Scars:
Definition
Plastic surgery is all about modifying the shape. As a matter of fact, the word “plastic” comes from the Greek “plastikos,” which means form. In order to modify the shape of the face or body, we often have to make incisions into the skin to either remove excess skin or access layers beneath it. When we suture the skin back together, the healing process begins. First, the two sides are joined by a glue-like material that the body forms, called a fibrin clot. We then have a period of inflammation and proliferation that allows microscopic blood vessels to grow from side to side. The clot is gradually removed and replaced by collagen fibers that give the wound more strength and prevent separation. By about six weeks, most of the skin’s strength is restored. This is why I tell my patients to be very careful not to distract or pull on the scars until the healing is complete. In plastic surgery, we encourage better healing by pulling together the deep layers of skin with dissolving sutures and approximating the edges carefully to minimize the body’s work and make the healing happen faster and better. Regardless of all our efforts, we must accept that every cut we make in the body will result in a scar. So the scar is the price we pay for a healed wound.
Prevention.
What do I do to make the scar not be visible or be minimally visible, and what makes some people heal so well and not have a visible scar? Now, let’s talk about what makes a scar visible. A great scar would look like a vey thin line in the skin that is not raised, and not red or white or dark. This type of healing is ideal and happens most frequently in the face and eyelids when all efforts have been made to make the wound heal better. The skin has natural tension lines called Langer’s lines. We make every effort to make the scar that we created follow these lines. We also try to hide the scars. For example, when I do a facelift, I place the scar in the natural creases of the skin and behind the ear cartilages. When the scars are by the hairlines, I would cut the hair in a beveled fashion so that the hair would grow through the scar and hide it. In the breast, we keep the scars under the breast and around the areolae as much as possible. In the abdomen, we keep the scars where they could be covered by a bikini, etc. The techniques of skin closure respect three principles: 1) Avoid unnecessary tension in the closure. 2) Absorb tension from the skin by keeping the tension in the deep layers. 3) Meticulous edge-to-edge approximation with no tension. Adhering to these principles and placing the scar in creases, following the Langer’s lines, and hiding as much of the scars as possible will result in the greatest healing of most scars. We often use other preventative measures after surgery like avoiding sun exposure, sunscreens when the incisions are healed, silicone sheets or tapes, silicone gels, paper tapes, onion extract creams, etc.
Treatment of visible scars
Now let’s talk about what makes a scar visible despite all these efforts in certain cases. The visible scars are either hypertrophic, atrophic, or keloid. Hypertrophic scars are raised, red, and wide. They can also be itchy or tender. Atrophic scars are wide and depressed. They can be pigmented or white. The keloids are abnormal growths of collagen fibers that sometimes grow into tumor-like masses. There is often a genetic factor contributing to keloid scar formation, as this is most common amongst African Americans and other darker-skinned people. We talked about the prevention of scars, but what should be done if they happen regardless? The hypertrophic scars could be injected with steroids like triamcinolone, 5-FU, silicone, and pressure, angiotensin receptor blockers, dupilumab, bleomycin, pentoxifylline, laser therapy, and even cryotherapy inside the keloids. Many of these measures are used in combination. Surgical removal and injection treatments are also combined in worse cases. The first thing to do if you notice a visible scar is to talk to your plastic surgeon and plan the correct treatment early. Scarring is the most enigmatic aspect of plastic surgery; therefore, the worst thing you could do is try to research it yourself and fall into the wrong hands and get a treatment that could give you worse results.
Common Questions Patients Search About Choosing a Plastic Surgeon
What is the best age to get plastic surgery?
There is no universal “right” age — the right age depends on the procedure and what's driving the concern. Rhinoplasty is appropriate once the face is fully developed (typically 16+ for girls, 17+ for boys). Lip lift is often best in the 40s and 50s when the upper lip starts to lengthen. Facelift is most commonly performed in the late 50s through the 70s. Dr. Rafizadeh's North Jersey patients span every adult decade; the decision is anatomy-driven, not age-driven.
How do I choose the right plastic surgeon?
Look for board certification by the American Board of Plastic Surgery (not adjacent specialties like “cosmetic surgery”), a substantial volume of the specific procedure you want, a consistent before-and-after gallery, and independent reviews (RealSelf, Google, word of mouth). Ask how often they perform the procedure, what their revision rate is, and whether they use computer simulation during consultation. The right surgeon will answer all of these in concrete terms.
Does the age of the plastic surgeon matter?
Experience tends to matter more than youth. A surgeon who has performed thousands of facelifts over 30+ years has seen anatomic variations a newer surgeon hasn't, and complications they're better prepared to prevent. The right combination is a surgeon who is experienced enough to have refined their technique and engaged enough to incorporate genuine advances (computer imaging, lighter anesthesia, regional nerve blocks). Dr. Rafizadeh has been in practice in Morristown for 40+ years and continues to attend national and international conferences.
Am I too old for cosmetic surgery?
Almost never — what matters is health, not age. Many of Dr. Rafizadeh's North Jersey patients are in their 70s and 80s. The anesthesia plan matters more in this age group: local anesthesia with light sedation (his default for facial procedures) is dramatically safer than general anesthesia for older patients and avoids the cognitive concerns associated with deeper anesthetic exposure.
How much should a board-certified plastic surgeon cost?
Board-certified plastic surgeons typically price 20–40% higher than non-plastic-surgery providers (cosmetic surgeons, ENT-only practices, medspas doing surgical procedures). That premium pays for training, accredited facilities, and the lower revision rates that come with experience. In Northern New Jersey, expecting facelift or breast augmentation pricing below $10,000 should prompt questions about who is actually performing the surgery, where, and with what credentials.
What's the difference between a plastic surgeon and a cosmetic surgeon?
A plastic surgeon is board-certified by the American Board of Plastic Surgery after 6–7 years of dedicated residency. “Cosmetic surgeon” is not a recognized specialty by the American Board of Medical Specialties — the term is used by physicians from other backgrounds (ENT, dermatology, OB/GYN, family medicine, even dentistry) who have taken weekend courses in cosmetic procedures. The distinction matters for safety, particularly for surgical procedures.
What should I not say to a plastic surgeon?
Don't ask for a procedure based on a celebrity's face — great surgeons design results around your bone structure, not someone else's. Don't ask for an arbitrary cup size or millimeter measurement without context; pre-specifying a number often produces results that don't fit. And don't hide your medical history, medications, or supplements — many of these affect bleeding and healing, and your surgeon needs the full picture to plan safely.
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