Can you do the kind of surgery that doesn’t leave a scar?

As a plastic surgeon, at least once a week I’m asked:

Will it leave a scar?

 

As I explain to my patients, any time a cut is made all the way through the skin, it heals with a scar.  Today I’ll tell you how to make that scar better.

Courtesy of Office.com

Three things control how good a scar is:

1. How the wound was made.  Sharp, clean cuts leave better ones than say, a dog bite, or road rash.

2. How the wound is closed.  Certainly having a doctor who is expert at repairing cuts and lacerations will help.  But I’m also a plastic surgeon, not a magic surgeon – no matter how perfectly I repair a laceration, it will still leave a scar.

3. How the wound heals. Wounds that heal quickly tend to form less noticeable scars.  Some part of this is genetics, and some part is environment.  If you tend to form big, raised scars, then that’s how your body responds to injury.

So what can you do as a patient to get the best scar possible?  Let’s ignore number two- as long as you see a well-trained doctor, that part is pretty much out of your hands.  And many cuts and scrapes don’t even require the care of a doctor, but still leave scars.  Here are the top 4 things you can do to improve the appearance of a scar:

1. Clean the wound or cut.  Once.  Immediately after the injury, using mild soap and warm water.  That’s all you need.  Avoid peroxide, alcohol, and betadine.  Although these solutions do kill germs, they kill healthy cells as well, and repeatedly dousing a cut in peroxide or betadine will make it heal more slowly.  What do you get when a wound heals slowly?  A worse scar.

2. Keep it moist.  When I was a kid, my mom used to take my band-aids off every day to “let things air out.”  You don’t need to do this, and wounds that are uncovered are exposed to germs.  Keep things covered, and keep them moist using antibiotic ointment or even plain Vaseline.  Granted, you don’t want the surrounding skin looking like a prune, but the cut itself should be covered with Vaseline or antibiotic ointment at all times.

3. Use a scar product.  There are some great scar products out there.  I’ll fully admit that we don’t know exactly why they work, but the fact is, they do work.  Mederma will fade the redness of a scar more quickly.  The product I personally recommend to all my patients is Kelo-cote.  It’s a silicone-based produce, and silicone has been shown multiple times to fade redness and help scars flatten out.  It’s available online, and you don’t need a prescription.

4. Be patient!  Scars take 6-12 months to mature.  Yep- a full year before you know how that scar will really look.  Now if that scar is getting raised, red, or keeps getting bigger go see your doctor.  We have some other tricks up our sleeves such as steroid injections.  But if it’s just not fading as quickly as you want, remember that it takes several months to flatten out and for the redness to fade.

 

Thanks to Dr. Bernstein and Dr. Lin for letting me steal some of your favorite lines!

Do you have any questions about scarring or scar products?

Related Articles:

Disclaimer: This webpage is for general information only. It is not intended to diagnose or treat any medical illness, or give any specific medical advice. Because medical knowlege is constantly evolving, I cannot guarantee the accuracy or timeliness of any information in this blog.

5 Tips for Choosing a Plastic Surgeon

How do you pick a great doctor?

Back when I was a kid, if you wanted a specialist such as a plastic surgeon, you had a choice of maybe two in a 100 mile radius from my small home town.  Now I live in Cleveland, and last time I checked, there were over 50 plastic surgeons within only 50 miles.  Online reviews and sites like Angie’s List certainly give you some information.  Who your insurance covers will narrow things down as well.

Courtesy of Office.com

Below is my top 5 list of things to look for in a Plastic Surgeon, or really any type of surgeon.  Please notice that price is not anywhere on this list- I’ve found that unless you’re going someone who has really become famous for one particular type of procedure, Plastic Surgeons tend to price themselves pretty similarly within a given market.    Board certification is also not on this list- that is a complicated topic which I plan to write a dedicated post on later.

 

1) Make sure you feel comfortable with the doctor.  Sometimes your personalities don’t jive.  Sometimes you just get a bad vibe.  A surgeon is someone you’re entrusting your health, and your physical appearance to, and it’s critical that you feel comfortable sharing your worries and concerns with this person.

2) Ask how hard it is to get in touch with your doctor if you have a concern.  If you’re worried about something in the middle of the night after surgery, who do you call?  And more importantly, who will you end up talking to on the other end of the line?  It’s good to know if the doctor shares the duty of answering midnight calls with other physicians in his or her office, because you may end up talking to someone only vaguely familiar with your history and problems.

3) How often will the surgeon see you after your surgery or procedure, and for how long?  Will the frequency of visits leave you feeling well taken care of?

4) Does your surgeon have experience in the type of procedure you want?  Ask how many he or she has done, and don’t be shy about asking to see pictures.

5) Finally, does your surgeon explain things in a way you can understand?  Medicine can get very technical, and your ability to make good decisions about your health care is completely dependent on how well you understand what’s going on.  Some doctors are great at explaining things, others not so much.  Even if you’ve read up on the operation or procedure you’re having before hand, you want someone who can explain any complications or bumps in the road in language you can understand.

Do you have any tips for picking a great doctor?

Related Articles:

Disclaimer: This webpage is for general information only. It is not intended to diagnose or treat any medical illness, or give any specific medical advice. Because medical knowlege is constantly evolving, I cannot guarantee the accuracy or timeliness of any information in this blog.

When I was your age…

I walked uphill, in the snow, both ways…

 

Things have changed dramatically in medicine over the past decade, and effects of this change are just now starting to trickle down to where the general public is aware of them.

Courtesy of office.com

For those of you not in the business, resident physicians had work hours cut to 80 per week back in 2003.  Prior to that, these trainee physicians sometimes worked 100, or even 120 hours per week.  Of course, with the normal lag time such new restrictions have,  the law was not really enforced with any strictness until around 2007-2008.  So it’s only in the past 4-5 years that doctors have been training less than in previous years.

Does this have an effect on the quality of doctor you’ll see as a patient?  I trained right as the hour change was being enforced, and I wholeheartedly say “Yes!”

I understand that working 120 hours a week is absurd.  It is.  I’ve worked some 100 hour weeks (the 80 hour standard is average over a month, so you can still have some busy weeks in there), and you really don’t do anything but eat, sleep, and work.

80 hours, however, gives you plenty of time to clean the house, study, and even take on a hobby or two.  I ran a half marathon in residency, so clearly I did have some free time.  I’m super-slow, by the way, so those were some looong training runs!

But now there is talk of cutting the work week even more.  This is a terrible idea- let me explain. When the initial cuts took place, people thought of going into tougher (i.e. longer hours) specialties such as surgery that never would have thought of it before.  And with the new rule in place, you literally get kicked out of the hospital if you’re over hours.  Meaning someone else picks up the slack on the work you didn’t get done.  So there’s no motivation to become more efficient.  And there’s also no longer the mentality of “This is my patient, and I will take care of him/her until the job is done.”

Instead we have a new paradigm of shift work.  The night team comes on, and the day team leaves.  New doctors (and I’m speaking generally here.  There are, of course, exceptions) no longer have the same sense of ownership and responsibility.  And if they do, they get sent home regardless of their dedication.

So I ask you: do you want a doctor who’s learned to be efficient, so that he can get the work done and get you both home in a timely manner, and one that will stay to see the problem through?  Or one who works until his shift is over?

Related Articles:

Disclaimer: This webpage is for general information only. It is not intended to diagnose or treat any medical illness, or give any specific medical advice. Because medical knowlege is constantly evolving, I cannot guarantee the accuracy or timeliness of any information in this blog.

Why might your child need a plastic surgeon…?

…. and more importantly, how to avoid needing one!

I’m on call for the Emergency Room this week, which means I sometimes get called into the hospital in the middle of the night to take care of people with broken hands, broken faces, and bad cuts.  And many of those people are children.  Today I’m going to tell you, in a completely non-scientifically verified way, the top reasons I get called in to treat kids — and maybe give you some ideas for preventing them.

Courtesy of Office.com

1) Smashed Fingers

This one is common in children of all ages.  Kids love sticking their fingers in things, and I’ve seen injuries from  slammed doors, bicycles chains and everything in between.  What parents don’t realize is that in serious cases, kids can actually have their fingers cut or torn off in these types of injuries.  Even the less serious injuries often involve removing the fingernail to fix a torn nailbed, which means weeks out of sports activities or the pool.  I don’t know that there is a great way to prevent this type of injury, except for adult supervision (although I see this plenty in adults, too!)

2) Dog Bites

Kids’ faces are right at mouth height for many breeds of dogs.  And nearly all of the dog bites I’ve treated happened (a) with a dog the child knows and (b) were not an intentional attack on the dog’s part.  Usually the dog is going for a treat or a toy, and the child happens to be in the wrong place at the wrong time.  A friendly labrador accidentally catching a tooth on a child’s lip can mean dozens of stitches.  Supervision is key whenever children and pets are playing together.

3) Injuries from ATVs (fill in snowmobiles, motorcycles, or your motorized vehicle of choice here)

My mom was an ER nurse when I was growing up, and never let me ride a 4-wheeler, ATV or snowmobile.  I thought she was too strict at the time, but after seeing the number of kids that come in to the ER with severe facial fractures and head injuries after taking a spill off an ATV, I doubt I’ll ever let my own children on one.  If your family does participate in these types of activities, please use appropriate safety equipment, and never, ever, let your child ride on a vehicle with an adult who has been drinking.  This happens much more commonly than you would think.

4) Injuries from Lawnmowers

Nearly every summer I see at least one child who was accidentally run over by a push lawnmower, or fell off a riding lawnmower while riding on a parent’s lap.  And spending a summer in the hospital, having multiple operations to try to save your foot, is not something anyone should ever have to go through.  When you are operating any type of machinery, be it lawnmower or hedge clipper, make sure you know where your children are at all times.  And please don’t allow them to ride on your lap!

Do you have any questions about when to take kids to the ER? Or any great stories to share?

Related Articles:

Disclaimer: This webpage is for general information only. It is not intended to diagnose or treat any medical illness, or give any specific medical advice. Because medical knowlege is constantly evolving, I cannot guarantee the accuracy or timeliness of any information in this blog.

Lower Your Skin Cancer Risk in 5 minutes a Day…

From Women’s Health to Self, skin cancer has been in the news a lot this summer.  And it’s no wonder- skin cancer is the most common form of cancer in the Unites States, affecting 1 in 5 people (skincancer.org).  Today I’m going to tell you how to reduce your risk of skin cancer- and the best part is that it takes only 5 minutes a day… with an extra 1 hour time commitment once a year.

Courtesy of Office.com

The 5 Minutes

I do give people credit for wearing sunscreen if they’re out in the sun for awhile.  But the actual recommendation (and what I tell every one of my patients) is to wear SPF 30 every day.  Every. Single. Day.  The easiest thing to do is get a moisturizer with SPF 30 and cover your face and arms first thing in the morning.  This will protect you from the intermittent sun you’re exposed to while running errands during the day.  And yes, you should reapply at lunch, although I’ll admit even I’m not that good most days.  Total time for two applications of sunscreen- 5 minutes!

 

The 1 Hour

Once a year, go to your plastic surgeon or dermatologist and have him or her check you for skin cancer.  Just like going to the dentist or getting your oil changed, this is a regular maintenance thing.  Is it fun?  No.  Is it important?  Absolutely!  Getting a yearly skin exam means your doctor can spot many skin cancers while they’re small and easy to treat.  And wouldn’t you rather have a small scar, or even avoid developing skin cancer altogether?

So who should you see?  Many people don’t realize that both plastic surgeons and dermatologists treat skin cancer.  We both see a lot of skin.  If you have many, many moles or age spots, or a history of melanoma, then a dermatologist may be a better option.  Dermatologists are often able to look at suspicious areas using dermatoscopy, which allows them to better diagnose melanoma without a biopsy.  But both types of doctors can remove precancerous areas and biopsy suspicious areas.  The most thing is that you find a doctor you are comfortable with, and see him or her every year for a skin exam.  If you have a history of tanning or sunburns as a child, you should start this in your 20s.

And that’s it- sunscreen every day, and a skin exam every year can keep a small problem from turning into a big one.

Related Articles:

Disclaimer: This webpage is for general information only. It is not intended to diagnose or treat any medical illness, or give any specific medical advice. Because medical knowlege is constantly evolving, I cannot guarantee the accuracy or timeliness of any information in this blog.