Introduction: Scars & Cosmetic Surgery

Scars are an inevitable consequence of deep skin injuries or cuts. The appearance of scars may be able to be disguised or improved through treatment with various surgical and non-surgical modalities. These treatments aim to minimise the scars such that it blends in more with surrounding skin tone and texture or improve function, such as muscle and joint movement. Dr Leow is an expert in designing surgical incisions that aim to minimise the final scar, and use advanced and delicate repair techniques to try to give the best quality final scar.

In conjunction with precise scar revisions, Aesthetic Dermatology also offers a comprehensive range of cosmetic surgical procedures, including artistic treatments for skin, facial and body.

Treatment of Scars

Procedure Information: Treatment of Scars

Scars can be disfiguring and emotionally devastating. Side effects of scarring may include:

  • Severe itch
  • Pain
  • Interruption of sleep
  • Anxiety and/or depression
  • Disruption of daily activities

Scars may also result in development of post-traumatic stress reactions, social stigma and loss of self-esteem, leading to diminished quality of life. Physical deformity as a result of scar contractures can be functionally disabling.

Scarring is to various degrees part of the natural healing process following an injury. The appearance of a scar and treatment options depend on multiple factors, including the depth and size of the causative wound, its location, and patient factors such as age, sex, ethnicity and genetics. These are different types of scars, including:

  • Keloids: Resulting from an overly aggressive healing process, these scars extend beyond the site of the original wound, and may even hamper movement. They are most common among people with darker skin.
  • Contracture scars: These scars form on burns. During healing tissue contracts, and this can impair movement. Scarring often extends deeper, affecting muscles and nerves.
  • Hypertrophic scars: These are raised, red scars that are similar to keloids but do not extend beyond the boundary of the original wound.
  • Acne scars: These can range from raised bumps to pits or depressions that are angular or wavelike in appearance.

Raised, dense scars may be treated by injections that reduce the proliferation of cells within the scar. This effect is sometimes also achieved with superficial radiotherapy [link to Section 1 Item 8]. Depressed or undulating scars may be treated by laser resurfacing, chemical peels, dermal filler, fat transfer, dermal punch lifting and microneedling (see also [links to Sections 4 and 5]). Excision of a scar may be necessary when it is not only raised or depressed but also has a prominent difference in texture.

Pigmentary change, where only the colour of the affected skin is paler, darker or redder than surrounding skin, is often not true scarring and generally improves over time. This improvement can be hastened with laser and light therapy.

Skin Aging

Procedure Information: Skin Aging

Two primary factors cause facial skin aging: the natural aging process and sun damage.

Although it is not possible to reverse skin aging totally, it can be delayed and its effects treated. Reasons for treating aging skin include:

  • Skin cancer prevention
  • Restoring original skin colour, texture and tone
  • Combating a prematurely aged appearance.

Skin aging produces fine lines and wrinkles, age spots, pre-malignant sun spots, uneven pigmentation, broken capillaries, dull skin texture and colour, and other skin inconsistencies and skin diseases.

Aging skin can cause previously attractive features, such as a ‘beauty spot’ mole or tattoo to become unattractive. Previously indistinct features such as minor scars can become more prominent as wrinkles form around them.

Sun damage accelerates the aging process. Ultraviolet light can penetrate and damage all layers of the skin, including collagen and elastin fibres that give skin volume and resilience.

Non-prescription anti-aging creams and topical products only treat the milder symptoms of aging, such as damage to the skin’s outer layers.

The effects of skin aging can be treated in a variety of ways, including laser and light therapy, chemical peels, cryotherapy, photodynamic therapy, muscle relaxant injections, and dermal filler. [links to specific procedures]

Facial Enhancement

Procedure Information: Facial Enhancement

While beauty is in the eye of the beholder, we all have a sense of facial balance and symmetry; and of what is generally pleasing to look at. This is often referred to as the golden ratio of facial proportions.

Dr Leow has expertise in blepharoplasty, otoplasty and nasal recontouring.

Blepharoplasty
Loose or droopy eyelids can be mild to the degree of being hardly noticeable, to so severe that they impede vision. The condition may worsen over time. Left untreated, severe cases can lead to astigmatism and other problems with vision, as well as headaches. Baggy, droopy eyelids can also bring emotional, social and economic complications.

There are several different conditions that cause baggy or droopy eyelids. Some patients may exhibit two or even all three conditions.

  • Excess eyelid skin: Also known as dermatochalasis or festoons, and occasionally associated with fat herniation; this can result in a tired, aged or sad appearance when mild or obstruct part of a patient’s peripheral vision when more severe.
  • Abnormal position of the eyelid margin: Also known as ptosis, this condition can be congenital, but more often appears in adulthood. While ptosis is sometimes related to neuromuscular disorders, it most often is caused by weak attachments between the eyelid muscles and underlying eyelid structures.
  • Droopy eyebrow: Also known as brow ptosis, this condition can be associated with weakness of the muscles that raise the eyebrow, either due to illness or following injections for forehead wrinkles.

Blepharoplasty is a surgical procedure that can restore a youthful appearance to the eyes. The eyelids are tightened as excess skin and fat tissue are removed from the eye area.

Laser may also be used to treat mild to moderate cases. Laser energy causes blood to coagulate, which may diminish bleeding and swelling during the procedure. This method can tighten skin and improve wrinkles under the eye.

Apart from general surgical risks, an overly tight or uneven appearance may result from the removal of too much skin or uneven amounts of fat. Additional treatment can usually reverse this problem. On very rare occasions, bleeding can occur in the eye socket.

Nasal recontouring
Subtle improvements to the size, shape and contour or the nose can be achieved by laser ablation. This is possible as the often oily and sebaceous tissue of the nose hastens healing and reduces the risk of scarring.

Apart from purely cosmetic recontouring, this technique is also very effective in addressing the enlarges pores, sponginess, swelling and redness that characterise rhinophyma; a condition related to rosacea. When severe, this results in a extremely disfiguring enlarged lumpy nose.

Otoplasty
Prominent ears that protrude (bat ears) or are folded over (lop ears) can be corrected by adjusting the position of skin and/or cartilage to improve the shape, position and proportion of the ears. Asymmetric and protruding ears may be congenital or occur secondary to trauma. In moderate to severe cases, a support dressing is necessary to keep the ears in position and help avoid injury during healing. Reconstructive surgery of the ear is also necessary to repair defects following excision of skin cancers or benign lesions on the ear, as well as for laceration of the ear lobules (often from skin tears due to earrings).

Body Sculpting

Procedure Information: Body Sculpting

Advances in laser and light technology to achieve heating of deeper tissue through the surface of the skin have enabled non-invasive skin tightening and reduction of fat. These treatments are effective but at times efficacy if limited if the patient is very sensitive heat and is unable to tolerate prolonged treatment.

As fat is more sensitive to cold injury compared to the skin, sub-zero temperatures may be used to induce loss of fat cells. This treatment is known as cold-assisted lipolysis. The cellular process continues for three months within a single treatment to a zone, and has in many cases taken the place of liposuction, which carries more risks, such as severe discomfort, bleeding and infection.

For certain conditions, such as an abdominal ‘apron’ of loose skin following dramatic weight loss, surgical recontouring by excising excess skin and fat may be more suitable.

Recontouring on a smaller scale, such as to address small inconsistencies in nose shape, improving the appearance of the lips and restoring volume to the genitals (e.g. labia and penile shaft) can be achieved by using injectable dermal filler. See also Laser Peels & Body Contouring.

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