (unfavorable conditions for wound closure);
• behind the line of the greatest tension of the tissues with a facelift, and also within the scalp (favorable conditions for wound closure), the width of the scar on the average was (1.5 ± 0.37) mm with its normotrophic character.

Only in one observation was the formation of scars of a hypertrophic nature throughout the rumen. In this case, the patient was troubled by itching, the color of the scar remained purple-red. In the following, the intensity of symptoms gradually decreased.

In 7 (4%) patients, the formation of hypertrophic scars was observed in the behind-eye region along the hair growth line. Their prevention is to give the line of the cut a nonlinear shape (with the presence of a triangular projection).

Anterior abdominal wall plasty

A total of 122 patients were examined who had the following types of anterior abdominal wall plastic: tension-lateral (3-5 patients), vertical (10 patients) and classical with a 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 course of the lower horizontal scar at the level of the midline of the abdomen, and also at a distance of 5 and 15 cm in both directions.

The best indices of quality of scars were noted in patients who underwent stress-lateral plastic of the anterior abdominal wall, during which the edges of the cutaneous wound were sewn with little or no tension (favorable or ideal conditions for healing the wound.) All scars had a normotrophic character, and their the 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 operation of the classical type, these indices were approximately the same and averaged (3 ± 0.42) mm. After central abdominoplasty, the width of the scar was, on average, (4 ± 0.34) mm at points 5 cm above and below the navel.

Thus, with the anterior abdominal wall plasty in the vast majority of cases, the average width of the scar was more than 2 mm. This was due primarily to the fact that the very content of the operation makes it possible to create favorable conditions for healing the wound. However, when a significant area of the skin is removed, the scar then experiences a considerable tension associated with the extension of the anterior abdominal wall during extension of the trunk and after ingestion. This leads to a moderate enlargement of the scar, the quality of which can be improved by repeated surgery (excision of the scar with suturing) performed 6 to 12 months after the first intervention.

Breast lift

In 105 patients who underwent a breast lift, the measurement of the width of the scars was carried out at the following points:

• in four points of the peri-aureolar rumen, evenly spaced from each other;
• In the center of the vertical scar, going from the areola to the pectoral fold;
• in two points of a pectoral rumen.

The most significant mean width of the scar was noted on its vertical section, where it was (3.3 ± 0.23) mm. The width of peri-aureolar rumen averaged (1.7 ± 0.36) mm. The pectoral scar was thinner and its width averaged (1.3 ± 0.14) m.

These features were due to the fact that due to the constant stretching of the vertically located scar (with the patient's vertical position of the patient), it significantly expands and, as a rule, exceeds 3 m. There is every reason to believe that over the years the width of this scar may increase even more . Perioriothoracic and subfertinal scars under less severe conditions (favorable conditions for wound healing) were much less extensive.

Liposuction

The data presented indicate that the problem of scarring is unimportant for this type of operation.

Correction of scars

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

[1], [2], [3], [4], [5]