March 3, 2026 • 47 mins
What's are the most important elements to plastic surgery? A result that looks natural with a beautiful scar.
But if your scars heal poorly, it can feel like you traded one insecurity for another. In this episode of Plastic Surgery Uncensored, Dr. Rady Rahban dives into the “holy grail” question patients obsess over: How do you actually get a great scar?He breaks down what’s real, what’s nonsense, and what most surgeons won’t say out loud:
Dr. Rahban explains the timeline for revision, who’s a good candidate, and why some revisions fail when tension is the real culprit.If you’ve ever Googled “best scar cream” or been promised a “miracle laser,” press play first.
✨ If you enjoyed this episode of Plastic Surgery Uncensored:
✔️ Subscribe on Apple Podcasts, Spotify, or wherever you listen.
✔️ Rate & Review—your feedback helps more people find us.
✔️ Follow Dr. Rady Rahban across all platforms for daily insights, behind-the-scenes, and patient education:
But if your scars heal poorly, it can feel like you traded one insecurity for another. In this episode of Plastic Surgery Uncensored, Dr. Rady Rahban dives into the “holy grail” question patients obsess over: How do you actually get a great scar?He breaks down what’s real, what’s nonsense, and what most surgeons won’t say out loud:
- “Scarless” surgery is a lie (concealed ≠ scarless)
- Scar outcome is decided the moment the incision is made
- Burning the dermis, crushing tissue, poor blood supply, and excess tension can ruin healing
- The truth about genetics — and how it’s often used to deflect blame
- Why early lasers and steroid injections can backfire
- The only post-op scar routine that consistently helps: pressure + massage + simple silicone
Dr. Rahban explains the timeline for revision, who’s a good candidate, and why some revisions fail when tension is the real culprit.If you’ve ever Googled “best scar cream” or been promised a “miracle laser,” press play first.
✨ If you enjoyed this episode of Plastic Surgery Uncensored:
✔️ Subscribe on Apple Podcasts, Spotify, or wherever you listen.
✔️ Rate & Review—your feedback helps more people find us.
✔️ Follow Dr. Rady Rahban across all platforms for daily insights, behind-the-scenes, and patient education:
- Instagram: @drradyrahban
- TikTok: @radyrahbanMD
- YouTube: @Rady Rahban
- Facebook: @Rady Rahban
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:07):
Welcome to another episode of Plastic Surgery Uncensored. I'm your host,
doctor Roddy Raband, and as always, we have a fascinating
and educational episode ahead of us. This episode is actually
one of the concepts within plastic surgery that is the
one of the most important aspects of my practice over
twenty plus years, something that I've repeated and continue to
(00:29):
repeat and repeat, probably till I retire, Things that I
post about all the time, things that we discussed NonStop,
which is what is the holy grail of an amazing scar?
What is the truth behind getting a fantastic scar? That
is I'm having surgery, if not my biggest one of
(00:52):
my biggest concerns is having a garbage, terrible, horrible, thick,
ugly scar. I really wish and I pray that I
have an invisible scar or a barely visible scar. So
this is really really important because, in my opinion, it's
the underbelly, It's the basic premise behind all of cosmetic surgery.
(01:14):
If you have your gallbladder removed and your scar is
not ideal in a weird way, you can substantiate it
in your own brain and you're like, well, I mean,
I was sick and my gall bladder blah blah blah.
Same thing with a hysterectomy, even a C section. Don't
get me wrong, nobody likes ugly scars at any time.
But when you go to get a breast lift or
a tummy tuck or a face if and the scars
turn out terrible, you've literally gone in to do an
(01:36):
esthetic surgery because there's something about your body that kind
of makes you insecure. You're hoping as a result of
this surgery and all this money and suffering, you come
out more secure. And now you've exchanged one problem for
arguably another problem, and in some instance it's a bigger,
worse problem because at least the problem before was natural.
So nothing, in my opinion, is more important than decisions
(02:00):
and scars. And arguably nothing is more misleading and nonsensical
and mislead and and patients are lied to more than
when it comes to scars. So what are we going
to chat about? Number One, We're going to talk about
what actually improves scars and what is just garbage marketing
mumbo jumbo. Number two, we're going to talk about sort
(02:21):
of how a scar is supposed to behave. What's the timeline,
what's the sort of the normal healing process of a scar.
We're going to talk about how anatomy plays a role,
how your genetics plays a role, and then we're going
to talk about if and when I have a horrible scar,
(02:43):
what do I do about it, what's the timing for
a scar revision, et cetera. So one of the basic
misconceptions of scars, as follows number one, is that if
I go to a plastic surgeon, right, I should and
can't expect for there to be no scar. So the
word scarless is thrown around in plastic surgery like no
(03:07):
one's business. It is a lie. There is no such
thing as scarless anything surgical. I am creating a scar,
even if the scar is literally three millimeters. Three millimeters,
Ladies and gentlemen, go get a ruler out. Three millimeters
(03:28):
is microscopic. It's a scar. I punctured you, I made
a hole. I cut you, and every human being unless
they're neonate in the in the uterus, in the womb,
makes a visible scar. So the question of whether or
not I can have a scarless breastlift, scarless tummy tuck,
scarless facelift is a lie. There are people advertising scarless facelifts.
(03:51):
It's not scarless. It is a very well concealed scar,
one in the hairline and all intents and purposes, it
hides a scar well, but it's not scarless by any means.
If you shaved your head, you would see the scar.
So that's number one. The idea is that, oh, in
order for me to get a good scar, I need
to do ABCD. In other words, I need creams, I
(04:14):
need lasers, I need injections, that sort of. This notion
that we live in today is more is better. So
I had a surgery, and in order for me to
get a good outcome, if I don't do at least
four or five things, I'm going to be for sure
guaranteed a terrible scar. And if I do the four
or five things, I'm going to for sure be guaranteed
day better scar. Totally a lie, complete myth, nonsense. The
(04:37):
idea that all scars heal should heal the same, even
within you, so you are the same person, even with
the same surgeon. I'm the same surgeon, in different areas
of your body, you will have different healing. I lid
scars can and should heal nearly invisible again. Notice I
(05:01):
said nearly. It's there, but it's so faint and so
thin that we would probably look for it for a minute.
But a scar on your shoulder is going to heal
much thicker. A scar on your knee will thick be thicker.
The one across your chest will be thicker. Even though
you and me are the same, there is, for an
excuse me, different anatomy, different thickness, different tension, etc. So
(05:24):
definitely scars are not all the same. Next, I'm going
to run out to scar I had surgery yesterday. I'm
going to run out and start intervening with lasers and
creams and stuff. Not only do they not really work,
in my opinion, the worst thing you can do is
start to mess with them when the scar is premature
and naive and hasn't even begun to heal. It's kind
of like mowing your grasp before it has a chance
(05:46):
to really grow in and be solid. If you go
and plant some seeds and make grass grow and it's
just barely you know, that little flimsy, shitty grass that
you have growing in the beginning, and then you run
a blonwd mower over it, you're going to just destroy it.
It's not ready for any kind of intervention. And lastly,
this idea or notion that every scar can be fixed,
what do you mean? So there are individuals who call
(06:07):
my office who have had multiple interventions and really, unfortunately
and sadly do not understand that sometimes it is what
it is and we need to accept that. So let's
dive into the idea of in my opinion, the number
one listen carefully, number one thing that leads to a good, thin, flat, narrow,
(06:37):
light scar versus a bad, wide, raised, thick, dark scar.
So let me rephrase that again for you understand. We
need to first define what our goal is, what is
our endpoint. We need to know what we're trying to accomplish.
We are not trying to accomplish an invisible scar or
(06:58):
scarless scar. We're trying to accomplish a really nice and
thin and arguably concealable scar. So the most important thing
in it is your surgeon. Why because at the moment
that the surgeon begins the surgery, he or she is
(07:21):
determining your scar outcome. The second I touch you, I
determine whether or not you will have a good or
bad outcome. Let me explain you why when I do
surgery doesn't matter where on the body, it is. Every
incision I make, I use a brand new blade, sharp
(07:42):
as hell, and I go through all the layers of
the skin with my blade. Let me elaborate so you
understand the skin is made up of multiple layers. It's
it's the epidermis and then the dermiss and then we
get into fat. So surgeons trig Additionally, what they do
is they cut the skin. They go through the epidermis
(08:04):
and a little bit into the dermis, and then they stop.
Why because your skin will start to bleed. The area
of your skin that bleeds when you cut yourself is
the dermis, and if you are a healthy young person,
you will bleed like stink and it's annoying because blood
gets everywhere. So what surgeons normally do is they cut
through part of the dermis and then use electro cottery
(08:29):
that is a hot knife and char and burn through
the rest of the dermis. Why do they do that
because it instantanely stops the bleeding from the skin, and
that makes it easier to continue surgery because you're not
bleeding all over the place. And by bleeding, I'm not
referring to bleeding to death. I'm talking about just annoyance
oozing everywhere and makes things messy. What's the issue, doctor Reband?
(08:54):
The issue is that surgeon has now burned your skin.
You charge the dermis when you close the scar. What
do you think is actually healing in six months to
a year the dermis? So if I burn your eyelid
with cattery, or you spill hot oil on your thigh,
(09:16):
how does that scar heal like shit? So from the
get go, right out of the gate, your surgeon has
fucked you because they have burned the thing that they're
going to come back and sew, and if God forbid,
your body is very inflammatory and reactive, your scar will
heal like shit. So what should they do? They should
(09:38):
inject all of your incisions with local anesthetic with epinephrine
prior to beginning surgery. Then after fifteen or twenty minutes
when they start surgery, that epinephrine is taken full effect,
and when they cut the skin, it doesn't bleed nearly
as much. And they should cut through all the skin
(10:01):
with a knife, sharp, clean, no trauma. Then when they
get to the deeper structures then they can start using
the electrocottery and cauterize and lift the flaps and separate
the breast tissue and ab them in in the data DA.
That right there, ladies and gentlemen, is one of the
most critical elements of surgery that's done every single day
(10:22):
by every type of surgeon. The number of surgeons who
have joined me to watch there and I tell them this,
they're like, ah shit, yeah, you're right. The reason is
they just come in, they start surgery, no one puts local,
they make the cut, it starts bleeding, and then they
hear this and they're burning all those little blood vessels
that later are going to be the source of healing
in your skin. The next thing that matters is how
(10:46):
much tension there is. So when I'm doing a flap,
So these are all the things the surgeon is doing
to make you have a shitty scar. When I'm doing surgery,
I'm removing I'm removing skin from your abdomen, I am
removing skin from your breast, I am removing skin from
(11:07):
your face. I am removing skin from your eyelids. How
much I remove determines if you look good, if you're underdone,
or if you're overdone. So let's talk about when we
overdo things. We remove too much skin from your abdomen.
Oh that sounds terrible. So then I want to close you,
bring you back together, and you are now under a
(11:29):
shit ton of tension, a lot of tension. Why because
I've remove too much skin. So we have to flex
the bed. Flex the bed, flex the bed. Now you're
super hunched over, tight as hell, and we sew you close.
You're closed. It's fine. Now. Every hour of every day
for the next six months, you are pulling on that
scar because you're just trying to stand like a normal person.
(11:52):
When your incisions feel tension, meaning the scar start to
feel pulling, it triggers on a cellular level, your body's
intelligence and it says to the body, fuck, we're coming apart.
We're coming apart, may day, mayday. This incision is about
to rip open. So what does your intelligent body do.
(12:14):
Make a lot more scar tissue, and well, this shit closed. Okay,
Oh no, this is coming apart. Oh no, okay, call
in the troops. More scar, more scar, more scar. Now,
all of a sudden, your scar is twice as thick
because your body doesn't want it to come apart. And
why would it come apart because we've removed too much.
(12:35):
The next thing is as I'm managing and holding all
these tissues that I'm going to sew together, I'm putting
them back together, right, but I have to hold on
to them. I crush the shit out of them with
clamps and squeeze them, and my tech is holding the
flaps really aggressively. So I am opening something up, doing surgery,
and then putting it back together. The thing I'm putting
(12:56):
back together is a thing I'm asking to heal. Right,
I'm putting it back together. Imagine as I'm managing and
holding that tissue as I'm doing my surgery, me or
my tech is crushing it with clamps and being very aggressive.
Now I've crushed and squeezed the edges of your skin
that I am now asking to heal beautifully. How do
(13:16):
you think that's gonna heal? So you are now starting
to understand that when someone tells you you healed like shit,
it's your fault and you didn't use enough cream. Do
you understand how this doesn't all make sense? Now? You
guys don't understand this. No one's gonna blame the surgeon.
But that's the surgeon's fault, and then we get to
(13:38):
how much blood supply is left at the end of it.
So how does a scar heal biologically like on a
cellular level, how does it heal with blood? Blood brings
in nutrients and oxygen and protein and fibroblasts and alas,
and blood physically brings it there. So blood to get there,
it needs blood supply. So when we do surgery, we
(14:00):
lift things up and separate them to make them come together.
If you overly lift things and overly separate them, then
the blood supply to the end where the scar is
doesn't get there, and things heal with less blood supply
and therefore heal worse. So when surgeons do surgeries, they're
(14:22):
very aggressive and they're really lifting up flaps. We refer
to that as undermining, and they're very aggressive while undermining.
That leads to ischemia and separation and gapping and necrosis.
So that makes a huge difference. So if your scar
is gasping because it doesn't have enough oxygen, you shouldn't
(14:43):
be shocked at it's healed like shit or separated. The
next thing that has to do with separation and stuff
has to do with how this is the most singular
important I that I'm going to share with you today.
How well does your surgeon close your incisions? So let's
(15:10):
back up here. Ninety nine percent of surgeons who do
body contouring or large amounts of surgery that means breakioplasts, breastlifts,
tummy tucks, thigh lifts, body lifts. I'm not talking about eyelids.
I'm not talking about chinnogs. Why because those surgeries have
(15:31):
like eight sutures in them, But when I do a
tummy tuck, there's five hundred sutures. Ninety nine percent of
surgeons who do body contouring have someone help them do surgery.
Let's back up here. Have you ever met a busy
lawyer who doesn't have a pairalegal. Have you ever met
a busy accountant who doesn't use a bookkeeper? Have you
(15:52):
ever met a busy architect who doesn't have a draftsman.
How about a dentist who doesn't have a hygienis. Have
you ever been to a restaurant where it's busy and
the waiters don't have bus boys. So it should come
as no surprise and no shock to you that plastic
surgeons and all surgeons for that matter have people who
help them close. So the question you need to be
(16:12):
asking this is so important is every consult you guys
have when you're meeting with your surgeon and you're meeting
them in person, the question you need to ask them
is doctor so and so, asides from you, who is
not in the room, who is not helping you? Who
(16:33):
else other than you is closing? And the answer ninety
nine percent of the time is the tech. I know
you want me to repeat that, the tech. What do
you mean the tech? You mean the tech the guy
that hands the instruments who went to tech school is
not illegal in California. Yeah, but it gets done. And
I can promise you I've been in one hundred oars
(16:55):
with some of the most reputable surgeons that you would
consider world renowned, and they're not even the room closing.
That's right. When it comes to closing, if you're lucky,
your surgeon will close your right breast while the tech
closes the left breast. But more out of times, out
of none, the busier, fat and more successful they are.
They're out of the room, marking the next patient, getting
(17:16):
things going, and the tech and or two techs are
closing your incisions. I promise you, I guarantee you, I
give you my word. They are not closing you in totality,
and in my opinion, that's malpractice. I know it's not malpractice,
even though technically texts are not allowed to close. But
(17:37):
they'll have a physician assistant, they'll have another junior assistant,
they'll have someone there closing besides themselves because they got
to get the hell out and closing is a pain
in the ass. No one likes to close. So where
I have highly highly highly put energy in time and
really dedicate myself is in all the above things. I
(17:58):
just spend the last fifteen minutes telling you, and yes,
ladies and gentlemen, I close. Have closed every single incision
in every single patient for twenty plus years. That is astronomical.
You can ask any tech, you can ask any surgeon.
No one has ever closed a patient of mind since
the day I started. Now, we have closures, and we
(18:21):
have closures, So whipping some sincision together shitty is not
doing the patient a favor. You're actually better off having
the tech close and take their time than have a
surgeon being a rush. When I say I close, I
mean I close and I'm talking about layer after layer
after layer. Why because, as I mentioned to you before,
(18:42):
tension pulling on the incision causes the scars to thicken.
So the way we get around it, because inevitably, even
if you don't remove a lot of tissue, there's tension,
is by putting deeper tissues together, holding the tension deeper
so that the skin has very little tension, so the
scar which you see doesn't look thickened. So when I close,
(19:05):
say an abdominoplasty, a tummy tuck, or a breastlift or
a thigh lift, it's three to four layers of closure,
the deep one, the intermediate one, the superficial one. And
the thing that is even crazier and more bananas is
when I'm done closing, everything is closed. It looks amazing.
We can walk the hell out. I take a stitch
called six o nilon. For those of you who are curious,
(19:27):
go google six on nilon. The size of a six
o nilon suture is that of your hair. It is
the size of your hair. It is a permanent black
suture that I use to close the skin after I've closed,
which then requires for me to take it out because
it's a permanent suture. Why on earth would I do that?
(19:48):
What kind of craziness is that? When I tell other surgeons,
They're like, what are you crazy? I use six on
nylon during eyelid surgery, eelid surgery, facelift surgery, things that
are rhinoplasti super delicate. Why the hell would I use
that during your breast reduction? Because it brings the skin
edges in the most perfect reapproximation. When your skin is
(20:10):
closest to where it was when it started, it makes
the least amount of scar. Think about it. When your
skin is cut open and then brought back together, the
only thing that brings the skin back together is the
scar that welds it back together. The more gaps and
more space there is between the two edges, the more weld,
(20:32):
the more paste, the more cement you need to bring
it together. So if the skin edges are almost kissing
as if they were never separated, your body's like, sweet,
all right, let's just put in a little bit of weld.
If there's tons of gaps and separations and high and
low and your skin's your body's like, what the fuck
(20:54):
is this shit? Now? I need a lot of paste
and a lot of weld and so it has more
burden to do it. So what I just demonstrated to
you is the single most important thing you can do.
Find a surgeon who gives a shit because I assure
you I do not enjoy closing. But I'm a psychoanal
(21:18):
super what's the right word. I'm a real particular person.
Now that being said, Okay, so does oh doctor bonds
from from what you just said? Every one of your
incisions is phenomenal negative, Yes, a lot, and most of
(21:39):
my incisions are fantastic, but some are not. Well, what's
the difference. The difference is the other half, the other
fifty percent of it is your genetic predisposition? What are
you going to make? What kind of scar does your
body generate? So the surgeon's done their part amazing, cross
(22:01):
every t dotted, every eye checked, every box. Now you
can be a great healer and you can be a
shitty healer. What does that mean? Your scars? Are they white?
Are they red? Are they brown? Are they black? Are
they thin? Are they thick? Are they flat? Are they raised?
You have a predisposition? There are individuals, they are not
that many by their way, So don't let the surgeon
(22:22):
blame you for his shitty work. Very commonly, the surgeon says, oh,
you're a terrible healer. You make keloids, and then they
come here, we do a revision and they heal perfect.
Wait what happened to your kiloid making? So yes, the
patients do contribute, but it's far and few between. And
we know that because every once in a while someone
will say, I pierced my ears and I made a
(22:43):
cauliflower a huge, raised, ugly scar. Well, that certainly wasn't
the surgeon. They just poked a hole in it. Or
I cut my elbow and it made this thick, ugly
ass scar. Or my c section is thick, and my
gallbladders and everything I've ever cut becomes thick. Yes, there
are those individuals, and yes those individuals are unlikely to
make an amazing scar. But no, when you heal like shit,
(23:08):
you need an amazing closure. That's when you really need
your surgeon to care because you are already predisposed to
make a terrible scar. So if your surgeon does a
great job, you'll make a terrible scar. And if your
surgeon does a terrible job, you'll make a horrific, awful scar.
So the people who's likely to make a crappier scar
(23:31):
are more in need of making a good closure. Now
there are genetic predispositions. We know that people with very
high quality skin, thick, oily, subacious, amazing beautiful skin, make
crappier scars. Wait what you just said? They make great Yes,
the thicker and more robust your skin, the thicker your scar.
(23:53):
Who has a robust skin? Kids, kids make crappy scars.
Their scars are thicker, raised red. Who makes great scars?
Old people, eighty year old people who get skin cancer
and we rearrange their faces and make all kinds of
crazy scut cuts. Six months later, you're like, where did
it go? Because they have no collagen left in their skin,
and that means they can't make thick scars. My son,
(24:15):
on the other hand, has amazing healing potential. His scars
are going to be crazy thick because his body's like, ew,
let's do this, let's heal. So Black patients, Asian patients,
some Latinos, some Middle Easterners. Those people with thick, oily
skin tend to make thicker scars. Who doesn't make thick scars, Caucasians, people,
(24:35):
Anglo Saxon Irish, Dutch, English, White French, freckily dry. Again generalities,
but generally so the two ladies and gentlemen, most important
things about your scar or your surgeon's willingness to do
the things I mention, and your predisposition. After that, everything
(24:57):
I'm about to tell you, and there's a lot, makes
up five percent of it. You mean the scar creams
five percent of it. You mean the laser five percent
of it? You mean the hyperbarica five percent of it.
If you have a shitty surgeon or you heal poorly,
you can literally put anything you want on your incisions
and nothing's gonna matter. Read the millions and millions of reviews.
(25:20):
Let me ask you a question. If tomorrow there was
a cream a laser that made scars go away or
significantly better, do you think it would be a secret.
Do you think only the guy in Glendale would have
it or the surgeon in Germany would have it? Do
you not think the company that makes the cream or
(25:43):
the company that makes the lasers would be a trillion
dollar business? Just think for a moment. People in Africa
know what botox are because botox works and it's everywhere.
People who who who who live in the middle of
nowhere know what propecia is because it works. It's a
(26:07):
trillion dollars, but you have never Why are there eight
gazillion scar creams and four million lasers because everyone is
full of shit. Trust me, if there was one that
would work, I'd have it. I'd lather it onto every patient.
So let's now get into some of the nuances. So
the role of tension matters. I elaborated, but I'm gonna
(26:29):
highlight it. So if I cut on your shoulder, you're
gonna make a shitty scar compared to your eyelid because
there's movement on your shoulder, and no matter what I
tell you, you're gonna move. So that is why I
am so adamant, and patients get irked for you not
to do any exercise for six weeks. What do you
mean no exercise because you'll start pulling on your incisions early,
(26:51):
which then signals on a molecular level, we need to
thicken and thicken and thicken. So I am very very
about letting scars heal without any undue tension. That has
to do with how much I remove, but also what
you do afterwards. So you want to be very careful.
Where you cut makes a difference. For example, patients come
(27:13):
to me and they say, have a mole in the
middle of my chest. I'd like it removed, No way,
I can't. Literally, we were on vacation and somebody I
saw a beautiful woman with a massive kiloid across your chest,
and I knew. We became friendly with them, and I
knew it came from a ZiT from a single stoop,
and sure enough it was like the size of an
like chocolate bar, and it started as a dot. And
(27:37):
now and it happens, It happens over because there's so
much tension across your chest. Every time you breathe and
move and grab, it's pulling and that creates thick, thick scars.
So you want to avoid areas on your face that
have high tension. So it's very very important. Now let's
talk about what actually does help in the five percent category.
(28:04):
So we're in the five percent category. Now we've established
it's nothing big, but so scar creams and scar strips
aka silicone so yes, if you are a burn patient
and your scars are super super thick, there are two
things that we know work and they probably work in conjunction.
(28:24):
One is tension and one is some silicone because of
some electric magnetic changes. So let's back up here. So
probably the number one thing you can do. People never
believe me because they're expecting it to be some expensive
special thing is massage. What happens is your body at
(28:49):
six weeks. Let me back up here. Sorry, it is
so much for me to tell you. Let me tell
you about general healing. When you come to my office
and I operate on you, within the first four weeks,
you will think I walk on water. Why because your
scar will I promise you be as thin as dental flaws.
I give you my word. Why because I spent shit
(29:09):
ton of time closing it and it's pristine. But then
at six weeks, your body goes thanks so much for
all the help. Let me take over from here, and
what you start doing around six weeks is start laying
down scar tissue till then the only thing holding your
scar together is all the sutures I put in. But
we both know that those sutures are temporary because they're deep,
(29:32):
and we both know that what holds you together year four, five, six, seven,
nine thirty is scar tissue. That scar tissue doesn't kick
in for a little bit, and around six weeks you
start noticing, hmm, my scar is getting a little red. Huh,
my scar is getting a little itchy. Huh, my scar
is getting a little raised. And all those are normal,
because that means your scar is healing. Your body is healing.
(29:55):
It is bringing in all the tools. It's bringing in
the cement and the bricks and the grout and all
that other stuff that's healing. Starts around six weeks and
kind of keeps going and going and going and going
and going somewhere around like six to eight nine months.
Your body will continuously build scar for that period of time,
(30:21):
and that is why scars tend to get thicker, redder,
more itchy, more raised. For six months, it doesn't matter
how great you're a surgeon. Closed. It is healing, and
you now get this sudden desire to do something to it.
But it's in the middle of healing the scars of
(30:43):
mind that turn into invisible lines. We're thick, a little thick,
a little red, and a little itchy. Around six months, now,
around six months seven months, your body goes click, We're done.
We're done building. It's done. The inflammation is done. We're done.
We're done. Done. Then your body goes okay, guys, let's
make this a little cleaner. It's kind of messy, and
(31:06):
remodeling starts, and your body starts to cool off. The
redness starts gradually fading, the scar starts gradually flattening, the
itching and pain starts going away, the numbness around it
starts improving. That process of remodeling takes up to two
(31:29):
to three years. Come on, what do you two to
three years? But you should incrementally see your scar getting better,
a little less red, a little less follen, and slow
on and so forth, so on and so forth. So
a normal, amazingly healed wound does what I just said
to you. So when you look at your scar, and
(31:51):
let's say it's healing pretty good and it's been around
six months, be patient. People come to me all the
time and ask for scar revision. Hey, doctor, bondiscar looks
like shit. I want to fix. How long ago do
you have your surgery? Four months ago? Won't touch it? Well?
Why not? Because it's inflamed. Even though it may still
heal like crap, We want to let it cool off.
(32:13):
Number one. Every once in a while, things get better
enough where you're like, oh, it's not amazing, but it's
this is tolerable because you're looking at it at its
worst point, and then otherwise the tension releases, it relaxes.
If I go in in the middle of a storm
and try to clean up and fix things, what do
(32:33):
you think is going to happen in the middle of
a storm. I'm going to create another storm within a storm.
So you need to be patient, and your surgeons need
to advise you to just take it easy. The next
thing that happens that drives me insane and bananas is
pay attention so important. You're at six months, your scar's
a little red, a little itchy. You go to your
(32:54):
spa and boom, They're like, let's put in some steroid.
Steroid injections is the kiss of death. Go look at
my post, Go read the hundreds and thousands of people
they put steroid. And steroid is like napalm and it
just phsh and it thins out and stops everything. Well
(33:15):
that's great, yeah, it it is way too aggressive. And
what it does is it, yes, will turn off the
redness in many instances and flatten things in many instances
and also start destroying the surrounding tissue, all the healthy skin,
all the fat that's underneath. You start getting tel adjectasis,
and then you get something that was maybe manageable. Now
(33:37):
it's this mote and it's just completely destroyed. Imagine you
just take a flamethrower at it. So you can read
time and time and time and time again, people saying
that they went and they got steroids, and within couple
of weeks to months the ARAA just hollowed out. So
you do not go get steroid injections in the middle
of your healing when it's healing well, unless once in
(34:00):
a blue moon it's super thick and someone knows what
the hell they're doing. Nine out of ten times it backfires.
I've probably injected steroids in a scar ten times and
twenty years, and I deal only with scars. So avoid that.
You run out and get a bunch of lasers. Oh
lasers work, Oh my god, advertisements for lasers insane. Lasers
(34:24):
don't do shit. All they do is irritate and aggravate.
Do you know how many dark skin patients have come
to me over the years whose scars were slowly fading.
They weren't gone, they were getting impatient, and then they
go and get a laser done, and then all of
a sudden, the whole area darkens. It gets much darker,
and now they have to use like pigment cream and whatever.
(34:46):
Lasers are burning and heating the surface. The very most
they can do, the very most they can do is
take a little bit of texture off the top of it.
You want a laser and mature scar, have at it.
I don't think it's gonna help much. But when you
start lasering immature scars, you start adding heat to a
thing that's already was heated and it's trying to heal.
(35:07):
Oh but I saw amazing before and afters. Oh did you? Hmm?
Let's talk about her before and afters from lasers. So
what they do is they take a picture of a
scar that's at six months, which is premature and healing,
then they laser it. Then they show you the scar
at a year and a half, and what, oh my god,
(35:28):
look at that. The scar went away? And what was
gonna happen if you didn't laser it. It was gonna
go away. So these creams and scar lasers that people
show you is bullshit, because what you need to do
is show the scar without the laser in the cream,
and the scar with the laser in the cream, and
(35:48):
then show me at eighteen months, and if you can
show me that that area that was lasered is better
than the area that wasn't. Now we're talking. They never
do that. They show a scar that's on its way
to healing, and then they put cocoa oil and butter
and vitamin e and blueberry juice, and it heals. It
was healing anyways. You just didn't wait long enough. So
(36:13):
don't do it. You are wasting money. One of two
things are gonna happen. One, you wasted money. It healed anyways,
didn't help. Two it made things worse and hollowed things
out or made it hyperpigmented. The only two things that
I think work is some silicone, which I will elaborate on,
and the other is pressure. So now we go back
(36:36):
to what I told you does work. Silicone works because
somehow it creates some barrier. No one really fully understands it,
and it does some kind of like electromagnetic something. We
used to use silicone strips. I don't use silicone strips. Well,
why not? You just said silicone works? Because when you
put the silicone strip on an incision, it buries and
(36:58):
doesn't let the incision breathe. Skin is breathing, it exudes oils,
Things come out of your skin, and when you cover it, it
gets trapped and you get irritation, and you get pimples
and dirt and bacteria and redness. And people often say
(37:23):
that when I was using the silicone strips, my skin didntolerated. Well,
the reason is not the silicone, but the barrier. When
I let wounds heal, I let them always breathe. I
don't use steriry strips, I don't use exclusive cover dressings.
I let your incisions breathe because they're breathable. Have you
ever tried to put like a glove on for long
(37:45):
hours or get your skin super wet. It doesn't breathe,
and all of a sudden your skin looks like shit.
Your skin needs to breathe. So now we have liquid silicone,
which is kind of like a thin barrier. And I
like the liquid silicone, So I recommend to my patients
a little bit of liquid silicone. Is it the Holy
Grail is gonna save your life? Now? But I do
(38:05):
think it's better than nothing. Now, what I do think works,
and I do think works really well. Is pressure? What
do I mean by pressure? Pressure means that your scars
are healing and they think their job is to make
this scar super thick and protect you from coming apart.
(38:26):
When you massage or put pressure on a cellular level.
It has been shown that the collagen, the fibroblast, the
elastin goes from being all bunched up under a microscope.
When you look at it, it's imagine all mangled like
hair is all tangled up, and when you put pressure
(38:49):
on it consistently and massage it, they all line up.
Everything lines up. It's like combing hair. The hair lines
up and it flattens and thins out out. That is
why when patients are burned we put silicone and thick, thick,
thick gloves or pressure garments because the pressure on the
(39:09):
scar sells it to chill axe chill axe. So what
you do is you try to apply the scar cream
with gentle massage at six weeks and on, not right away.
What do I do immediately, doctor Raban? Nothing? What do
you mean nothing? Immediately? Don't touch your scar for six weeks.
(39:32):
Don't touch your scar for six weeks it needs. That's
the little grass growing. You start fucking with it and
walking on it and mowing it and trimming it, you
will kill the grass. It needs a chance to anchor
and grow and seed and be permanent before you start
mowing it. At six weeks, your scars now mature and
you can start doing whatever you want to do to it.
(39:54):
I would recommend taking a little bit of scar cream
and generally massaging the scar on a regular basis with
digital pressure. The more you massage, the better it does.
But I can't massage constantly. Aha, That's where paper tape
comes in. So if you come to my office and
you are my patient, I have some old school techniques
that I use, and they're what I refer to the
(40:15):
poor man's scar management. Surgeons love to advertise, come to me.
I'm doctor so and so I have I do your surgery.
And guess what, I have a very elaborate post operative
scar management treatment that nobody else has. Really, doctor, really
is that? What it is is that the truth? My
scar management costs you fifty bucks. Go look at my
(40:38):
scars fifty bucks because it's me and you and a
bunch of little things. So massage liquid scar cream and
some paper tape. That's it. Everything else to this point
is bullshit. Not because I'm trying to be cool and
tell you go do it. I don't care. If it worked,
(40:59):
I would want You don't think I want to have
invisible scars me, of course I do. I'll become the
best surgeon ever. The number one things the patient's complained
about online is shitty scars. So if I could advertise
that I have no scars or the most amazing scars
because I use a special cream or laser. Nobody else
has it, just doctor Raban, then I'd be like making
(41:19):
trillions of dollars. It's just not true. If I didn't
have to sew you up, I would be heaven Heaven.
I'd be out of the o R in like half
the time. But it's not gonna happen. So unfortunately, as
the saying goes, if it's too good to be true,
it's not true. And the old saying goes is there
are no shortcuts, And the shortcuts that are not there
(41:40):
is that I have to sit there sew you excellent.
You have to be a good patient, follow my instructions.
You cannot go and start doing yoga in two weeks
start pulling on everything. And last, but not least, you
got to stay out of the goddamn sun, because if
you are a pigmented person, not a white person, when
(42:00):
you sit in the sun, your body decides to generate
some pigment and it's going to pigment the scar. But
even that, while it is important, is overrated. So I
hope that very long, elaborate, entailed explanation of scars helps you.
(42:20):
The last thing I'm going to tell you is okay, well, great,
doctor obaum well, I appreciate that, but it's too late.
I already have the goddamn scar. My breastcar sucks, my
ABDOMINOPLASTI scar sucks, my c section sucks, my gallbladder sucks,
my orthopedic surgery sucks. What do I do about that now?
And the answer is very simple. After probably around six
(42:40):
months to a year, that scar is not fully mature,
because I told you it takes two to three years,
but it's mature enough. You need to revise it. You
can sit there and sprinkle all the cream and lasers
and steroids you like, nothing's going to change. You need
to come in, find us ur who will cut it out,
(43:01):
throw it in the trash it then now is a
brand new incision. And then you do everything I just
said as if you're starting from scratch A. The surgeon
must take their time. Multilayer closure, release the tension, make
sure not to over undermine. Close it pristine. Two, you
(43:22):
need to have reasonable genetics. So out of every ten
patients that come to my practice with shitty scars, eight
of them are significantly better. Two of them look exactly
the same. When you come to me and I revise
your scar, and you look exactly the same. It's your genetics.
It's your genetics. You've got to make it, and you're
(43:43):
gonna make it, and you're gonna make it. But eight
out of ten were told it was their genetics, and
when we revise them they did better. So cut it out.
Do the closure I mentioned. You find someone who really cares,
hope that your genetics is the eight out of ten,
not the two out of ten. Do the basic things
(44:04):
I did. The one caveat is if you have a
lot of tension, listen carefully. If you have a lot
of tension, they remove way too much skin from my belly,
way too much skin around my areola. Then cutting it
out and closing it will one hundred percent fail because
(44:27):
you are now taking something that's so tight, cutting out
scar and making it tighter. It's now tighter, it's tighter
than it was. There's no closure, special magic that's gonna
make more skin. And so when a patient comes to
me sadly and that is the way they got to
where they got and they're super tight or whatever. As
(44:49):
much as I want nothing more than to be a
hero and help you, I know that if I cut
it out and close it, I'm gonna be right back
where you are even more risky. It could come apart
and separate. So when it comes to revisions, you need
to make sure you are a good candidate. But many
many many patients over the years I've revised their scars
and they're significantly better. So do not allow doctors to
(45:13):
gaslight you that, hey doctor, it's odd, but like my
C section healed pretty good, but my breastlift healed like shit.
Oh it's your genetics. Really, it's my genetics. So many
times they'll blame you for their own shitty work, or
that you didn't use enough creams or better. Yet, now
that I've already charged you tons of money for your surgery.
(45:33):
Why don't you come in and let me do five
rounds of lasers and twenty five injections, and by the way,
I'm going to charge you for that, and at the
end you're no better, And well, what can I tell you?
It was your genetics at any rate. That's a wrap.
I'm very passionate about this because I feel like it's
like the most basic aspect of plastic surgery, and it's
the most under under It's the most poorly understood aspect
(45:57):
of plastic surgery. And the more advanced we get, the
more we rely on other things to lead to good outcomes.
All right, guys, that's a rap. That's yet another amazing
episode of plastic surgery uncensored as always, I'm going to
leave you with two partying requests. One is, if you
love my show, if you love the episode, if you
love listening to plastic surgery and censored. Right now, before
(46:20):
you get off the treadmill, go and write a lovely review.
Everyone who puts this show together appreciate it and makes
them feel good about being here on a Sunday. The
other is, right now, before you get off that treadmill,
forward this show to two friends two friends that you
probably don't think two plastic surgery. But whoa what do
(46:41):
you know? So and so just did it and they
didn't tell you and now they look like crap. You
never know who's going to need or benefit from this information,
and if you send it to them, frankly, you could
be doing them a huge favor. All right, guys, that's
a rap. Until next week, I'm your host, doctor Rody Rabond.
See you on plastic surgery Uncensored
Welcome to another episode of Plastic Surgery Uncensored. I'm your host,
doctor Roddy Raband, and as always, we have a fascinating
and educational episode ahead of us. This episode is actually
one of the concepts within plastic surgery that is the
one of the most important aspects of my practice over
twenty plus years, something that I've repeated and continue to
(00:29):
repeat and repeat, probably till I retire, Things that I
post about all the time, things that we discussed NonStop,
which is what is the holy grail of an amazing scar?
What is the truth behind getting a fantastic scar? That
is I'm having surgery, if not my biggest one of
(00:52):
my biggest concerns is having a garbage, terrible, horrible, thick,
ugly scar. I really wish and I pray that I
have an invisible scar or a barely visible scar. So
this is really really important because, in my opinion, it's
the underbelly, It's the basic premise behind all of cosmetic surgery.
(01:14):
If you have your gallbladder removed and your scar is
not ideal in a weird way, you can substantiate it
in your own brain and you're like, well, I mean,
I was sick and my gall bladder blah blah blah.
Same thing with a hysterectomy, even a C section. Don't
get me wrong, nobody likes ugly scars at any time.
But when you go to get a breast lift or
a tummy tuck or a face if and the scars
turn out terrible, you've literally gone in to do an
(01:36):
esthetic surgery because there's something about your body that kind
of makes you insecure. You're hoping as a result of
this surgery and all this money and suffering, you come
out more secure. And now you've exchanged one problem for
arguably another problem, and in some instance it's a bigger,
worse problem because at least the problem before was natural.
So nothing, in my opinion, is more important than decisions
(02:00):
and scars. And arguably nothing is more misleading and nonsensical
and mislead and and patients are lied to more than
when it comes to scars. So what are we going
to chat about? Number One, We're going to talk about
what actually improves scars and what is just garbage marketing
mumbo jumbo. Number two, we're going to talk about sort
(02:21):
of how a scar is supposed to behave. What's the timeline,
what's the sort of the normal healing process of a scar.
We're going to talk about how anatomy plays a role,
how your genetics plays a role, and then we're going
to talk about if and when I have a horrible scar,
(02:43):
what do I do about it, what's the timing for
a scar revision, et cetera. So one of the basic
misconceptions of scars, as follows number one, is that if
I go to a plastic surgeon, right, I should and
can't expect for there to be no scar. So the
word scarless is thrown around in plastic surgery like no
(03:07):
one's business. It is a lie. There is no such
thing as scarless anything surgical. I am creating a scar,
even if the scar is literally three millimeters. Three millimeters,
Ladies and gentlemen, go get a ruler out. Three millimeters
(03:28):
is microscopic. It's a scar. I punctured you, I made
a hole. I cut you, and every human being unless
they're neonate in the in the uterus, in the womb,
makes a visible scar. So the question of whether or
not I can have a scarless breastlift, scarless tummy tuck,
scarless facelift is a lie. There are people advertising scarless facelifts.
(03:51):
It's not scarless. It is a very well concealed scar,
one in the hairline and all intents and purposes, it
hides a scar well, but it's not scarless by any means.
If you shaved your head, you would see the scar.
So that's number one. The idea is that, oh, in
order for me to get a good scar, I need
to do ABCD. In other words, I need creams, I
(04:14):
need lasers, I need injections, that sort of. This notion
that we live in today is more is better. So
I had a surgery, and in order for me to
get a good outcome, if I don't do at least
four or five things, I'm going to be for sure
guaranteed a terrible scar. And if I do the four
or five things, I'm going to for sure be guaranteed
day better scar. Totally a lie, complete myth, nonsense. The
(04:37):
idea that all scars heal should heal the same, even
within you, so you are the same person, even with
the same surgeon. I'm the same surgeon, in different areas
of your body, you will have different healing. I lid
scars can and should heal nearly invisible again. Notice I
(05:01):
said nearly. It's there, but it's so faint and so
thin that we would probably look for it for a minute.
But a scar on your shoulder is going to heal
much thicker. A scar on your knee will thick be thicker.
The one across your chest will be thicker. Even though
you and me are the same, there is, for an
excuse me, different anatomy, different thickness, different tension, etc. So
(05:24):
definitely scars are not all the same. Next, I'm going
to run out to scar I had surgery yesterday. I'm
going to run out and start intervening with lasers and
creams and stuff. Not only do they not really work,
in my opinion, the worst thing you can do is
start to mess with them when the scar is premature
and naive and hasn't even begun to heal. It's kind
of like mowing your grasp before it has a chance
(05:46):
to really grow in and be solid. If you go
and plant some seeds and make grass grow and it's
just barely you know, that little flimsy, shitty grass that
you have growing in the beginning, and then you run
a blonwd mower over it, you're going to just destroy it.
It's not ready for any kind of intervention. And lastly,
this idea or notion that every scar can be fixed,
what do you mean? So there are individuals who call
(06:07):
my office who have had multiple interventions and really, unfortunately
and sadly do not understand that sometimes it is what
it is and we need to accept that. So let's
dive into the idea of in my opinion, the number
one listen carefully, number one thing that leads to a good, thin, flat, narrow,
(06:37):
light scar versus a bad, wide, raised, thick, dark scar.
So let me rephrase that again for you understand. We
need to first define what our goal is, what is
our endpoint. We need to know what we're trying to accomplish.
We are not trying to accomplish an invisible scar or
(06:58):
scarless scar. We're trying to accomplish a really nice and
thin and arguably concealable scar. So the most important thing
in it is your surgeon. Why because at the moment
that the surgeon begins the surgery, he or she is
(07:21):
determining your scar outcome. The second I touch you, I
determine whether or not you will have a good or
bad outcome. Let me explain you why when I do
surgery doesn't matter where on the body, it is. Every
incision I make, I use a brand new blade, sharp
(07:42):
as hell, and I go through all the layers of
the skin with my blade. Let me elaborate so you
understand the skin is made up of multiple layers. It's
it's the epidermis and then the dermiss and then we
get into fat. So surgeons trig Additionally, what they do
is they cut the skin. They go through the epidermis
(08:04):
and a little bit into the dermis, and then they stop.
Why because your skin will start to bleed. The area
of your skin that bleeds when you cut yourself is
the dermis, and if you are a healthy young person,
you will bleed like stink and it's annoying because blood
gets everywhere. So what surgeons normally do is they cut
through part of the dermis and then use electro cottery
(08:29):
that is a hot knife and char and burn through
the rest of the dermis. Why do they do that
because it instantanely stops the bleeding from the skin, and
that makes it easier to continue surgery because you're not
bleeding all over the place. And by bleeding, I'm not
referring to bleeding to death. I'm talking about just annoyance
oozing everywhere and makes things messy. What's the issue, doctor Reband?
(08:54):
The issue is that surgeon has now burned your skin.
You charge the dermis when you close the scar. What
do you think is actually healing in six months to
a year the dermis? So if I burn your eyelid
with cattery, or you spill hot oil on your thigh,
(09:16):
how does that scar heal like shit? So from the
get go, right out of the gate, your surgeon has
fucked you because they have burned the thing that they're
going to come back and sew, and if God forbid,
your body is very inflammatory and reactive, your scar will
heal like shit. So what should they do? They should
(09:38):
inject all of your incisions with local anesthetic with epinephrine
prior to beginning surgery. Then after fifteen or twenty minutes
when they start surgery, that epinephrine is taken full effect,
and when they cut the skin, it doesn't bleed nearly
as much. And they should cut through all the skin
(10:01):
with a knife, sharp, clean, no trauma. Then when they
get to the deeper structures then they can start using
the electrocottery and cauterize and lift the flaps and separate
the breast tissue and ab them in in the data DA.
That right there, ladies and gentlemen, is one of the
most critical elements of surgery that's done every single day
(10:22):
by every type of surgeon. The number of surgeons who
have joined me to watch there and I tell them this,
they're like, ah shit, yeah, you're right. The reason is
they just come in, they start surgery, no one puts local,
they make the cut, it starts bleeding, and then they
hear this and they're burning all those little blood vessels
that later are going to be the source of healing
in your skin. The next thing that matters is how
(10:46):
much tension there is. So when I'm doing a flap,
So these are all the things the surgeon is doing
to make you have a shitty scar. When I'm doing surgery,
I'm removing I'm removing skin from your abdomen, I am
removing skin from your breast, I am removing skin from
(11:07):
your face. I am removing skin from your eyelids. How
much I remove determines if you look good, if you're underdone,
or if you're overdone. So let's talk about when we
overdo things. We remove too much skin from your abdomen.
Oh that sounds terrible. So then I want to close you,
bring you back together, and you are now under a
(11:29):
shit ton of tension, a lot of tension. Why because
I've remove too much skin. So we have to flex
the bed. Flex the bed, flex the bed. Now you're
super hunched over, tight as hell, and we sew you close.
You're closed. It's fine. Now. Every hour of every day
for the next six months, you are pulling on that
scar because you're just trying to stand like a normal person.
(11:52):
When your incisions feel tension, meaning the scar start to
feel pulling, it triggers on a cellular level, your body's
intelligence and it says to the body, fuck, we're coming apart.
We're coming apart, may day, mayday. This incision is about
to rip open. So what does your intelligent body do.
(12:14):
Make a lot more scar tissue, and well, this shit closed. Okay,
Oh no, this is coming apart. Oh no, okay, call
in the troops. More scar, more scar, more scar. Now,
all of a sudden, your scar is twice as thick
because your body doesn't want it to come apart. And
why would it come apart because we've removed too much.
(12:35):
The next thing is as I'm managing and holding all
these tissues that I'm going to sew together, I'm putting
them back together, right, but I have to hold on
to them. I crush the shit out of them with
clamps and squeeze them, and my tech is holding the
flaps really aggressively. So I am opening something up, doing surgery,
and then putting it back together. The thing I'm putting
(12:56):
back together is a thing I'm asking to heal. Right,
I'm putting it back together. Imagine as I'm managing and
holding that tissue as I'm doing my surgery, me or
my tech is crushing it with clamps and being very aggressive.
Now I've crushed and squeezed the edges of your skin
that I am now asking to heal beautifully. How do
(13:16):
you think that's gonna heal? So you are now starting
to understand that when someone tells you you healed like shit,
it's your fault and you didn't use enough cream. Do
you understand how this doesn't all make sense? Now? You
guys don't understand this. No one's gonna blame the surgeon.
But that's the surgeon's fault, and then we get to
(13:38):
how much blood supply is left at the end of it.
So how does a scar heal biologically like on a
cellular level, how does it heal with blood? Blood brings
in nutrients and oxygen and protein and fibroblasts and alas,
and blood physically brings it there. So blood to get there,
it needs blood supply. So when we do surgery, we
(14:00):
lift things up and separate them to make them come together.
If you overly lift things and overly separate them, then
the blood supply to the end where the scar is
doesn't get there, and things heal with less blood supply
and therefore heal worse. So when surgeons do surgeries, they're
(14:22):
very aggressive and they're really lifting up flaps. We refer
to that as undermining, and they're very aggressive while undermining.
That leads to ischemia and separation and gapping and necrosis.
So that makes a huge difference. So if your scar
is gasping because it doesn't have enough oxygen, you shouldn't
(14:43):
be shocked at it's healed like shit or separated. The
next thing that has to do with separation and stuff
has to do with how this is the most singular
important I that I'm going to share with you today.
How well does your surgeon close your incisions? So let's
(15:10):
back up here. Ninety nine percent of surgeons who do
body contouring or large amounts of surgery that means breakioplasts, breastlifts,
tummy tucks, thigh lifts, body lifts. I'm not talking about eyelids.
I'm not talking about chinnogs. Why because those surgeries have
(15:31):
like eight sutures in them, But when I do a
tummy tuck, there's five hundred sutures. Ninety nine percent of
surgeons who do body contouring have someone help them do surgery.
Let's back up here. Have you ever met a busy
lawyer who doesn't have a pairalegal. Have you ever met
a busy accountant who doesn't use a bookkeeper? Have you
(15:52):
ever met a busy architect who doesn't have a draftsman.
How about a dentist who doesn't have a hygienis. Have
you ever been to a restaurant where it's busy and
the waiters don't have bus boys. So it should come
as no surprise and no shock to you that plastic
surgeons and all surgeons for that matter have people who
help them close. So the question you need to be
(16:12):
asking this is so important is every consult you guys
have when you're meeting with your surgeon and you're meeting
them in person, the question you need to ask them
is doctor so and so, asides from you, who is
not in the room, who is not helping you? Who
(16:33):
else other than you is closing? And the answer ninety
nine percent of the time is the tech. I know
you want me to repeat that, the tech. What do
you mean the tech? You mean the tech the guy
that hands the instruments who went to tech school is
not illegal in California. Yeah, but it gets done. And
I can promise you I've been in one hundred oars
(16:55):
with some of the most reputable surgeons that you would
consider world renowned, and they're not even the room closing.
That's right. When it comes to closing, if you're lucky,
your surgeon will close your right breast while the tech
closes the left breast. But more out of times, out
of none, the busier, fat and more successful they are.
They're out of the room, marking the next patient, getting
(17:16):
things going, and the tech and or two techs are
closing your incisions. I promise you, I guarantee you, I
give you my word. They are not closing you in totality,
and in my opinion, that's malpractice. I know it's not malpractice,
even though technically texts are not allowed to close. But
(17:37):
they'll have a physician assistant, they'll have another junior assistant,
they'll have someone there closing besides themselves because they got
to get the hell out and closing is a pain
in the ass. No one likes to close. So where
I have highly highly highly put energy in time and
really dedicate myself is in all the above things. I
(17:58):
just spend the last fifteen minutes telling you, and yes,
ladies and gentlemen, I close. Have closed every single incision
in every single patient for twenty plus years. That is astronomical.
You can ask any tech, you can ask any surgeon.
No one has ever closed a patient of mind since
the day I started. Now, we have closures, and we
(18:21):
have closures, So whipping some sincision together shitty is not
doing the patient a favor. You're actually better off having
the tech close and take their time than have a
surgeon being a rush. When I say I close, I
mean I close and I'm talking about layer after layer
after layer. Why because, as I mentioned to you before,
(18:42):
tension pulling on the incision causes the scars to thicken.
So the way we get around it, because inevitably, even
if you don't remove a lot of tissue, there's tension,
is by putting deeper tissues together, holding the tension deeper
so that the skin has very little tension, so the
scar which you see doesn't look thickened. So when I close,
(19:05):
say an abdominoplasty, a tummy tuck, or a breastlift or
a thigh lift, it's three to four layers of closure,
the deep one, the intermediate one, the superficial one. And
the thing that is even crazier and more bananas is
when I'm done closing, everything is closed. It looks amazing.
We can walk the hell out. I take a stitch
called six o nilon. For those of you who are curious,
(19:27):
go google six on nilon. The size of a six
o nilon suture is that of your hair. It is
the size of your hair. It is a permanent black
suture that I use to close the skin after I've closed,
which then requires for me to take it out because
it's a permanent suture. Why on earth would I do that?
(19:48):
What kind of craziness is that? When I tell other surgeons,
They're like, what are you crazy? I use six on
nylon during eyelid surgery, eelid surgery, facelift surgery, things that
are rhinoplasti super delicate. Why the hell would I use
that during your breast reduction? Because it brings the skin
edges in the most perfect reapproximation. When your skin is
(20:10):
closest to where it was when it started, it makes
the least amount of scar. Think about it. When your
skin is cut open and then brought back together, the
only thing that brings the skin back together is the
scar that welds it back together. The more gaps and
more space there is between the two edges, the more weld,
(20:32):
the more paste, the more cement you need to bring
it together. So if the skin edges are almost kissing
as if they were never separated, your body's like, sweet,
all right, let's just put in a little bit of weld.
If there's tons of gaps and separations and high and
low and your skin's your body's like, what the fuck
(20:54):
is this shit? Now? I need a lot of paste
and a lot of weld and so it has more
burden to do it. So what I just demonstrated to
you is the single most important thing you can do.
Find a surgeon who gives a shit because I assure
you I do not enjoy closing. But I'm a psychoanal
(21:18):
super what's the right word. I'm a real particular person.
Now that being said, Okay, so does oh doctor bonds
from from what you just said? Every one of your
incisions is phenomenal negative, Yes, a lot, and most of
(21:39):
my incisions are fantastic, but some are not. Well, what's
the difference. The difference is the other half, the other
fifty percent of it is your genetic predisposition? What are
you going to make? What kind of scar does your
body generate? So the surgeon's done their part amazing, cross
(22:01):
every t dotted, every eye checked, every box. Now you
can be a great healer and you can be a
shitty healer. What does that mean? Your scars? Are they white?
Are they red? Are they brown? Are they black? Are
they thin? Are they thick? Are they flat? Are they raised?
You have a predisposition? There are individuals, they are not
that many by their way, So don't let the surgeon
(22:22):
blame you for his shitty work. Very commonly, the surgeon says, oh,
you're a terrible healer. You make keloids, and then they
come here, we do a revision and they heal perfect.
Wait what happened to your kiloid making? So yes, the
patients do contribute, but it's far and few between. And
we know that because every once in a while someone
will say, I pierced my ears and I made a
(22:43):
cauliflower a huge, raised, ugly scar. Well, that certainly wasn't
the surgeon. They just poked a hole in it. Or
I cut my elbow and it made this thick, ugly
ass scar. Or my c section is thick, and my
gallbladders and everything I've ever cut becomes thick. Yes, there
are those individuals, and yes those individuals are unlikely to
make an amazing scar. But no, when you heal like shit,
(23:08):
you need an amazing closure. That's when you really need
your surgeon to care because you are already predisposed to
make a terrible scar. So if your surgeon does a
great job, you'll make a terrible scar. And if your
surgeon does a terrible job, you'll make a horrific, awful scar.
So the people who's likely to make a crappier scar
(23:31):
are more in need of making a good closure. Now
there are genetic predispositions. We know that people with very
high quality skin, thick, oily, subacious, amazing beautiful skin, make
crappier scars. Wait what you just said? They make great Yes,
the thicker and more robust your skin, the thicker your scar.
(23:53):
Who has a robust skin? Kids, kids make crappy scars.
Their scars are thicker, raised red. Who makes great scars?
Old people, eighty year old people who get skin cancer
and we rearrange their faces and make all kinds of
crazy scut cuts. Six months later, you're like, where did
it go? Because they have no collagen left in their skin,
and that means they can't make thick scars. My son,
(24:15):
on the other hand, has amazing healing potential. His scars
are going to be crazy thick because his body's like, ew,
let's do this, let's heal. So Black patients, Asian patients,
some Latinos, some Middle Easterners. Those people with thick, oily
skin tend to make thicker scars. Who doesn't make thick scars, Caucasians, people,
(24:35):
Anglo Saxon Irish, Dutch, English, White French, freckily dry. Again generalities,
but generally so the two ladies and gentlemen, most important
things about your scar or your surgeon's willingness to do
the things I mention, and your predisposition. After that, everything
(24:57):
I'm about to tell you, and there's a lot, makes
up five percent of it. You mean the scar creams
five percent of it. You mean the laser five percent
of it? You mean the hyperbarica five percent of it.
If you have a shitty surgeon or you heal poorly,
you can literally put anything you want on your incisions
and nothing's gonna matter. Read the millions and millions of reviews.
(25:20):
Let me ask you a question. If tomorrow there was
a cream a laser that made scars go away or
significantly better, do you think it would be a secret.
Do you think only the guy in Glendale would have
it or the surgeon in Germany would have it? Do
you not think the company that makes the cream or
(25:43):
the company that makes the lasers would be a trillion
dollar business? Just think for a moment. People in Africa
know what botox are because botox works and it's everywhere.
People who who who who live in the middle of
nowhere know what propecia is because it works. It's a
(26:07):
trillion dollars, but you have never Why are there eight
gazillion scar creams and four million lasers because everyone is
full of shit. Trust me, if there was one that
would work, I'd have it. I'd lather it onto every patient.
So let's now get into some of the nuances. So
the role of tension matters. I elaborated, but I'm gonna
(26:29):
highlight it. So if I cut on your shoulder, you're
gonna make a shitty scar compared to your eyelid because
there's movement on your shoulder, and no matter what I
tell you, you're gonna move. So that is why I
am so adamant, and patients get irked for you not
to do any exercise for six weeks. What do you
mean no exercise because you'll start pulling on your incisions early,
(26:51):
which then signals on a molecular level, we need to
thicken and thicken and thicken. So I am very very
about letting scars heal without any undue tension. That has
to do with how much I remove, but also what
you do afterwards. So you want to be very careful.
Where you cut makes a difference. For example, patients come
(27:13):
to me and they say, have a mole in the
middle of my chest. I'd like it removed, No way,
I can't. Literally, we were on vacation and somebody I
saw a beautiful woman with a massive kiloid across your chest,
and I knew. We became friendly with them, and I
knew it came from a ZiT from a single stoop,
and sure enough it was like the size of an
like chocolate bar, and it started as a dot. And
(27:37):
now and it happens, It happens over because there's so
much tension across your chest. Every time you breathe and
move and grab, it's pulling and that creates thick, thick scars.
So you want to avoid areas on your face that
have high tension. So it's very very important. Now let's
talk about what actually does help in the five percent category.
(28:04):
So we're in the five percent category. Now we've established
it's nothing big, but so scar creams and scar strips
aka silicone so yes, if you are a burn patient
and your scars are super super thick, there are two
things that we know work and they probably work in conjunction.
(28:24):
One is tension and one is some silicone because of
some electric magnetic changes. So let's back up here. So
probably the number one thing you can do. People never
believe me because they're expecting it to be some expensive
special thing is massage. What happens is your body at
(28:49):
six weeks. Let me back up here. Sorry, it is
so much for me to tell you. Let me tell
you about general healing. When you come to my office
and I operate on you, within the first four weeks,
you will think I walk on water. Why because your
scar will I promise you be as thin as dental flaws.
I give you my word. Why because I spent shit
(29:09):
ton of time closing it and it's pristine. But then
at six weeks, your body goes thanks so much for
all the help. Let me take over from here, and
what you start doing around six weeks is start laying
down scar tissue till then the only thing holding your
scar together is all the sutures I put in. But
we both know that those sutures are temporary because they're deep,
(29:32):
and we both know that what holds you together year four, five, six, seven,
nine thirty is scar tissue. That scar tissue doesn't kick
in for a little bit, and around six weeks you
start noticing, hmm, my scar is getting a little red. Huh,
my scar is getting a little itchy. Huh, my scar
is getting a little raised. And all those are normal,
because that means your scar is healing. Your body is healing.
(29:55):
It is bringing in all the tools. It's bringing in
the cement and the bricks and the grout and all
that other stuff that's healing. Starts around six weeks and
kind of keeps going and going and going and going
and going somewhere around like six to eight nine months.
Your body will continuously build scar for that period of time,
(30:21):
and that is why scars tend to get thicker, redder,
more itchy, more raised. For six months, it doesn't matter
how great you're a surgeon. Closed. It is healing, and
you now get this sudden desire to do something to it.
But it's in the middle of healing the scars of
(30:43):
mind that turn into invisible lines. We're thick, a little thick,
a little red, and a little itchy. Around six months, now,
around six months seven months, your body goes click, We're done.
We're done building. It's done. The inflammation is done. We're done.
We're done. Done. Then your body goes okay, guys, let's
make this a little cleaner. It's kind of messy, and
(31:06):
remodeling starts, and your body starts to cool off. The
redness starts gradually fading, the scar starts gradually flattening, the
itching and pain starts going away, the numbness around it
starts improving. That process of remodeling takes up to two
(31:29):
to three years. Come on, what do you two to
three years? But you should incrementally see your scar getting better,
a little less red, a little less follen, and slow
on and so forth, so on and so forth. So
a normal, amazingly healed wound does what I just said
to you. So when you look at your scar, and
(31:51):
let's say it's healing pretty good and it's been around
six months, be patient. People come to me all the
time and ask for scar revision. Hey, doctor, bondiscar looks
like shit. I want to fix. How long ago do
you have your surgery? Four months ago? Won't touch it? Well?
Why not? Because it's inflamed. Even though it may still
heal like crap, We want to let it cool off.
(32:13):
Number one. Every once in a while, things get better
enough where you're like, oh, it's not amazing, but it's
this is tolerable because you're looking at it at its
worst point, and then otherwise the tension releases, it relaxes.
If I go in in the middle of a storm
and try to clean up and fix things, what do
(32:33):
you think is going to happen in the middle of
a storm. I'm going to create another storm within a storm.
So you need to be patient, and your surgeons need
to advise you to just take it easy. The next
thing that happens that drives me insane and bananas is
pay attention so important. You're at six months, your scar's
a little red, a little itchy. You go to your
(32:54):
spa and boom, They're like, let's put in some steroid.
Steroid injections is the kiss of death. Go look at
my post, Go read the hundreds and thousands of people
they put steroid. And steroid is like napalm and it
just phsh and it thins out and stops everything. Well
(33:15):
that's great, yeah, it it is way too aggressive. And
what it does is it, yes, will turn off the
redness in many instances and flatten things in many instances
and also start destroying the surrounding tissue, all the healthy skin,
all the fat that's underneath. You start getting tel adjectasis,
and then you get something that was maybe manageable. Now
(33:37):
it's this mote and it's just completely destroyed. Imagine you
just take a flamethrower at it. So you can read
time and time and time and time again, people saying
that they went and they got steroids, and within couple
of weeks to months the ARAA just hollowed out. So
you do not go get steroid injections in the middle
of your healing when it's healing well, unless once in
(34:00):
a blue moon it's super thick and someone knows what
the hell they're doing. Nine out of ten times it backfires.
I've probably injected steroids in a scar ten times and
twenty years, and I deal only with scars. So avoid that.
You run out and get a bunch of lasers. Oh
lasers work, Oh my god, advertisements for lasers insane. Lasers
(34:24):
don't do shit. All they do is irritate and aggravate.
Do you know how many dark skin patients have come
to me over the years whose scars were slowly fading.
They weren't gone, they were getting impatient, and then they
go and get a laser done, and then all of
a sudden, the whole area darkens. It gets much darker,
and now they have to use like pigment cream and whatever.
(34:46):
Lasers are burning and heating the surface. The very most
they can do, the very most they can do is
take a little bit of texture off the top of it.
You want a laser and mature scar, have at it.
I don't think it's gonna help much. But when you
start lasering immature scars, you start adding heat to a
thing that's already was heated and it's trying to heal.
(35:07):
Oh but I saw amazing before and afters. Oh did you? Hmm?
Let's talk about her before and afters from lasers. So
what they do is they take a picture of a
scar that's at six months, which is premature and healing,
then they laser it. Then they show you the scar
at a year and a half, and what, oh my god,
(35:28):
look at that. The scar went away? And what was
gonna happen if you didn't laser it. It was gonna
go away. So these creams and scar lasers that people
show you is bullshit, because what you need to do
is show the scar without the laser in the cream,
and the scar with the laser in the cream, and
(35:48):
then show me at eighteen months, and if you can
show me that that area that was lasered is better
than the area that wasn't. Now we're talking. They never
do that. They show a scar that's on its way
to healing, and then they put cocoa oil and butter
and vitamin e and blueberry juice, and it heals. It
was healing anyways. You just didn't wait long enough. So
(36:13):
don't do it. You are wasting money. One of two
things are gonna happen. One, you wasted money. It healed anyways,
didn't help. Two it made things worse and hollowed things
out or made it hyperpigmented. The only two things that
I think work is some silicone, which I will elaborate on,
and the other is pressure. So now we go back
(36:36):
to what I told you does work. Silicone works because
somehow it creates some barrier. No one really fully understands it,
and it does some kind of like electromagnetic something. We
used to use silicone strips. I don't use silicone strips. Well,
why not? You just said silicone works? Because when you
put the silicone strip on an incision, it buries and
(36:58):
doesn't let the incision breathe. Skin is breathing, it exudes oils,
Things come out of your skin, and when you cover it, it
gets trapped and you get irritation, and you get pimples
and dirt and bacteria and redness. And people often say
(37:23):
that when I was using the silicone strips, my skin didntolerated. Well,
the reason is not the silicone, but the barrier. When
I let wounds heal, I let them always breathe. I
don't use steriry strips, I don't use exclusive cover dressings.
I let your incisions breathe because they're breathable. Have you
ever tried to put like a glove on for long
(37:45):
hours or get your skin super wet. It doesn't breathe,
and all of a sudden your skin looks like shit.
Your skin needs to breathe. So now we have liquid silicone,
which is kind of like a thin barrier. And I
like the liquid silicone, So I recommend to my patients
a little bit of liquid silicone. Is it the Holy
Grail is gonna save your life? Now? But I do
(38:05):
think it's better than nothing. Now, what I do think works,
and I do think works really well. Is pressure? What
do I mean by pressure? Pressure means that your scars
are healing and they think their job is to make
this scar super thick and protect you from coming apart.
(38:26):
When you massage or put pressure on a cellular level.
It has been shown that the collagen, the fibroblast, the
elastin goes from being all bunched up under a microscope.
When you look at it, it's imagine all mangled like
hair is all tangled up, and when you put pressure
(38:49):
on it consistently and massage it, they all line up.
Everything lines up. It's like combing hair. The hair lines
up and it flattens and thins out out. That is
why when patients are burned we put silicone and thick, thick,
thick gloves or pressure garments because the pressure on the
(39:09):
scar sells it to chill axe chill axe. So what
you do is you try to apply the scar cream
with gentle massage at six weeks and on, not right away.
What do I do immediately, doctor Raban? Nothing? What do
you mean nothing? Immediately? Don't touch your scar for six weeks.
(39:32):
Don't touch your scar for six weeks it needs. That's
the little grass growing. You start fucking with it and
walking on it and mowing it and trimming it, you
will kill the grass. It needs a chance to anchor
and grow and seed and be permanent before you start
mowing it. At six weeks, your scars now mature and
you can start doing whatever you want to do to it.
(39:54):
I would recommend taking a little bit of scar cream
and generally massaging the scar on a regular basis with
digital pressure. The more you massage, the better it does.
But I can't massage constantly. Aha, That's where paper tape
comes in. So if you come to my office and
you are my patient, I have some old school techniques
that I use, and they're what I refer to the
(40:15):
poor man's scar management. Surgeons love to advertise, come to me.
I'm doctor so and so I have I do your surgery.
And guess what, I have a very elaborate post operative
scar management treatment that nobody else has. Really, doctor, really
is that? What it is is that the truth? My
scar management costs you fifty bucks. Go look at my
(40:38):
scars fifty bucks because it's me and you and a
bunch of little things. So massage liquid scar cream and
some paper tape. That's it. Everything else to this point
is bullshit. Not because I'm trying to be cool and
tell you go do it. I don't care. If it worked,
(40:59):
I would want You don't think I want to have
invisible scars me, of course I do. I'll become the
best surgeon ever. The number one things the patient's complained
about online is shitty scars. So if I could advertise
that I have no scars or the most amazing scars
because I use a special cream or laser. Nobody else
has it, just doctor Raban, then I'd be like making
(41:19):
trillions of dollars. It's just not true. If I didn't
have to sew you up, I would be heaven Heaven.
I'd be out of the o R in like half
the time. But it's not gonna happen. So unfortunately, as
the saying goes, if it's too good to be true,
it's not true. And the old saying goes is there
are no shortcuts, And the shortcuts that are not there
(41:40):
is that I have to sit there sew you excellent.
You have to be a good patient, follow my instructions.
You cannot go and start doing yoga in two weeks
start pulling on everything. And last, but not least, you
got to stay out of the goddamn sun, because if
you are a pigmented person, not a white person, when
(42:00):
you sit in the sun, your body decides to generate
some pigment and it's going to pigment the scar. But
even that, while it is important, is overrated. So I
hope that very long, elaborate, entailed explanation of scars helps you.
(42:20):
The last thing I'm going to tell you is okay, well, great,
doctor obaum well, I appreciate that, but it's too late.
I already have the goddamn scar. My breastcar sucks, my
ABDOMINOPLASTI scar sucks, my c section sucks, my gallbladder sucks,
my orthopedic surgery sucks. What do I do about that now?
And the answer is very simple. After probably around six
(42:40):
months to a year, that scar is not fully mature,
because I told you it takes two to three years,
but it's mature enough. You need to revise it. You
can sit there and sprinkle all the cream and lasers
and steroids you like, nothing's going to change. You need
to come in, find us ur who will cut it out,
(43:01):
throw it in the trash it then now is a
brand new incision. And then you do everything I just
said as if you're starting from scratch A. The surgeon
must take their time. Multilayer closure, release the tension, make
sure not to over undermine. Close it pristine. Two, you
(43:22):
need to have reasonable genetics. So out of every ten
patients that come to my practice with shitty scars, eight
of them are significantly better. Two of them look exactly
the same. When you come to me and I revise
your scar, and you look exactly the same. It's your genetics.
It's your genetics. You've got to make it, and you're
(43:43):
gonna make it, and you're gonna make it. But eight
out of ten were told it was their genetics, and
when we revise them they did better. So cut it out.
Do the closure I mentioned. You find someone who really cares,
hope that your genetics is the eight out of ten,
not the two out of ten. Do the basic things
(44:04):
I did. The one caveat is if you have a
lot of tension, listen carefully. If you have a lot
of tension, they remove way too much skin from my belly,
way too much skin around my areola. Then cutting it
out and closing it will one hundred percent fail because
(44:27):
you are now taking something that's so tight, cutting out
scar and making it tighter. It's now tighter, it's tighter
than it was. There's no closure, special magic that's gonna
make more skin. And so when a patient comes to
me sadly and that is the way they got to
where they got and they're super tight or whatever. As
(44:49):
much as I want nothing more than to be a
hero and help you, I know that if I cut
it out and close it, I'm gonna be right back
where you are even more risky. It could come apart
and separate. So when it comes to revisions, you need
to make sure you are a good candidate. But many
many many patients over the years I've revised their scars
and they're significantly better. So do not allow doctors to
(45:13):
gaslight you that, hey doctor, it's odd, but like my
C section healed pretty good, but my breastlift healed like shit.
Oh it's your genetics. Really, it's my genetics. So many
times they'll blame you for their own shitty work, or
that you didn't use enough creams or better. Yet, now
that I've already charged you tons of money for your surgery.
(45:33):
Why don't you come in and let me do five
rounds of lasers and twenty five injections, and by the way,
I'm going to charge you for that, and at the
end you're no better, And well, what can I tell you?
It was your genetics at any rate. That's a wrap.
I'm very passionate about this because I feel like it's
like the most basic aspect of plastic surgery, and it's
the most under under It's the most poorly understood aspect
(45:57):
of plastic surgery. And the more advanced we get, the
more we rely on other things to lead to good outcomes.
All right, guys, that's a rap. That's yet another amazing
episode of plastic surgery uncensored as always, I'm going to
leave you with two partying requests. One is, if you
love my show, if you love the episode, if you
love listening to plastic surgery and censored. Right now, before
(46:20):
you get off the treadmill, go and write a lovely review.
Everyone who puts this show together appreciate it and makes
them feel good about being here on a Sunday. The
other is, right now, before you get off that treadmill,
forward this show to two friends two friends that you
probably don't think two plastic surgery. But whoa what do
(46:41):
you know? So and so just did it and they
didn't tell you and now they look like crap. You
never know who's going to need or benefit from this information,
and if you send it to them, frankly, you could
be doing them a huge favor. All right, guys, that's
a rap. Until next week, I'm your host, doctor Rody Rabond.
See you on plastic surgery Uncensored
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