Do you ever think of scars as art? Some cultures create magnificent scar designs of dots, lines, and curves, but unlike piercings and tattoos, scar decorations haven’t exactly caught on in the States (yet). In fact, some procedures are promoted as “scarless surgery” to attract interest.
A scar is nature’s clever tool to repair cuts and injuries to our skin and other tissues with the use of collagen as a sort of Crazy Glue. Our ancestors (sometimes) survived saber toothed cat injuries by sealing gaping wounds with scars. Scars are very important! But if we have a choice, most of us prefer our scars to be hidden or well-disguised.
Why can’t all surgery be “scarless?” Well, actually, even scarless surgery is usually not truly scarless, since the small incisions made to introduce instruments heal to become small scars. The reason those procedures can be done with very small scars is that no skin is removed.
When the goal is to remove loose skin, like in a tummy tuck or a facelift, the incisions are, by necessity, longer. Despite what you might think, a short scar is not always better than a long scar! Sometimes a short scar can result in a thick, raised scar with undesirable contours in the area, while a longer scar can look far better. The trick, of course, is for the surgeon to place the scars in discreet locations and to perform the surgery with excellent technique so that after they mature, the scars aren’t noticeable.
All scars start out immature, when they may be thick, raised, and pink or purple. Scars go through lots of chemical changes as they mature, and they need lots of oxygen for that to happen, New blood vessels form to allow an abundance of red blood cells to deliver that extra oxygen. What color are scars with those extra blood vessels? Pink! The chemical changes result in softening and flattening of a scar. Once they are mature, scars no longer need extra oxygen, so the blood vessels fade away, and tah dah! After several months, the thick, pink immature scar is a pale, flat mature scar. (Scars never go away completely.)
Not all scars heal well. Age, genetics, and where on your body a scar is located all determine how you’ll heal, but other factors play a role as well. If a wound is closed under tension (imagine if too much skin is removed in a tummy tuck or a facelift), the scar will likely widen and thicken. Smoking, infection, a hematoma (collection of blood), the surgeon’s technique, and suture material can all impact wound healing.
Board-certified plastic surgeons spend a great deal in training learning how to create the best scars. They are trained to treat the tissues well, to design the scar in the optimal direction, and to place the scars in discreet locations. Then they let their patients? amazing healing cells do the rest.