Do all incision scars go through the ‘red & raised’ cycle of healing?

Dr. Dean Kane Q & A Q. I’m currently 13 days post-op from a facelift. The incision scars around my ears are stunning in their lack of visibility as the scabs fall off. Is it inevitable that they WILL go through the ‘red and raised’ stage of healing in the next few weeks despite how invisible they look now (i.e. will they get worse from now)? A. Yes, All open skin trauma and incisions go through a red and raised cycle of healing; some patients more and others less.At 13 days, your incision looks wonderful! ​ ​The Nature and Timing of the Scarring Process. ​Any time the tissues undergo an injury, a cascade of events occurs to rid the body of dead or non-functional fibers, cells, particles and other changed material and redevelop a functional bodily defense. While the same cells, proteins, blood vessels, nerves, and scaffolding are used in the repair of skin as they are making skin, scars become more stiff, thickened and irregular than natural skin. Much of this is because it is collagen in a random alignment that is laid down rather than the basket weave pattern and stretchiness of natural dermis. This allows for strength but not elasticity. It also misses the addition of oil glands which give scars a shiny rather than satin reflection and dry rather than moist texture. Scars typically have no pigment as no melanocytes are weaved into the collagen to tan or form color. Collagen is the thread that holds the edges of a wound or incision together. It is not produced by the fibroblast for some 10-14 days after the incision or wound. So, it is sutures and fibrin which glue, approximate and make waterproof the cut. As is the ying and yang balance of all body functions, so is it with collagen or scar formation. Changes over time occur. Production and break-down of collagen over 1-2 years yields the strongest, most flexible and thinnest final scar. Patients of color and other individuals of American Indian and Irish descent as well as particular body areas such as the triangle between the shoulder blades and xyphoid also have the propensity to develop thicker, ropier, redder scars for a prolonged time; called hypertrophic scarring. Occasionally, collagen production can so far outweigh collagen break-down that the injury develops a benign tumor which grows bigger than the cut itself. This is called a keloid. Most of the time, scar production peaks in thickness, lumpiness, swelling, redness and irregularity in 12 weeks (3 months) and has subsided by 6 months. Another 6 months or more of scar remodeling occurs to breakdown the thick, lumpy scar into a smooth, thin sheet or line scar we desire. Occasionally, the breakdown of scar is greater than the buildup quality and quantity of scar and only the epidermis and the very thinned dermis of a “stretch-mark-like” scar results called an atrophic scar. With this background it is understandable how each patient’s repair process is unique and will differ in quality. While surgeons desire a perfect scar every time, scars are permanent reminders of the injury to the skin of a quality predestined and not overly influenced by surgical technique. ​ ​I hope this has been helpful. Be patient! Happy Holidays!   This information is not meant as medical advice. It is provided solely for education. Our practice would be pleased to discuss your unique circumstances and needs as they relate to these topics.
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