Reconstructive Skin Surgery
Plastic surgery is a fascinating specialty – it addresses clinical problems from head to toe and has been a wellspring of surgical creativity and innovations for centuries. Its fundamental principles – wise planning of reconstruction, creative thinking and delicate operating – represent a rock upon which a plastic surgeon’s mindset is set, a solid foundation upon which all other, additional subspecialist expertise is built on later.
Although various procedures require various sutures and dressings, in general, I am very keen for patients to have an active role in their wound care post-operatively. Wherever possible, I recommend early bathing with normal soap and water, sometimes as early as only one day after surgery. I usually tape the wound for the first 2 weeks after surgery. This is done with a light brown, skin coloured surgical tape which is additionally secured with overlying shower-proof dressings. These dressings are extremely comfortable, robust and usually stay in place for 1-2 weeks, until your first review. Such dressings are shower, but not bath proof, and if they become wet, just dry them using a hairdryer, which easily prolongs their adherence.
After a fortnight, I recommend a scar massage twice daily with a moisturizing cream. Vaseline, Vitamin E based ointments E45, Nivea, Bio-Oil or any other non-perfumed moisturiser that lubricates and facilitates massage will suffice. I have no particular preferences or strict recommendations which product to use, but would suggest caution with creams/ointments which contain fragranced substitutes as those can be irritating for the fresh wound. I do also see no justification for use of expensive cosmeceuticals as they are unlikely to make notable difference at the early phase of healing. The main thing is that the scar is massaged and moisturized regularly for at least 3-6 months, ideally up to a year. The purpose of this is to speed up the natural healing and repair process and allow the scars to soften, flatten and become paler.
Moisturizers and massage are by far the best treatment for scars but additional treatments such as silicone gel sheeting or silicone gel applications may also be beneficial for patients who develop hypertrophic scars. However, there is no scientific evidence for the benefit of Bio-oil, but many people do use this and like it. Arnica is available, either as a cream or a tablet. Arnica is particularly helpful in resolving bruising and swelling after aesthetic surgery procedures, but can be helpful on other areas of the body too. Tablets are taken from 1-2 days before surgery until bruising and swelling have settled.
It is essential to protect your scar from the direct sunshine, especially over the summer months for up to a year after surgery. If immature scars are exposed to the sun, they can become pigmented or stay red permanently. It is therefore important to cover scars with clothing or sun protection factors (SPF30 and above) to optimize scar outcome.
Urgent concern after your surgery ?
Please ring the hospital where you have been operated on or my secretary and they will get in touch with me