Scarless Surgery, Is It Possible?

I hear this virtually every day.  Patients want or need a surgical procedure but they don’t want any scars.  The reality is there is no such thing as “scarless” surgery. Yet.

Injury to the skin of early gestational mammalian fetuses results in regeneration of the skin instead of healing through scar tissue.  Interestingly enough, this also occurs in certain adult amphibian species.  Fetal “scarless” wound healing occurs much differently than wound healing with scar tissue.

During gestation there are genes that get turned on for a brief period of time.  These genes result in the production of various proteins that lead to the regeneration of fetal skin as opposed to healing via scar tissue.  Sadly, these genes stop functioning part of the way through gestation and normal healing begins.

But, there are ways to reduce the appearance of scars.  All it takes is an understanding of human anatomy.  Plastic surgeons are trained to completely understand the anatomy of the skin and everything deep to it.  It is these deeper tissues that give us the ability to create virtually invisible scars.  The key is to keep tension off of the skin.  Deep to the skin but superficial to the muscle layer is a layer of fibrous tissue.  This layer is found throughout the body.  By placing strong sutures in this layer tension is taken off of the skin and thus an excellent, thin scar.

There has been a significant amount of research directed at identifying all of the necessary components of skin regeneration so that eventually scarless surgery will be possible.  But for now we’ll have to rely on our understanding of anatomy to reduce tension on the skin in order to create virtually, inconspicuous scars.