“No Scar” or “Scarless” Surgical Procedures

An internet search for cosmetic surgery may reveal advertisements for “scarless breast augmentation”, “no scar tummy tuck,” or similar claims.  Is it really possible for a surgical skin incision to heal with no scar?  As much as plastic surgeons try to minimize scarring, it is misleading to claim that a surgical wound will heal with no scar at all.  

Fortunately, many techniques can be employed to minimize scars and sometimes have them fade to the extent that they are barely visible.  

Below are proactive steps I use to minimize the appearance of scars:

1. Meticulous surgical technique and gentle tissue handling.
2. Hiding the scar in the body’s natural contours (for example, breast augmentation surgery scars are located under the breast crease
3. For breast augmentation surgery, a shorter scar is accomplished by using an insertion sleeve (e.g. Keller Funnel).  An insertion sleeve has many advantages, one of which is inserting the breast implant through a smaller incision.
4. Placing incisions where they would be hidden by clothing.  For example, if an abdominoplasty incision is made low on the abdomen (right on the upper pubic region), it will typically be hidden by undergarments.
5. Performing a layered wound closure, so deeper sutures help take tension off the healing skin layer.  
6. For tummy tuck cases, I use a wound closure technique called “quilting sutures” or “sequential tension closure.” These sutures anchor the superficial abdominal tissues down to the underlying abdominal wall, reducing tugging and pulling on the actual tummy tuck incision as it heals.
7. I use dissolving sutures with an incorporated agent that resists bacteria. These sutures (e.g., Monocryl Plus) decrease the risk of suture access. Minimizing infection risk is important since infections can increase scarring. However, these sutures are significantly more expensive, so they are not used by all clinics/hospitals.
8. I use skin tapes (e.g., Steri-strips) or a combination of wound glue plus mesh tape (e.g., Prineo wound closure system) to help ease tension on the wound in the first weeks of healing.
9. All surgery patient having major cosmetic surgery are given a complimentary package of silicone-based scar gel and informed about its use in improving the appearance of scars. Multiple medical studies have shown the benefit of using silicone-based creams or incision tapes to help reduce the appearance of scars.

It is important to have a frank discussion with your surgeon about the anticipated location, length, and appearance of the surgical scar.  In most cases, these scars fade dramatically, but uncommonly thick, raised scars called “keloids” or “hypertrophic scars” will develop.  It is not possible for any surgeon to guarantee that a scar will completely disappear.   

On my website, you will notice that in the photo gallery, some of the postoperative photos specifically reveal the scar.  Others show patients wearing their usual clothing to show that surgical scars are often hidden under a bathing suit or underwear. This enables patients to get an idea of how their result will look both in clothing and completely undressed.

Please note that this information is intended for my patients only.  Medical science is always changing, so the most accurate and up-to-date information will be obtained during an in-person consultation.