Skin surgery

A scar is the visible part of a lesion of the dermis after the tissue is repaired following an incision during an operation or after an injury.

Loading

Introduction

Scar formation is an integral part of the healing process. Aside from very minor lesions, every wound (after an accident, disease, or surgical procedure) causes a more or less significant scar. Scar tissue is not identical to the tissue it replaces and is usually of inferior functional quality. For example, skin scars are more sensitive to ultraviolet radiation; sweat glands and hair follicles do not develop under the scar. However, some tissues (for example bone) can heal without structural or functional deterioration.

It should be noted that when a surgical procedure requires an incision of the skin, it will repair itself leaving a scar that cannot disappear completely, regardless of the technique used to close it.

The only damage to the skin that disappears without leaving a scar is that involving only the most superficial part of the skin, the epidermis.
When an incision crosses the dermis, that is, the deep part of the skin, regardless of the skill of the surgeon and the care provided, the surgical procedure will leave behind it a scar that will progressively diminish, becoming more or less discreet, certainly, but never become completely invisible.

We treat scars when they are abnormal or unsightly and require surgical treatment.

It is impossible to make a scar disappear completely, whether by surgery or any other means (ointments, tattooing, peeling, laser, etc.).

The aim of surgical revision is to replace a “defective” scar (with a flaw or anomaly) by a new scar that one hopes will be less troublesome and more discreet.
In most cases, only stabilised scars at the end of their natural development (6 months to 2 years) can be treated. Scar formation proceeds mainly in three phases. The first phase starts several days after the procedure; the scar is generally good and narrow. Then, at the end of 1 to 2 months post-operation, it becomes redder, hard, and swollen, and itching is frequent. This stage lasts 3 to 6 months on average. The scar then enters its final phase, where it starts to fade and become more supple. Itching likewise disappears. At the end of this more or less long and unpredictable process the scar is indelible, pale, supple and without sensation.

Throughout its development, it is important to care for your scar so that it becomes as discreet as possible; it must be protected from the sun (clothing, hat, and sunscreen), moisturised with creams and massaged daily. In some cases your surgeon can prescribe silicone strips or gel for you to reduce the redness or the swollen appearance.

  • Attempts at surgical correction are only appropriate in the following cases:
  • retractile scars: very indurate and “curled”, not extensible, highly unsightly and sometimes even restricting certain movements.
  • ulcerated scars: their fragility leads to frequent superficial “abrasions” that become permanent, deepen and get worse.
  • unsightly scars: broad, coloured, irregular, displaced, sunken, adhering, etc.

It must be noted that treatment of a scar that is normal but simply broad (a frequent case) is highly unpredictable, as the broadening is often due to a disorder in scar formation intrinsic to the patient and independent of the surgical technique.

Loading

Skin tumours

Skin tumours (or lesions) are spots or growths on the skin, of varying size, shape and colour.
They can be located on any part of the face or body. Every type of cell contained in the skin is
capable of transforming into a benign or malignant tumour; thus there are a large number of skin tumours, ranging from a simple “beauty mark” to a very rare tumour. They can appear throughout life or be present at birth. They are most often diagnosed by a dermatologist or by your general practitioner, who asks a plastic surgeon to excise them.

This note, while not exhaustive, aims to discuss the most frequently encountered skin tumours. Rare lesions will be explained to you on a case by case basis by your specialist.

Three principal types of skin tumours can be distinguished:

* Benign tumours:

Some initially benign lesions (like some “beauty marks”) can sometimes transform and
develop into malignancies; it is therefore sensible to remove them preventively.
Other purely benign lesions can be removed because they are bothersome due to rubbing or irritation, or for purely aesthetic reasons.

* Suspicious tumours:

Simple visual examination of a lesion does not always ensure that it is benign.
In this case, surgical ablation will be performed and the lesion will undergo an anatomo-pathological examination (under a microscope); only this can confirm the diagnosis.

* Malignant tumours

Cancers of the skin must of course be removed, as surgery is very often the only treatment allowing a complete cure. The aim is therefore to remove them completely, leaving a “safety margin”, that is, going at a distance around the edges and in depth to maximise the chances of avoiding a recurrence.

What has been removed will routinely undergo an anatomo-pathological analysis (under a microscope) to confirm the diagnosis and corroborate the fact that the lesion has been completely removed.

Loading