Surgery that leaves no scars? Not Exactly… Part 2!

Plastic surgeons are touted for performing cosmetic and reconstructive surgery that leaves no scars! Of course, this is impossible because you can’t do surgery that leaves no scars. Scars are a natural way that the body heals after surgery or any kind of damage. Previously we discussed that facial plastic surgeons hide scars within the natural lines and boundaries of the face. Today we’re going to cover another way that facial plastic surgeons hide their work: by matching textures.

Animals camouflage themselves by growing skin with texture that blends in with the ground where they live. There’s an armadillo in this picture, off to the left. I found it in my back yard in Texas right after moving in.

Zebras are another example of using camouflage. Instead of blending in with the background vegetation, zebras use their stripes to blend in with the other members of their herd. When you have a herd of striped animals, it is harder for predators to focus in on one individual. This was taken at the Virginia Safari Park outside of Lexington, VA. I highly recommend it, especially if you have kids.

When facial plastic surgeons are addressing skin cancer, the first goal is to get rid of all of the cancer. The second goal is to repair the area so it looks as good as new. Often times the areas needing repair are too large to simply pull the wound edges together with stitches. In these cases, we have a couple of options.

We can get skin from somewhere else and sew it in. This is called a “skin graft”. For facial reconstruction, we usually take skin grafts from the side of the face in front of the ear or above the collar bone. While this works well in repairing a skin cancer wound, these grafts tend to be pretty obvious after they have healed. This is because they have a different texture than the surrounding skin. Their thickness may not match so the resulting contours might be off. These areas of skintight have also received different amounts of sun (an therefore sun damage) than the area that they repair.

For these reasons, skin grafts have generally fallen out of favor over the last thirty years. Instead, we will take skin next to the area to be repaired, lift it up, and move it to cover the area. We call this technique a “local flap.” The skin adjacent to a cancer defect is much more likely to be an excellent match in terms of color and texture than skin from somewhere else. This is particularly true of the nose.

Bilobe Flap

The bilobe flap is a classic example of a local flap. We often use it for skin cancers on the nose because it provides an excellent match for the unique texture of nasal skin. The tumor is removed and the remaining skin swings over to repair the defect. The scar is virtually invisible because it provides such an excellent texture match!

Basal cell cancer on the nasal tip

The cancer has been removed and repaired with a bilobe flap.  This picture was taken six weeks after surgery.

Here, I’ve traced out the scar. No additional reconstructive procedures were performed.

This patient’s result looks extremely natural because, like the armadillo, the texture of the repair matches the texture of the surrounding skin very well. The eye is fooled into thinking that no surgery was done. THAT is the ultimate goal of facial plastic surgery!