Monday 25 January 2021

Got a Scar You Hate? You Don't Have to Live with It

Scarring can have a big impact on your wellbeing - not only can scars detract from your appearance, but they can also remind you of trauma you’d rather forget. 




You might think there’s nothing you can do about scars. After all, you might have got them as a result of previous surgery. But scar correction surgery can often work wonders in reducing the size of a scar, smoothing out the texture and making it much neater and less noticeable. 


Scar correction can also help in cases where the skin has healed in such a way that it is restricting movement or causing pain. And it’s also suitable for burn scars and deep acne scars. 


Director of Ocean Clinic Group Dr Kai Kaye is a specialist in scar revision, having trained in this field at the Plastic and Reconstructive Surgery Department at the University of Aachen in Germany. Read on to find out what causes bad scars and what can be done to correct them…


Why do I have a bad scar?


Scarring can turn out badly for a number of reasons. Factors that influence how well you heal include:


  • Your skin type - some people simply scar worse than others. Darker skin is more prone to make the worst scars and people with very pale skin can also be poor scar makers.

  • The location of the scar - if it’s along a joint, on skin which has a lot of movement (on a knee, for example) the scarring will be worse than if it’s on skin that doesn’t move (like behind the ear).

  • The suture technique - if your wound is not stitched up well - or you fail to get medical attention for a wound - it can result in uneven healing.

  • Your aftercare - if you fail to look after your scar during the healing process, for example by exposing it to UV light, it can become discoloured. 


Types of scars


Beyond normal, fine-line scars, there are four different types of scars that can result in a less than optimal healing outcome. These are:


Keloid scars - A keloid scar is one that’s raised, often red, and goes beyond the boundaries of the original wound. They’re caused by an overgrowth of tissue that happens when too much collagen is produced at the site of a wound. Some people are prone to keloid scarring, especially people with more pigment in their skin. In these individuals, even a simple insect bite can end up in a significant scar. Keloid scars are often itchy or painful and can restrict movement if they're near a joint.


Hypertrophic scars - Like keloid scars, hypertrophic scars are ones that rise above the surface of the skin, however, they do not extend beyond the boundary of the original wound. They’re also the result of an imbalance in collagen at the site of the wound. Hypertrophic scars occur when there is a lot of tension around a healing wound. They may continue to thicken for up to 6 months before gradually improving over a few years.


Atrophic scars -  These are pitted or sunken scars caused by a bad case of acne or chickenpox. They can also develop as a result of an injury that causes a loss of underlying fat.  Atrophic scars stay within the boundary of the original wound and typically occur in the face or on the back.


Scar contractures - Scar contractures are tight scars that occur on a joint. They’re often caused by burns and happen when the skin "shrinks" and pulls on the surrounding tissue. This restricts movement of the joint, which can also make them painful. 



What’s a ‘good’ scar?


A 'good' scar is one that fades to be a barely noticeable fine line that blends in with the surrounding skin tone. It should be placed in the right direction to ensure there is not too much tension exerted on the scar. Wherever possible, the scar should be hidden in the natural folds of the skin, for example beneath the breast or in the groin. 


Experienced surgeons can influence the result through meticulous technique and by using dissolving sutures or glue and removing other stitches early enough to avoid stitch marks. What’s more, proper aftercare - such as using silicone sheets - will ensure the best results. 


How a bad scar is repaired


If you have a scar that is causing you problems or you consider ugly there are various options available to you. In addition to surgical excision, there are non-surgical treatments that can improve the appearance of a scar. Usually, the best results can be achieved through a combination of surgery and non-invasive procedures. 


Surgical correction


Scar excision - In simple terms, scar excision is cutting out the existing scar and resealing the wound. But there are a number of different excision techniques a surgeon can use depending on the type of scar you have. For example, extramarginal scar excision involves excision of a small margin of the normal skin along with the scar in order to get normal tissue at the wound margins. On the other hand, intramarginal scar excision is done by cutting away portions of the scar at intervals of 6-12 weeks in order to preserve the normal skin as much as possible.


Tissue expansion - This is a procedure performed to promote the growth of healthy supplementary skin used for the replacement of damaged skin. It’s carried out by placing a balloon-like expander underneath the skin near the damaged region. Over time, the expander is filled with saline (or saltwater) solution causing the skin around it to stretch and grow. Once the new skin has reached its ideal size the tissue expander is removed and the new skin is redistributed, replacing the damaged area of skin. Often, tissue expansion is done before reconstructive burn surgery, using the new skin to replace scar tissue at the burn injury site.


Skin flaps - A skin flap is healthy skin and tissue that is partly detached and moved to cover a nearby wound. Flaps are transferred with their own, original blood supply (pedicle flap) and can be ‘local’ or ‘regional’. Local flaps are flaps that are located adjacent to the scar site. Regional flaps are located at a distance from the donor site and are used for extensively burned contractures on movable areas such as the anterior neck. Sometimes a flap is moved to a new site and the blood vessels are surgically reconnected. This is called a ‘free’ flap.


Skin graft - A skin graft involves removing skin from one area of the body and moving it (without its blood supply) to another. Skin grafts survive as oxygen and nutrients diffuse into them from the underlying wound bed. A ‘split-thickness’ graft involves removing the top layer of the skin (the epidermis) as well as a portion of the deeper layer of the skin, called the dermis, usually harvested from the front or outer thigh, abdomen, buttocks, or back. Split-thickness grafts are used to cover large areas. ‘Full-thickness’ grafts involve removing all of the epidermis and dermis from the donor site. These are usually taken from the abdomen, groin or forearm and are used for small wounds on highly visible parts of the body, such as the face. 


Fat graft - Fat grafting involves the extraction of fat from a donor site on the body (such as the tummy). It’s then processed and used to restore volume under depressed or adherent scars. Because fat tissue is rich in growth factors and stem cells it also results in skin regeneration, with excellent results for scar correction. 




Non-surgical correction


Steroid injections - Especially effective in keloid scars and hypertrophic scars, steroids are injected directly into the scar tissue to help decrease the itching, redness, and burning sensations that these scars may produce. The injections also help to decrease the size of the scar and soften the scar tissue. Injections are repeated over a 3-6 months period, resulting in progressive improvement. 


Laser resurfacing - Laser resurfacing uses high-energy light to burn away damaged skin. Lasers may be used to smooth a scar, remove the abnormal colour of a scar, or flatten a scar. 


Dermabrasion -  Dermabrasion involves removing the top layers of skin with an electrical machine that abrades the skin. As the skin heals from the procedure, the surface appears smoother and fresher. It’s a useful treatment for small surgical scars and acne scars.


Chemical peels - Chemical peels offer another method for resurfacing the skin. A chemical solution is applied to dissolve the top layer of skin. This triggers the skin to regenerate, often improving the appearance of superficial scars and correcting irregular colour.


Microneedling - Tiny needles are used to create micro-injuries to the inner and outer layers of the scar tissue, triggering the body’s healing process. By encouraging the production of new collagen and elastin, microneedling improves the texture of the scar. The channels created by the needles can also be used for the deep delivery of topical creams. 


Ultrasound treatment - Ultherapy is an ultrasound treatment used to stimulate collagen and elastin. It does this by heating the layers beneath the skin and creating thermal microtrauma - this leads to a reformation of elastic fibres and improves the appearance of scars. 


Hyaluronic acid filler - To fill atrophic scars (sunken or pitted), Radiesse, an injectable filler can be used. The filler is diluted (mixed with saline and lidocaine to thin it out) and injected superficially. As well as adding volume and making the surface of the scar smoother, it can help to improve discolouration. 


Downtime and aftercare


In most cases, scar correction treatment can be done on an outpatient basis and requires little to no downtime. Only when extensive skin grafting is required do patients need to stay overnight in the clinic. 


To achieve the best possible results, all our scar correction treatments include advanced scar care dressings. Silicone sheets and patches are important tools as they help to soften and decrease the redness of scars. 


We also provide compression garments to wear over the treated area and apply pressure to the scar. Especially useful in the treatment of burn scars, pressure therapy may be applied continuously for many months in order to avoid the scar elevating above the surrounding skin level and to reduce itching, redness and swelling.


Would you like to know how the appearance of your scar could be improved? Let us take a look. We offer both in-clinic and online consultations. Contact Ocean Clinic to book.


Tuesday 12 January 2021

The 7 Biggest Plastic Surgery Trends for 2021

The coronavirus pandemic has changed how we work, how we socialise and even how we look. It’s led to new behaviours and changed priorities, and one area these can especially be seen is plastic and cosmetic surgery. 


Weeks in lockdown led to pent up demand for treatment, with people eager to feel good about themselves once again. But, thanks to our new mask-wearing, socially-distanced reality, there’s been a shift in the types of procedures people want. 


As we go into the new year, and the pandemic continues to affect our way of life, these changes look set to stick around. Let’s take a look at the top cosmetic concerns right now and the 7 key plastic surgery trends for 2021


Zoom face maintenance 


The biggest change we see in terms of the treatments people want is an increased focus on the face. Prior to coronavirus, procedures to augment the body - like Brazilian butt lift and breast enlargement - were most in demand, but now people’s attention has moved above the shoulders.


The reason for this is the massive increase in video calls most of us are doing. Whether it’s work meetings or simply keeping in touch with family and friends, we’re all using platforms like Zoom and FaceTime more often. And when we’re speaking on video, it’s hard not to focus on our own image - and all the imperfections! Naturally, then, we’re seeking out facial surgery and aesthetic treatments that make us look better on camera. 


Face mask eye 'tweakments'


While video calls have caused us to notice aspects of our face we’d like to change - wearing masks has also made us look at ourselves in new ways. When you wear a face mask, as many of us now have to do all day at work, only half of the face is on show. This means that we no longer assess our face as a whole and are focused only on the upper half. 


Suddenly, all we can see is crow’s feet, eye bags, dark circles and sagging eyelids. And because we have to wear masks for all our social interactions, it has become more important that our eye area is attractive. Treatments that have seen a boost as a result of this include, upper and lower blepharoplasty, under eye filler and cosmetic injections


Mask treatments


Wearing a face mask hasn’t just made us paranoid about our ageing or tired-looking eyes, it’s also caused many of us to break out in spots. Lots of people who never had problems with their skin before are now suffering from pimples and rashes. 


As well as using topical skin creams, people are turning to treatments including chemical peels, ILP/lasers, mesotherapy and PRP facials to tackle outbreaks and treat leftover hyperpigmentation and scarring.


Game-changing injectables


Cosmetic injectables are great for a quick fix and people can’t get enough of them right now. But one of the downsides is that they don’t last that long. Cosmetic injections wear off fairly quickly - typically, after three or four months. That looks set to change with the new generation of neurotoxins and hyaluronic acid fillers set to hit the market this year. 


DAXI works by paralysing the muscles that cause wrinkles in the eye and brow areas, but it is said to last significantly longer - around six months. Likewise, a new type of filler known as Resilient Hyaluronic Acid (RHA), promises to last up to two years and provide natural-looking results on severe wrinkles. 


Combo treatments


While plastic surgery and aesthetic medicine are two separate fields, we’re increasingly seeing them come together. Combining surgical and non-surgical treatments can provide enhanced results. And practitioners continue to experiment with new combinations to push the boundaries of what’s possible.


Ocean Clinic’s own “magic” combo for treating extensive stretchmarks involves three non-invasive treatments. Ultrasound treatment Ultherapy is combined with injectable filler Radiesse and microneedling device Dermapen 4. The protocol can also be used in conjunction with liposuction for the best possible results. 


The “Fakelift” 


Thanks to the huge range of aesthetic treatments that practitioners now have in their toolbox, it’s possible to simulate results that were previously only achievable through surgical procedures. One such procedure is the facelift. As we’ve seen, facial treatments are especially in demand at the moment, but not everyone wants to go under the knife. 


The “fakelift” is an alternative solution. The procedure involves using Nanofat microneedling to plump out and rejuvenate the skin, followed by Radio Frequency to tighten it and muscle relaxing injections to ease facial lines. What's great about this procedure is that it can offer many benefits of a traditional facelift without the downtime. 


Preventing ageing


As we go into 2021 and beyond, there will be a fundamental shift in how we use anti-ageing treatments. Because these procedures are becoming much more mainstream, people's expectations for ageing are changing - we don’t just want to fix wrinkles and sagging when they occur, we want to stop them from happening in the first place!


This means the focus will move from restorative treatments to preventative treatments and people will start having cosmetic injections, skin tightening and skin resurfacing procedures at an earlier age. This will let them maintain their appearance for as long as possible, effectively stopping the clock rather than turning it back.



Want to know more about these plastic surgery trends or any other cosmetic procedures? We’re offering online consultations - book yours now!