Hiding Scars

Visible scars are inevitable after any surgery.   Emergency surgery unfortunately will leave scars which are obvious as a trade for saving a life.   Elective surgery does allow for planning.   This planning allows for design of scar placement and the application of technologies which reduce scar length.   Most notable in general surgery are the recent advancements in endoscopic surgery and its application in “natural orifice surgery.”
Arguably the first natural orifice surgery is rhinoplasty or cosmetic nose surgery.   This operation developed at the end of the 19th century is done through multiple incisions within the nostrils.   The supporting structure of the nose is resculpted by addition and/or subtraction of tissue and implants to give a more aesthetically pleasing nose shape.
More recently, the advent of liposuction has allowed the safe removal of fat through multiple tiny carefully placed inconspicuous incisions. In fact, once healed many of these scars are hard to find!   Prior to liposuction, long unsightly incisions were used in an effort to remove excess fat and sometimes skin.
The planning of all cosmetic surgery centers around the final anticipated scar.   The direction, location, and length are the keystones of design.   Scar direction as it relates to normal skin creases and wrinkles is critical.   Generally, scars which parallel these lines heal better and are less apparent.   Minimizing scar length obviously reduces scar size.   This is a constant battle in cosmetic surgery.   As a surgeon I need access to the treatment area to complete dissection, sculpting and control bleeding.   Finally, we want to place any visible scars such that they are either easily covered by the smallest bathing suit you want to wear or easily concealed with make up and/or hair style.   Elegant surgical design is possible only when all these things are taken into consideration.

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