Posts Tagged scar

Reader Question: Acne Scarring Treatment

Posted by admin in Dr D's Truth on June 3, 2013

Hello, Dr Di Saia,

I’ve had acne for a few years (it is now almost completely gone) and I am now left with a few but noticeable facial scars. What is the best way to deal with them? What fillers would you recommend? Would a chemical peel or microdermobrasion be enough?? (I personally don’t think it would be). I am 19, by the way. Thank you for your professional advice!

Acne scarring is an extremely variable problem. The treatment depends upon severity and skin type. A single facial peel will likely not be enough to improve any, but the lightest of cases. You really need an individual professional evaluation regarding peels, fillers, and other surgical options as they pertain to your specific case.

Best Regards,

John Di Saia MD

Related:

Basic Skin Care

Originally posted 2005-07-24 15:35:00.

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Brachioplasty – Arm Lift – The Truth

Posted by admin in Dr D's Patients, Dr D's Truth on April 15, 2013

Brachioplasty surgery has been called the “Arm Lift” and it kinda does “lift” the arm. The areas treated in the upper arm have been called amongst other things “Bat Wings.” Surgery tightens the skin around the upper arm which can hang unattractively in those who have lost a good deal of weight. This varies of course.

Traditional brachioplasty surgery is performed through an incision (and leaves a scar) from the arm pit to the elbow. Care is taken to try to make the scar fall into a less often seen area when the arms are at the sides. The scars from surgery take a year or more to mature and are often not the prettiest even when efforts are made to make them so at surgery.

Short scar techniques have come around, but in many cases either fail to fix the problem adequately or bind the arm to the chest in a disabling manner.

The bottom line on brachioplasty is that the “short scar” methods are probably more risky than they are worth and the scars from surgery take a year or more to mature in many cases. Still for the gastric bypass patient these operations are occasionally desirable.

Best Regards,

John Di Saia MD

Related:

A Nice Breast Lift/Implant and Arm Lift “Before & After” from the practice

Originally posted 2011-07-27 07:30:28.

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Saddleback San Clemente Emergency Room Plastics Case

Posted by admin in Dr D's Patients on April 15, 2013

ER Doctor Closed Wound With One Layer Nylon Sutures

As some of you know I used to see patients at Saddleback San Clemente and take care of some of their emergency business. As I dropped off staff January 1st I figured I was done with emergencies for a while.

Less than 3 weeks following my staff resignation however I received a frantic call from a patient who had been seen in the emergency room in San Clemente. She was worried about how her newly closed eyebrow and forehead wound might scar. She said the staff in the emergency room promised her no scar. I would not have promised that. She indicated that she had asked for a plastic surgeon, but the emergency room doctor had closed the wound.

After a few minutes on the phone the woman asked if there was anything I could do. Well I needed to see the wound, but indicated most healed without much scarring. I ended up seeing her the following morning when I returned to San Clemente.

To make a long story short, I revised about 2/3rds of the wound where the exposed nylon was more likely to result in train track scars. I indicated to the patient that I might be able to reduce the scar, but nothing would eliminate it entirely. Removal of the black nylon sutures at areas not covered by eyebrow hair was advisable in my opinion. Alternative support was placed. That’s the plastic surgery part.

When you go to the emergency room, there will not always be a plastic surgeon available. When I saw patients in that San Clemente emergency room, about half would disappear when the bill came around. This tendency has made plastic surgeons less willing to take emergency room call. The emergency room doctor is exactly that. Understand that when you go.

Best Regards,

John Di Saia MD

Originally posted 2011-01-19 10:00:35.

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Reader Question: Hard Breast Implants – Will Capsulotomy Help?

Posted by admin in Dr D's Truth on March 5, 2013

I had breast implants and they have become hard over the last few years. Will capsulotomy surgery help?

Breast implants can harden (actually the tissue around the implants can harden) resulting in distortion of the breasts and at times pain. We have discussed the problem (Capsular Contracture) here before.

Significant breast implant hardening does not complicate all breast implant patients, but when it does additional surgery is the only good solution. The process involves the formation of a “capsule” of scar surrounding the breast implant. At times this capsule has an elastic consistency and at other times it can be “studded” by deposits of calcium that make it really rock hard.

Surgery to soften the hardened breast can involve scoring the scarred capsule to release the tension (Capsulotomy.) When the capsule is quite firm or studded with calcium, more involved surgery is in order. Capsulectomy involves the removal of all or parts of that scarred capsule.

Whether either of these treatments will work depends upon the cause of the contracture. Usually the implants can be replaced, but in really severe cases they need to be removed.

What you really need is a good evaluation by an experienced plastic surgeon to figure your best course of action.

Best Regards,

John Di Saia MD

Related:

“What Do I Do With These Old Breast Implants?”

Originally posted 2011-07-06 07:30:03.

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Basic “Scar Minimizing” Wound Care – Early Scrapes

Posted by admin in Dr D's Truth on March 5, 2013

Not long ago I scraped my forehead on a cabinet. There was little embedded dirt or grime. A scrape is just a wide superficial wound with a thin layer “worn away” skin .

These wounds bleed a bit and a scab forms. How does a plastic surgeon take care of such a wound when he is the patient? I like anyone else like to try to minimize the scar. These wounds go through stages:

I. Early (days) – Bleed and Scab – I put pressure on it with clean gauze to stop the bleeding. I took a good look to make sure there was no other injury that might need further attention like a deeper cut, embedded material or continued bleeding. I gently cleaned debris from the wound bed with soap and water without trying to remove the scab. Then I dressed the wound with Silvasorb Wound Gel. I repeated this every day or so to keep the wound moist. (I am partial to the ionic silver wound gels as they encourage quicker healing and and be left on days at a time without a problem when things are clean. Bacteria do not seem to become immune to the effects of silver dressings. You can use double or triple antibiotic ointment if you like, but you will have to do it 2-3 times daily and the wound will probably look “angrier” longer.) I kept the healing wound out of the sun.

II. Intermediate to Late (weeks) – The scab will peel away slowly as the tissue heals beneath it. Once the scab is gone and the wound is closed it no longer requires gel or antibiotic ointment. I will keep it out of the sun either covered with a bandage or with sunscreen of SPF 50 or greater for several months. This helps minimize the color change between the wounded area and the adjacent skin. There are other scar therapy treatments we will cover in a later post.

Best Regards,

John Di Saia MD

P.S. If your wound doesn’t improve with whatever wound therapy you are using over the first few days after wounding, see your doctor. Increased pain, redness or drainage means you need to see your doctor. My personal wound care observations are not a substitution for your own professional care.

Originally posted 2011-01-31 07:30:28.

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Whitney Houston – Scars at Autopsy Reveal Cosmetic Surgery

Posted by admin in celebrity plastic surgery on April 9, 2012

The 48-year-old was also scarred by decades of cosmetic surgery, alcohol-fueled fights and falls.

She had marks on her stomach, chest and upper left thigh believed to be from cosmetic procedures. A scar on her left forearm may also have been self-inflicted.

Source: nypost.com/p/news/national/whitney_houston_body_ravaged_reveals_RDiLw8SpFnsJj4lYtAJqtN#ixzz1rUkoPfFn

So lets take inventory:

(1) Stomach scars: Probably a tummy tuck. Liposuction scars are usually small and probably would have escaped the eye of the pathologist.

(2) Chest scars: Probably a breast augmentation plus or minus breast lift surgery.

(3) One upper thigh: Probably a scar revision. Maybe not cosmetic. Cosmetic procedures usually occur on both sides.

(4) Left forearm scars: Probably from cutting. Kinda sad. Whitney had a hard life.

Best Regards,

John Di Saia MD

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Octomom Scar Watch

Posted by admin in celebrity plastic surgery on January 6, 2012

Octomom must still be on a list or two. She was recently seen at some celebrity boxing match and given the opportunity posed for some pictures:


Source: thesuperficial.com/octomom-scars-pregnancy-08-2011

She is still apparently calling them pregnancy scars. The last time I recall Octomom was in a bikini denying she had had plastic surgery.

Well that is a tummy tuck scar. By all appearances it seems a bit wide and is associated with a pretty large contour irregularity (which I don’t see too often,) but then again I don’t know who did it or how Octo took care of herself afterward.

Best Regards,

John Di Saia MD

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Reader Question: Did Adult Star Rachel Love have a Tummy Tuck?

Posted by admin in celebrity plastic surgery on December 23, 2011

I don’t know if you know many of the women in the porn industry, but I just saw images of Rachel Love from her return after not “working” for years. See in this picture, she has a scar low on her tummy and a big tattoo near her [female parts.] Is she hiding a tummy tuck scar?

It is unusual for women in the adult industry to have plastic surgery procedures that come with any significant length of exposed scar. Seeing the issues you pointed out as well as the circular scar near her belly button however I’d say you are probably right. This appears to be a pretty nicely done extended tummy tuck although the image might have been re-touched. The scar might have been placed a bit lower toward the lower central abdomen though. :)

Best Regards,

John Di Saia MD

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Reader Question: Can You Fix My Pregnancy Tweaked Belly Button?

Posted by admin in Dr D's Truth, Reader Question on November 28, 2011

Pregnancy, Piercing and Hernia Repair Changed This Belly Button

Reader Question:

When I was pregnant, my daughter pushed against my belly button the last couple of months and stretched it out. Then I ended up having two hernias which also stretched it out. Unfortunately I pierced my belly button when I was 15 and the skin above my belly button is now extremely loose. Can you fix this?

I am 26 and had my baby in Sept of 2010. I gained 30 pounds (healthy) and immediately had the two hernias. I think they were a result of the pregnancy or labor. I had them repaired in Jan of 2011. I am planning on having one more child. If it’s not a boy, then we’ll be having another one. Lastly, no I am not a fitness model. I’d like to be!

Belly button plastic surgery is usually referred to as umbilicoplasty. It is a routine part of tummy tuck operations as it becomes necessary when moving the position of the umbilical opening. As you have discovered, the belly button can be changed by pregnancy, weight changes and trauma which adds scarring. Belly button hernia repair is focused upon fixing the muscular layers under the skin. It usually does little for the loose skin and/or scar above that repair.

You seem to have a condition of extra loose skin with scar tissue that gives your belly button a lumpy and less than tight look. The best treatment for the whole picture here is a tummy tuck, but for that I would wait until after you have completed your childbearing. A limited umbilicoplasty might be done before that to just tuck the skin a tiny bit, but the results would not be as remarkable as those you would see with a tummy tuck. I would need to see and examine you to be able to confirm what the image has shown and predict if this might be productive for you.

Best Regards,

John Di Saia MD

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Orange County Tummy Tuck Scar Burn Case

Posted by admin in Are You Kidding Me? on November 11, 2011

Oc Register Blog

A Costa Mesa cosmetologist was charged Thursday with practicing medicine without a license after she allegedly caused second-degree burns while attempting cosmetic surgery on a tummy tuck scar with a laser.

You gotta love this one: a lady gets burned when allowing a Cosmetologist to use a laser to treat her tummy tuck scar. When you want a scar treated maybe look into a plastic surgeon for a scar revision?

Best Regards,

John Di Saia MD

Originally posted 2009-01-15 08:30:00.

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