Archive for the ‘Scar Removal / scar reduction / scar revision / scar treatment’ Category

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Cleaning your incisions after any procedure that requires suturing.

Friday, July 16th, 2010

This is a blog to discuss how to clean your incisions after any surgical procedure. The key for healing is to remove all crusting and to start with an incision that has the skin edges as close as possible together. The crusting is important to remove because the crusts can be nourishment for bacteria that can proliferate and cause more scarring. I usually suggest to my patients that they use vinegar and distilled water in a 1:3 dilution to clean the incisions. I tell people to do this twice a day. The goal is to get there incision to look like a fine wrinkle. If they keep doing this during the first 2 weeks the incision has the potential to heal incredibly. Always have vaseline over the incisions. It has been scientifically shown that skin cells grow faster when they have two surfaces to grow on. The vaseline serves as the other surface and this promotes the healing. You want the skin cells to grow over the incision as fast as possible. This reduces the scarring. Some people advocate hydrogen peroxide. I would caution that the use of this can be risky. I use the same dilution with hydrogen peroxide and distilled water in a 1:3 dilution. The key with the use of hydrogen peroxide if you are going to take the risk is to use it sparingly. You just want to use it to take the crusting off and then stop. If you do this more than that you can have more scarring. So being conservative is very important. If in doubt don’t use the hydrogen peroxide. And if you do use it, do so for only the first week and that is it. You should continue to clean your incision for about the first two weeks and keep vaseline on the incision at all times. After this you can do regular skin care and use sunscreen during the day (approximately 12 hours) and then silicone gel during the evening for 12 hours. The silicone gel can be found at any pharmacy or drugstore, like Bartells. I would do the silicone gel for the next 3 months. It is one of the only things that have statistically shown to make a difference in preventing scarring. Vitamin E, aloe vera, mederma based on my knowledge and recent literature search (05 / 2010) does not make a scientific difference. Following up with your doctor is really important to do so that they can make sure that you are on the way to healing the right way!

Thanks for reading, Dr Young

Dr Young specializes in Facial Plastic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington

Posted in Scar Removal / scar reduction / scar revision / scar treatment, Skin Care / Intense Pulse Light, Uncategorized | Comments Off on Cleaning your incisions after any procedure that requires suturing.

Areas of redness and scratches should heal after Active FX and co2 laser resurfacing. But Scarring should be determined by your doctor.

Tuesday, July 13th, 2010

This is a question that I answered for someone that was worried about red streaks on there face about a week after their procedure.  They wanted to know if these were areas that were possible likely places to scar.  This is how I answered her question:

Areas of redness and scratches should heal after Active FX and co2 laser resurfacing. This could be scratches that you did while you were sleeping but could also be from the laser resurfacing itself.  I would continue your current cleaning regime.  Six days after your procedure you should still be healing and with fractional co2 resurfacing, your skin should be totally healed over.  If it were more traditional resurfacing your skin could still be healing over.  The areas that are red will take some time to resolve.  As some of the other authors have suggested sunscreen and sun avoidance are crucial during the first month and up to 6 months after the procedure.  The redness will take some time to resolve but not as long if you had the traditional resurfacing.  Some suggest steroids after your skin has healed over, but this could affect the healing and collagen production and most people would suggest against it.  Intense Pulse Light or the v beam, or any laser that concentrates light in the 585nm range, your doctor should be able to determine what is best, can help with some of this redness by attacking the vessels that are causing the redness.  Otherwise the healing will just take some time.  One thing that could be important to determine is if there is significant swelling, redness and tenderness that could indicate scarring.  This is something that your doctor should determine and in this situation, a high dose topical steroid could be needed to stem possible scarring.

Thanks for reading, Dr Young

Dr Young specializes in Facial Plastic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington

Posted in Intense Pulse Light, Laser Resurfacing, Scar Removal / scar reduction / scar revision / scar treatment | Comments Off on Areas of redness and scratches should heal after Active FX and co2 laser resurfacing. But Scarring should be determined by your doctor.

Is Acne Surgery covered by insurance companies

Monday, June 7th, 2010

For treating acne flares and medical treatment, most insurance companies cover many of these expenses.  When it comes to improving acne scars and the cosmetic portion through Acne Surgery, in my experience, insurance companies generally do not cover these expenses. You should always inquire with the particular insurance companies that you are covered under and their particular policies.  When it comes to active lesions which require some procedures such as incisions and drainages, extractions, and surgically treating active lesions; insurance companies are more likely to treat these.  I usually treat the cosmetic portions that result from Acne which aren’t covered by insurance such as laser treatments, scar excisions, subcision, grafting of skin to scars, etc. Here is a live demonstration video of an Acne Treatment Procedure.

Thanks for reading,

Dr Young

Dr Young specializes in Facial Plastic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington

Posted in Acne Scar Treatment, Scar Removal / scar reduction / scar revision / scar treatment, Uncategorized | Comments Off on Is Acne Surgery covered by insurance companies

Scar revision basics

Saturday, May 8th, 2010

When I look at a scar I consider a number of things when I think about a possible scar revision (Dr Young has extensive experience in scar revision in Bellevue, WA) First thing to realize is that people tend to see and notice lines that are longer than 0.7cm.  Anything longer than that, a person is more easily able to identify the line.  So if a straight scar is longer than this it may be prudent to break it apart. This can be done with z plasty where the scar is broken up by a z pattern.  Or a geometric line closure, where the scar is broken up by a combination of squares, half circles, triangles etc.  That way, the scar is not noticed as much. If it is depressed, you should exise the depressed portion and close the new incision with it being elevated.  I have a number of techniques to do this.  The closure should be done in such a way that the incision is closed as the finest line possible.    After closure, I like to do resurfacing with either dermabrasion or co2 resurfacing or a combination 6-8 weeks later.  Ice pick scars can be elevated by excising around it and elevating the tissue and then with reclosure.  Box car scars that are a square or rectangular areas that are depressed can be elevated and then closed in the elevated state.  If the area is a large depressed area, sometimes rotating flaps into the area is the best and this depends on how it looks and how large and if there is tissue in the area.  Also the tissue in the area cannot be around a vital structure like the eyebrow, mouth or eye.  But even around these structures flaps can be developed and used for reconstruction purposes. Here is a video on Scar Revision.

scar treatment geometric line closure video

Thanks for reading, Dr Young

Dr Young specializes in Facial Plastic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington

Posted in Scar Removal / scar reduction / scar revision / scar treatment | Comments Off on Scar revision basics

What are the best sutures to use to reduce scarring?

Wednesday, March 10th, 2010

The are a couple of things I adhere to in order to reduce scarring.  Sometimes scarring is hard to avoid when the person’s genetics are predisposing them to scarring.  But we take every effort to reduce scarring.  First we try to avoid tension to the skin closure.  This is done by decreasing the tension on the surface by cinching the deeper structures together.  Usually the goal is to have the skin be a little puckered in the above the rest of the areas.  This reduces tension the part of the incision that is most seen on the surface.  We also take face sutures out at 5-6 days and eye sutures out sometimes a little earlier depending on what I’m trying to accomplish.  The average is usually 7 days.  The reason why this is important is that the longer you leave the sutures in, the more train tracking or marks are left on the surface which can lead to more scarring and more marks on the skin indicating that an incision was made previously. So I err on the earlier side at 5-6 days.

We also use monofiliment sutures, like 5-0 and 6-0 prolene.  Monofiliment (sutures like nylon, ethilon, etc), means that the sutures is made out of one strand of suture material.  Polyfilament means that the sutures is made out of more than one strand.  When the suture is made out of more than one strand, the is an increase in the interstitial spaces between the strands.  This allows bacteria to hide from our white infection fighting cells and the results can be infection, more inflammation, and ultimately more scarring.  Prolene is not absorbed by the body and needs to be taken out.  It creates less inflammation than absorbable sutures (like vicryl, fast absorbing gut, chromic gut, biosyn, polysorb, etc) and thus can avoid more scarring.  There are many studies that support this notion on a clinical level (on the level of patient outcomes). Here is a video on Scar Revision.

These same principles are what I do for Scar Revision and scar improvement procedures.

Thanks for reading, Dr Young

Dr Young specializes in Facial Cosmetic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington

Posted in Procedures, Scar Removal / scar reduction / scar revision / scar treatment | Comments Off on What are the best sutures to use to reduce scarring?

Lip scars around the border of my lips are hard, sensitive and I have discomfort when I smile and talk, etc. What are some options to make this situation better?

Thursday, February 25th, 2010

Steroid injections and possibly fat injections could soften the scars up during scar revision (Doctor Philip Young Seattle Washington) (scar improvement, cosmetic scar surgery, plastic surgery of scars).  It sounds like the main reason for your questions is the feeling of the scars and not the actually appearance.  Scar revision for appearance would be a totally different thing.  I think that steroids would be something that could soften up the scars. It may take a couple of treatments to get the right effect.  I usually do injections every 6-10 weeks.  There are risks with steroid injections like poor wound healing, muscle and bone loss, hormonal changes, water retention, weight gain, hair growth, changes in your appearance, psychiatric issues, change in appetite, etc that you should be aware of.  But these are associated with more long term risks that you get when you ingest steroids for long periods of time.  Also fat injections are great to break up scar contracture and also repair the area, although this would depend on how it looked. Fat brings soft feeling tissue to the area and can also break up the scars and the tough tissue within the scars.  This will require some knowledge on how to use certain instruments to get this effect on the part of your surgeon.

If you didn’t like the way the scars looked then some type of scar revision would be possible.  You can excise the scars out with a new closure of the incision.  Laser resurfacing can be another option to improve the surface quality of the scars.

I hope that helps.

Thanks for reading, Dr Young

Dr Young specializes in Facial Cosmetic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington

Posted in Fat Transfer / Fat Injections, Lip Augmentation / Lip Fillers / Lip Injections / Lip Reduction / Lip Grafts / Lip Advancements / Fat Injections of the Lip, Scar Removal / scar reduction / scar revision / scar treatment | Comments Off on Lip scars around the border of my lips are hard, sensitive and I have discomfort when I smile and talk, etc. What are some options to make this situation better?

What can fraxel, ipl, chemical peels do to help Acne?

Friday, February 5th, 2010

What can fraxel, ipl, chemical peels do to help Acne?  The patient who asked this question also mentioned that another doctor told him that the scars eventually all reform and recreate the past scars.  What can be done for this patient.

Acne scars (Dr Young Bellevue Washington) can be improved through excisions, resurfacing, fat injections.  It all depends on the type of scar you want to improve.  If there involves a significant difference in the level of the scar you need to improve that mostly by excision.  This is more so with depressed scars.  There are many ways to try to elevate the scars including very strong chemical peels in the depressed scars which will elevate the scars. Subcision is a technique that can be used to incise around the depressed scar releasing the tethering component to allow the scar to rise up to the level of the surrounding skin.  Or just excision which is the better choice because you make the ultimate incision smaller.  Resurfacing after the subcision or excision comes next and this is where the incisions are made to look less noticeable.  Sometimes through acne, scarring is extensive in the subdermal and subcutaneous plane causing large areas to be adhesed to the deeper tissue.  Filler can separate this scarring but the best thing for this is fat injections.  Injecting fat into this large layer of scar will soften the adhesions and allow the skin to become more free.  The extra volume also allows the skin to be taken up more reducing more lines and wrinkles and a coalescence of scars to make larger scars.  Also with the layer of fat, the skin can begin to heal and remodel itself to make the skin look better.

IPL can decrease any vascularity from the acne. Fraxel can shrink some parts of the scar. While chemical peels can remove some of the scars that are more superficial.  But my preference is to excise and then resurface with a co2 laser.  I also consider fat grafting underneath the skin to allow it to heal. I personally don’t think fraxel works well for Acne scars.  IPL can help with the vascularity of the scars if they are new or possibly any pigmentation issues of the scars but that is the most it will do.  Chemical peels can help like any resurfacing but can be limited without changing the depressed or raised nature of the scars.

Here is a live demonstration video of an Acne Treatment Procedure.

Thanks for reading, Dr Young

Dr Young specializes in Facial Cosmetic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington

Posted in Acne Scar Treatment, Fat Transfer / Fat Injections, Scar Removal / scar reduction / scar revision / scar treatment | Comments Off on What can fraxel, ipl, chemical peels do to help Acne?

Ice pick scars from a previous doctor who used a needle to treat my acne.

Monday, February 1st, 2010

This is a question that I answered for a patient who had another doctor treat his active acne.

The acne scars that you are talking about can occur from regular acne.  There are many people with ice pick type of scars.  The needle surgery that your doctor did would have helped more than hurt.  The expression of the pus from the acne that are infected would have caused much bigger scars if the needle didn’t express the pus away.  Now with your scars there are many ways to approach them.  One is through deep chemical peels that can be applied to the deep part of the those scars.  This can help to an extent.  What might even be better is to have them excised and then after that heals you can then have the areas resurfaced with lasers, like co2 lasers.  The excision then resurfacing route can lead to excellent results.  I also employ dermasanding to the deeper scars after doing a few passes to the lesions / scars when I do Acne Scar Treatment (Seattle).  You can search my website for some results and examples.

Here is a live demonstration video of an Acne Treatment Procedure.

Thanks for reading, Dr Young

Dr Young specializes in Facial Cosmetic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington

Posted in Acne Scar Treatment, Scar Removal / scar reduction / scar revision / scar treatment | Comments Off on Ice pick scars from a previous doctor who used a needle to treat my acne.

How painful is dermabrasion? How would you rate the pain level? What are some anesthesia options for dermabrasion?

Monday, January 25th, 2010

Intense Pulse Light is a procedure where a wire brush is used to take down superficial and deeper layers of the skin to reduce scars, improve wrinkles, decrease pigmentary problems, etc.  It works under the same principle as Usually dermabrasion is not done without some type of anesthesia.  The types of anesthesia include local, regional, oral / iv sedation, general anesthesia.  Most physicians use a combination of above to do dermabrasion.  If it is a concentrated area like a scar, local anesthesia can be the only thing needed depending on the normal anxiety levels that a person usually gets in this type of situation.  If the person is likely to get anxious than oral or iv sedation can help.  For the whole face and larger areas, some type of whole body sedation through oral or iv sedation is helpful.  Regional anesthesia where the nerves are anesthetized can help the whole situation.

Thanks for reading, Dr Young

Dr Young specializes in Facial Cosmetic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington

Posted in Dermatology, Laser Resurfacing, Scar Removal / scar reduction / scar revision / scar treatment, Wrinkle Treatment | Comments Off on How painful is dermabrasion? How would you rate the pain level? What are some anesthesia options for dermabrasion?

Revising the earlobe due to a delay from a keloid in the area after an otoplasty procedure.

Tuesday, December 8th, 2009

Setting back the earlobe is not a difficult thing to do during otoplasty (ear shaping, ear pinning, ear reshaping, ear plastic surgery, ear cosmetic surgery, earplasty). You can cut the cartilage that holds the earlobe out (called cauda helicis). You can also adjust the skin to pull back the earlobes the right amount.  This can be done really anytime unless there are some things that were done near the area that might require healing before the earlobe revision.  The length of time to wait can be from 3 months more or less.

The biggest confounding issue is the Keloid.  The keloids can come back over and over again.  Steroids and excisions are the most common way to remove keloids. Sometimes, local flaps and recruitment of extra tissue and skin can be needed to remove keloids.  You should be prepared to have more than one revision to take care of the keloid.

Hope that helps!

Thanks for reading, Dr Young

Dr Young specializes in Facial Cosmetic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington

Posted in Otoplasty / Ear Reshaping / Ear Shaping, Scar Removal / scar reduction / scar revision / scar treatment | Comments Off on Revising the earlobe due to a delay from a keloid in the area after an otoplasty procedure.

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