Why Your Anti-Scar Product Won't Work

Silicone bandages, Kelo-cote, Scar Guard and other brand names definitely work to help scars look better up to 6 to 12 months after your procedure.  Plus, they're pretty cheap and painless.  So why don’t patients see more satisfying results?

Read more >>

How To Have Great Scars for Your Kids

Your child fell, and has a scratch…or worse.  The babysitter, school nurse, or your sister who's a drunk family member you used for child care has just called you to say that little Johnny is bleeding and you need to pick him up.  What do you do?

First, breathe.

As a plastic surgeon with 3 little ones wreaking havoc all over San Francisco, I know too well both sides of the this common predicament.  I hope this article gives you some edification on the topic and helps you to understand the medical and health insurance implications of what to do.

• Do You Actually Need to See a Doctor?
• ER or Urgent Care?
• Plastic Surgeon-  Yes or No?
• Short Term & Long-Term Follow-up
• WTH?  Why is the Health Insurance Bill so High?  And is This why Plastic Surgeons Drive Porsches

Do You Actually Need to See a Doctor?

It’s tempting to rush for the nearest hospital when you see blood all over your child’s face.  But take a minute to assess the situation.

Generally, you can stop bleeding with direct pressure.  But if it persists, don’t panic – just dab at the area repeatedly to soak up the blood and then take a good look at the cut.

If the cut is technically just a scrape, or the cut is very shallow, clean the wound with hydrogen peroxide, apply an antibiotic ointment, and slap a Band-Aid on it.  You should change this 1-2 times a day, and more often if your child gets it dirty.

If the wound is deeper, going all the way through the skin, then you should see a doctor for surgical glue or sutures. Surgical glue works well in many cases.  However, as a plastic surgeon, I find that it’s usually not applied correctly.  The doctor has to make sure that the skin edges are touching, or even overlapping, to get the best results.  Also, you obviously can’t use glue in areas such as the eyelid area or mouth.

Sutures, or stitches, may be used if the wound has a torn muscle or exposed bone.  The doctor will use dissolving sutures to close the deeper layers of muscle and tissue and removable sutures for the top layers of skin.  Removable sutures leave less scar tissue, hence a prettier scar.

ER or Urgent Care?

Parents are tempted to use urgent care or “Minute Clinics” because they are close-by, the waits are shorter, and they just want their kid to stop bleeding.  However, these facilities rarely have access to ER doctors and/or plastic surgeons.  The ability of an urgent care center provider to apply even surgical glue may vary wildly, and is unpredictable.  You may run into providers that are uncomfortable applying surgical glue or sutures to a child.

An ER should have access to ER doctors who are trained to make simple repairs.  Also, most ER’s have access to a plastic surgeon “on call”, a plastic surgeon that can be called in to do a repair that the ER doctor can’t or won’t do.  But yes, the wait will be longer.  Heart attacks and gunshot wounds take priority over little Johnny’s cut.

Plastic Surgeon-  Yes or No?

As a father, I would always want a plastic surgeon to examine and fix my kid’s wounds. A plastic surgeon will have surgical training, and will also know how to assess wounds and to fix them in as cosmetic a fashion as possible.  It’s my job to care about how scars look, so I know what to do to fix a laceration and how to care for it long-term.

But on the other hand, as a plastic surgeon, I could frankly care less about pediatric lacerations. Lemme explain.

Parents often want the “experienced” plastic surgeon to see their kid.  Well lady, that’s not going to happen.  Older plastic surgeons have established their cosmetic surgery practice, and are not interested in interrupting their sleep patterns to see a screaming child in the ER.  This is why you’re seeing the younger surgeons.

And, in reality, the younger surgeons ARE the better choice for pediatric lacerations because after their training, they have dealt with trauma patients, complex burns, complex reconstruction, and other wounds that are much bigger, nastier, scarier, and difficult to close than a cut to the face.  I felt insulted, personally, several times when parents asked me about “my experience” with pediatric lacerations.  It’s like asking a professional race car driver if he is comfortable driving a Mazda stick-shift.

Short & Long-Term Follow-up

When you’re done at the ER and go home, you will be given instructions on how to take care of the wound.  Depending on the wound or the doctor, you may be asked to touch nothing, or you may be asked to clean the wound and put another dressing on it on a daily basis.  It’s important to follow instructions.  The better the after-care, the better the scar.

After the initial healing period has passed and the skin has closed over the wound, long-term scar care should begin. Too often, people ignore scars after the sutures are out.  But a scar is not fully healed for 6-12 months after sutures are removed. You should keep the scar out of the sun or wear sunscreen.  You can also begin to use scar enhancing products such as silicone gel bandages, hydrocortisone and cortisone injections as necessary.

WTH?  Why is the Health Insurance Bill So High?  And is this why Plastic Surgeons Drive Porsches?

In general, despite what you may think, the payment for the surgeon repairing the scar is quite low. I’ve had 4 years of medical school, and 6 years of surgical training on top of that, to be awakened to fix a cut on a child who is screaming and moving.  I’m glad the scar looks great, and I’m overall glad I can help people once in a while, but I don’t think a payment of $200-500 for a typical pediatric laceration is too much.  When you consider 20-30 minutes to get to the hospital, 30-60 minutes to do the procedure, 20-30 minutes to get back home, loss of sleep, instructions, bonding with the parent, bedside manner and ALL follow-up visits within the next 90 days included in the cost of the surgical fee, I think you’re getting a bargain.

How much does it cost to have a plumber simply go to your house for an assessment, and do nothing?  $75?  And if the plumber does something, you’ll probably pay him at least $300 for a repair.  Laceration repair from a REAL plastic surgeon is no different.  I would expect to pay less for a non-plastic surgeon, but if you want a Rolls Royce, and not a used Hyundai, I would respectfully ask you to consider the training, level of service, and overall result, before you complain too much about the surgical fee.

Also, please remember that you’re in an ER, and there are OTHER CHARGES completely not associated with the surgeon’s fee. There may be an ER fee, medication fee, surgical supply fee, nursing fee, and God knows what else.  So, overall, the bill may be high, but you may notice what the surgeon actually gets may be reasonable.

And no, I don’t have a Porsche!

As always, this is not medical advice in the sense that we have a doctor-patient relationship.  You should ALWAYS see an actual doctor or nurse live, and in person, as opposed to reading stuff in the virtual world and attempting to do your own diagnoses.  So, quite reading this, stop the bleeding, and take a look at the wound!

How Do You Treat a Keloid Scar?

Keloid scars are very thick scars that form after normal scar tissue formation. Despite correct closure and excellent wound care, some people are more prone to developing thick scars. If your scar tissue is thicker, and extends beyond the original borders of your injury, then you may be developing a keloid scar.

Keloid scars can occur in anyone, but are more prone in certain areas of the body and among different ethnic groups. Keloid scars tend to occur more often in the upper arm, and neck areas. They are also more prone to happen among people with darker skin, such as African-Americans, Hispanics, Asians, and people from Southern Europe.

Keloid scars, along with healing incisions in general should initially be treated as a healing wound. Typically this would include cleansing of the incision, use of antibiotic ointment, and making sure you follow your plastic surgeon’s instructions. After all new skin has healed over the incision, if you scar become thicker, wider, more red, itchy, painful, or a combination of all of those problems, you may be developing a keloid scar.

Scars mature over 6-12 months, so it’s important to take care of your scar after surgery. This would include protection from the sun, special anti-scar creams, special bandages, and possible cortisone injections. These non-surgical options are effective within the first 6-12 months of your original injury.

If you have a keloid scar that is older than 6-12 months, then non-surgical options may not work. If this is the case, you may need surgical revision of your scar, which is typically done in an operating room setting. Every scar is different, so it’s difficult to say exactly what you need in terms of scar revision.

Should you desire more information about my available services, or want to schedule an appointment, please contact my Patient Care Coordinator at info@drkim.com, or call our office at 415-362-1846.

Did you find this article interesting?  Please share via Twitter, Facebook or Google Plus below.

7 Ways To Get a Beautiful Scar After Surgery

After your surgery, there are several ways to optimize the appearance of your surgical scar. As always, talk to your plastic surgeon first- he or she is able to examine you in person, and is able to give you the best advice.

Excellent care after surgery is crucial to getting a beautiful scar. This includes taking antibiotics by mouth as directed, using antibiotic cream on the incision as directed, and by following the instructions of your plastic surgeon.

Following instructions and taking a pro-active stance towards wound care is key in getting the looking scar possible. There may be several techniques in caring for wounds that you may not be aware of, and your plastic surgeon may be able to give you some.

You will most likely eventually have to take over the wound care of your surgical scar, and wash, dress, and change your wound on a routine basis. Now is not the time to feel queasy- unless you have a loved one who’s a nurse, you will probably have to take responsibility and care for your wound.

Please realize that scars take 6-12 months to fully heal and mature. Scars form pretty quickly to form new skin, but underneath the surface, it will take 6- 12 months for the scar tissue to finalize healing. During this maturation phase, your scar may change color, thickness, width, or itchiness. You should be aware of this and monitor your scar as needed.  If you notice a dramatic change or you're not happy with the way your scar looks, then you should talk to your plastic surgeon about it.

Once you have all new skin form over your scar, it’s important to protect it from the sun. Rays from sunlight may cause your scar to become more red, thicker, wider, or darker. You should try to protect your scar for 6-12 months after your procedure.

Don't be grumpy or despair if your scar isn't looking quite right within the first 6-12 months after your procedure. Scar tissue responds very nicely to non-surgical options within the first 6-12 months after your surgery. If you only see your plastic surgeon after 12 months from your operation, there is usually not much to do except revise the scar- to physically cut out the scar tissue and start over again. In my opinion, non-surgical treatment options should be tried first to make your scar look better.

Talk to your Plastic Surgeon, because in the end, most plastic surgeons take great pride in their work, and want to give you the best result possible. Open and honest communication will prevent any misunderstandings that may give you a less than optimal appearing scar.

Should you desire more information about my available services, or want to schedule an appointment, please contact my Patient Care Coordinator at info@drkim.com, or call our office at 415-362-1846.

Did you find this article interesting?  Please share via Twitter, Facebook or Google Plus below.

How To Get the Best Possible Scar After Any Plastic Surgery Procedure

To get the best aesthetic scar after surgery, it's important to remember the following.

Follow Directions

-  Plastic Surgeons are trained to make scars look as nice as possible.  Listen carefully to instructions on how to care for your scars right after your procedure

Allow your scar to form new skin

-  Right after surgery, scars heal and re-epithelizalize, which is a fancy term for growing new skin.  It may take 1-3 weeks for your scar to form completely new skin, but it's important to simply allow your body to do that before considering any scar enhancing products.  Antibiotic ointments such as Bacitracin or Neosporin may also be recommended during this phase.

Realize that scars mature over a long period of time

-  Scar undergo a maturation phase for 6-12 months after surgery.  Non surgical treatment is typically effective within the first 6-12 months after creation of the scar, and this is when non-surgical scar enhancers such as silicone gel bandages, hydrocortisone, cortisone injections, and protection from the sun will help with the long-term appearance of the scar.

Follow-up is very important

-  If your plastic surgeon doesn't know you're unhappy with your scar appearance, then he/ she will be unable to recommend any non-surgical enhancing product during the scar maturation phase which can help with your scar appearance.  Cortisone injections may be very helpful to make your scar appear more aesthetically pleasing, but this is essentially impossible to do on your own.   You'll need to see your plastic surgeon to get this done.

Realize that everyone's skin is different

-  Your skin and body may heal differently than your sister, brother, Mom, Dad, or your best friend.  Despite your best efforts, your scar may be unsightly.  Don't despair-  non-surgical treatments will work within a specified time period after surgery.  If you wait too long, then you may need scar revision, a minor surgical procedure to actually cut out the scar and scar tissue.

Should you desire more information about my available services, or want to schedule an appointment, please contact my Patient Care Coordinator at info@drkim.com, or call our office at 415-362-1846.

Did you find this article interesting?  Please share via Twitter, Facebook or Google Plus below.