Recommended scar management ?
The management of a wound begins prior to an operation, with good planning of surgical incisions so that they are easily hidden, or blend into natural features and landmarks. Richard will discuss any incision he is likely to make with you prior to your operation.
Precise surgical technique minimizes tissue trauma and gives your operation site the best chance of healing beautifully. Richard will perform this in theatre and in the early post-operative period, and will guide you to achieve the best possible results in the following 12 months
The early surgical care is invaluable, as is the scar management.
Richard recommends the following:
Precise surgery and meticulous technique
Early suture removal
(in children, I may elect to leave buried sutures or absorbable sutures so as to avoid further trauma to your child). Suture removal may be at day 5 or 7 depending on the site and complexity of the wound.
Daily gentle wash with saline. Topical antibiotic application 3-times daily. (Chloromycetin, bactroban, fucidin).
Day 14 – 12 weeks (once crusts scabs have been removed)
Taping and anti-inflammatory scar care
Richard commonly uses brown 3M Micropore tape
The tape is applied every 24-48 hours after the scar is thoroughly cleaned.
Twice daily massage (5 minutes, twice a day), regardless of what is chosen to massage, it is the act of massaging, and not the product that has been shown to yield the benefit.
Daily SPF 30 or greater.
Sun exposure will darken a scar and result in it becoming more visible. Wear sunscreen generally, but specifically to your surgical site. Either apply over micropore tape or directly to the scar.
What is ‘Bad scarring’ and how can it be treated?
A ‘bad’ scar has many causes, ranging from the type of injury, the surgical technique, to the patients skin type, genetics and wounds care.
Richard will see you at 1 week and 6 weeks post surgery. These check ups may be made more regular if required.
If Richard notice scars are not healing well, he may elect to do any one of the following:
-Watch and wait
-Pressure dressings, silicone dressings
-Excise the scar and re-do the repair
Generally, Richard will only perform scar revisions at 6 months following a surgery, when a scar is starting to show signs of healing.
About post op garments.
Richard believes strongly in supporting a wound as it heals. The early investment of compression and support ensures improved recovery, fewer complications, and better, flatter scars.
Richard has selected specific garments for procedures such as breast reductions, breast augmentation, mommy makeovers, tummy tucks and liposuction. Breast and lower limb reconstructions also require lightly compressive garments. Each procedure will differ but six to 12 weeks of compression is usually recommended for optimal results.
What about smoking?
Richard has a strong policy not to operate electively on smokers. This means that smoking should be stopped 3 weeks before surgery and not commenced before 2 weeks after surgery. This is important as smoking has been shown to increase complication rates of most plastic surgical procedures by 2 – 3 times. Please inform Richard about your current smoking status to ensure the best decision on how to proceed is made.
I am on Medication, should I still take it?
Most medication should be continued around the time, and on the morning of surgery. Certain medication may need to be stopped such as blood thinning agents. Over the counter herbal supplements such as fish oil, garlic, ginger, St John’s wort and many others actually increase your bleeding time. This makes complications more common and should be stopped 3 weeks before surgery. They can be recommenced 3 weeks after surgery. Please supply Richard with a full list of any tablet or supplement you may be taking around the time of surgery so he is fully informed.
When must I stop eating before my surgery?
All procedures performed under general anaesthesia or local anaesthesia and sedation require you to have fasted for 6 hours before surgery.
If you are being operated on in the morning, then please do not eat or drink after midnight.
If you are being operated on in the afternoon, then please eat nothing after 7am.
In-rooms procedures are performed under local anaesthetic only. In this case, you may eat and drink prior to the procedure without any risk.
What can I expect at my preoperative consultation?
For simple procedures, Richard will be happy to see you once and plan you for surgery. Consent can be signed at the consultation or on the morning of the procedure.
For more complex cases, and generally for cosmetic procedures, Richard prefers seeing you twice before your surgery. You will only be charged for the first consultation though.
The first consultation is generally to understand the problem, your goals and expectations, and ensure these can be met.
The second consultation will often be to clarify sizing, thoroughly discuss the procedure and take consent. This will often include pre-operative photographs. These are taken for the benefit of the patient and the surgeon. These are kept confidential and are used for medico legal purposes, education, training and comparison with your post-operative result. You may decline these photographs. It is your choice.
The benefit of two consultations is that it allows you to come back with questions you may want to clarify. It may be a good idea to write your questions down between consultations so you don’t forget to ask specific questions. You may even want to bring in photographs to give Richard a clearer idea of your goals.
What can I expect at my postoperative consultation?
Most patients will be seen at one and six weeks post operatively. This may be adjusted if required.
Week one post-operative checks are to ensure the wound is healing well. Sutures may need removal, wounds dressed and results following histology returned to you.
Week six post-operative checks are to review the outcome of the surgery and perform final post-operative photography. Any further information and questions may be answered at this stage.