AVOTERMIN: A NEW MEDICATION THAT REDUCES SCARRING - OUR PROGRAM FOR SCAR REDUCTION
OCTOBER 2008

A very exciting research study is being presented at The Annual Meeting Of The American Society Of Plastic Surgeons this fall. The study shows that injecting a substance called Avotermin into a wound will result in markedly less scarring. Avotermin promotes healing more similar to normal skin. This is an important step towards our goal of doing cosmetic surgery without noticeable scarring.

Avotermin neutralizes a specific growth factor in skin. This medication has been shown to reduce inflammation in wounds and to promote collagen structure in the scar that is similar to normal skin. Avotermin is being used in clinical trials.

In our Plastic Surgery office in Manhattan, we have a systemic approach to every cosmetic surgery procedure to achieve healing with the least possible scarring.

1. The first thing to say is that the face is privileged. When cosmetic surgery of the face is done properly, scars should really be undetectable. The skin of the face heals especially well.

2. Liposuction is also almost scar-free. One or two tiny puncture wounds in each area are all that is needed.

3. My biggest focus is on minimizing scars in cosmetic surgery of the breasts and of the abdomen.

4. Plan the operation meticulously so that the scars are as short as possible. There has been particular progress with this in cosmetic surgery of the breast.

5. Design the flaps and the incisions properly so that the wound can be closed without tension. Tension will lead to a wide scar. You don't want to pull the skin together.

6. Stitch the wound closed in three or four layers. The edges have to come together perfectly.

7. Close the most superficial layer of the wound with a suture just under the skin that will support the scar for several months and so prevent it from spreading.

8. All the stitches should be absorbable and buried under the skin. No stitches should have to be removed. Stitches that go through the skin and that have to be removed tend to leave stitch marks across the scar and do not support the scar.

9. The incision should be kept covered for several weeks. Depending on the individual patient, we cover the incision with paper tape, with silicone sheeting, or with a gel (Scarfade). Keeping the incision covered with any of these techniques minimizes scars.

10. For the occasional patient who develops a prominent scar, there are a number of ways to treat it. The most common treatments are lasers and injecting the scar with small amounts of Kenalog.

George J. Beraka, M.D.