If you type "scarless surgery" into an internet search engine, you'll discover that many doctors advertise scarless surgery as their specialty. But do their procedures live up to the hype? Well, yes - sometimes. Read on for a discussion of some of the hottest new scar-reducing and scar-removing techniques.

What is a Scar?

We all have some sort of scar on our bodies, but how well do we really understand what they are? Actually, scarring is an important part of natural healing processes, and will be negligible when the injury or incision involves only the outermost layers of skin (epidermis). When we damage the thick layer of tissue beneath the skin, the rebuilding process becomes much more complicated. Our bodies lay down collagen fibers (a protein which is naturally produced by the body) and this can result in a noticeable scar. After the wound has healed, the scar continues to grow and change as new skin tissue is form. The good news is that most scars come from superficial injuries, and fade on their own. However, plastic surgery involves cutting into the deep layers of the skin - and what then?

According to Dr. Craig Vander Kolk, MD, the first thing to consider is the hereditary and racial components. African Americans, for example, are more prone to keloid scars, while Asian Americans are more likely to have hypertrophic scarring. What all that means is that, depending on your ethnicity and skin tone, scarring may be an even more important consideration in plastic surgery than it may be for other people.

A keloid is a tough, raised, irregularly shaped scar that tend to continue enlarging long after the incision is made. Hypertrophic scars, on the other hand, are raised and ofen red, but they do not continue to enlarge beyond the initial incision site.

If all that sounds like enough to scare you away from plastic surgery, the good news is that there are many options for minimizing and healing scars, and a competent plastic surgeon can create a plan specifically tailored for your genetic and aesthetic needs.


Stop Them Before They Start

At the Weinberg Center for Women's Health & Medicine at Mercy Medical Center in Baltimore, Dr. Vander Kolk stresses the importance of having a good pre-surgery plan to avoid scarring. "We look at scars as a result of evaluation, planning, and how we take care of the patient after surgery."

"Where the incision is definitely is going to play a part," he explains. Incisions on thin skin, such as around the eyes, are often the least noticeable. Incisions on the thicker skin of the arms and back can lead to bigger scars. And incisions in areas that move and bend a lot, such as the elbows and knees, can easily become the most noticeable of all.

These differences may be why you hear so much about scar-free eye lifts rather than scarless arm lifts. And I have to admit, it is pretty amazing. In this procedure, the incision is actually inside the lower eyelid. The fatty tissue that causes bags under the eyes is removed, resulting in a more youthful, energetic appearance. The procedure may also include an upper eyelid lift, which can cause dramatic results. And fortunately, even though the upper eye lift procedure may involve an exterior incision, due to the thin skin in this area, scarring is most often quite minimal.

It is also possible to hide scars in the hair line and around and behind the ear, where they will be least noticeable. Careful closing technique is also crucial. Dr. Vander Kolk explains that tension is key: "You don't want it unduly tight, but there needs to be enough tension to re-drape the skin." A skilled surgeon can place more tension on the incisions that are hidden in the hairline so that the visible scars not hidden by hair have practically no tension on them, causing them to heal virtually scar-free. Tissue glue can also help reduce tension.

Dr. Vander Kolk warns against surgical decisions based solely on a promise for a "scar-free" technique, as these might not actually have the results they promise. He explains that a face-lift, for example, means removing the excess skin - and that means there will be some scarring, somewhere.

Dr. David Kung, MD, of the Scarless Surgery Center, disagrees. A specialist whose website claims he "has mastered non-ablative skin care and minimal access surgery," Dr. Kung claims that his techniques will have similar results to traditional procedures, but without the usual scars.

Dr. Kung further says that many of his procedures can be performed under local anesthetic and allow the patient to return to work within a matter of days. While all this sounds wonderful, I noted that he offers a surgery that has caused some controversy. His 24-Hour Scarless Surgical Facelift is a modified threadlift. His website doesn't go into detail about his modifications, which could certainly be significant improvements on the standard method.

Threadlifts work by inserting threads under the skin instead of placing sutures on top of the skin. Some plastic surgeons advise against the procedure because of the risk of threads breaking after surgery.

Afterward

Good nutrition, avoiding the sun, and massaging the skin can help minimize scarring during the healing process. According to Dr. Vander Kolk, Vitamin E can't hurt, and yet there is no scientific evidence that it helps, either. And it's important to know that some people develop an allergy to the supplement.

Silicone gel massage has been shown to be clinically effective. If the still-forming scar is red, steroid injections might also help. "Steroids," says Dr. Vander Kolk, "are anti-inflammatory and can decrease the abundance of inflamed cells which make a scar red and thick."

If a scar begins to form after surgery or an injury, it's important to see your doctor as soon as possible, while silicone gel massage or steroids can still help. "Scars are permanent," warns Dr. Vander Kolk. "But if they are red and thick, it will take scar revision surgery to minimize their appearance."

Like laser skin resurfacing, scar revision surgery removes the outer layer of dead, old skin cells. It accomplishes this by vaporizing away a layer of skin, exposing the more natural-looking layer underneath. Sometimes it takes more than one session of laser treatment to accomplish the desired results. Rarely, new scars form from the revision procedure itself. .

In New York, Dr. Michael Sachs, MD, uses laser scar removal even during the healing process, which he claims stops the scar from forming. According to his web site, "Within seven days of removing the stitches, depending upon the area involved and the rate of healing, an extremely thin (pencil thin) line of the coherent CO2 laser is used to lightly erase the incision line."

While laser scar revisions are the standard, many docs are experimenting with other techniques and preventative measures. For example, Tennessee plastic Surgeon, John D. Franklin, uses a little-known traditional healing agent called balsa of peru to help aid the incision healing process.

The Future of Scarless Surgery

Some surgeons are experimenting with natural-opening techniques, removing brain tumors through the nose, inserting unfilled breast implants through the belly button, and removing gallbladders through the vagina. What they're learning is that the benefits often go far beyond the prevention of unsightly scars. Using our already-existing body openings also seems to lead to shorter recovery times, reduces the need for anesthesia, and most often reduces post-operative pain. As these techniques are perfected and become more routine, perhaps the issue of scars will be an outdated one. Let's hope so. In the meantime, the possibility of scars shouldn't scare anyone away from a surgery they need or desire.