Plastic Surgery is a delicate specialty. A fine balance between science and art. A balance between improving a patient’s appearance and creating a scar.
As a surgeon, whenever I place an incision on a patient, I create a scar. This scar is permanent so it is essential that the improvement in the patient’s appearance can justify the scar.
As a Plastic Surgeon, I spend hours analysing scars. How can I make them better? Will changing the direction of the scar make it better? Will different suture material make for a better scar? These are the questions that I ask often to ensure I give my patients the very finest scars and the very best results.
For most of my operations I use buried and dissolving sutures. The wounds are dressed in surgery usually with steristrips, gauze and an adhesive dressing. I keep all wounds dry for at least 48 hours. These bandages are changed at day 6 post-operatively and replaced with a skin tone micropore tape. This tape is used continuously for 4-6 weeks, the tape is changed by the patient 2 times per week and washed using Vitamin E soap.
At your 6 week post-operative review, I decide whether or not to start Silicone gel therapy.
By the early 1980’s Silcone has been used for scar therapy. Its effectiveness has been repeatedly confirmed in clinical studies. The International Clinical Recommendations on Scar Management say that Silicone gel sheets should be the first choice in scar management.
Silicone gel works in several ways:
1. It increases the hydration of the epithelium making the scar softer.
2 It protects the scar from bacterial infection (infection causes a thicker scar).
3. It modulates the expression of Growth Factors.
TGFB stimulates fibroblasts to synthesise collagen. FGFB increases the production of collagenases which breakdown collagen. Silicone sheeting is thought to modulate the level of FGFB which results in less scar formation.
4. It reduces the itching and discomfort associated with some scars (Journal of Skin Medicine Dec 2012)
I recommend using the Silicone gel sheeting night and day for 90 days (3months). Often patients stop using the Silicone early because it is tedious to apply everyday, however, it is up to you and it will give you a better result.
So, after 4 months (1 month of micropore tape and 3 months of Silicone gel sheeting), I ask my patients to massage and moisturise with a highly concentrated Vitamin E oil (Bio-Oil). I then review the scars at 6 and 12 months.
At your post-operative review on day 6, you will be given a “post-op pack” which contains your micropore tape, Vitamin E soap, and Vitamin E oil. It also contains written instructions. At your 6 week appointment you will be given silicone gel sheeting if necessary.
The cost of all of this is included in you surgical fee. There are no additional charges.
Your post-operative care is a vital phase of your surgical journey. An experienced and trained eye is required to monitor your progress. It must be done immediately and properly to achieve the best possible results.