Dallas Facial Plastic Surgeon Dr. Sam Lam talks about how he closes wounds in a plastic surgical technique and highlights some differences between those who are trained in plastic surgery techniques and those who are not.

Full Audio Transcript:

This is a podcast talking about basic sewing techniques.

You know, there’s an old joke, which is what’s the definition of plastic surgery? Surgery done right.

And essentially what that means is that people say, well, look, if you have an accident, go to a plastic surgeon.

They’ll close it better.

Shouldn’t a surgeon just close it better?

And if that’s part of what you’re doing.

When I was doing head neck surgery, a lot of the neurosurgeons, sorry about this Neurosurgeons.

would have these horrible staple marks all over the scalp, cut everywhere, not caring about how the closure is, in a way, because they’re focused on the brain, they’re focused on getting the tumor out, making sure the patient survives, which is a noble surgery.

But if you’re a surgeon, shouldn’t you also care about the closure?

Shouldn’t you care about which direction the incision goes to follow what’s called relaxing tension lines, do it without tension, undermine appropriately, do the rotational flaps to better camouflage things, et cetera, et cetera, et cetera.

And I’m not going to go through all the million techniques of what a plastic surgeon does to help with making scars look good in terms of closure.

I’ve talked about some of those techniques in some other podcasts, but I thought about one thing, is that how I try to make an incision close better in terms of alignment.

So the way that I do it is, for example, if I’ve got one side of the incision longer than the other side and it’s not overly too long, I will compensate by taking larger bites on the side that is longer so that I will be able to match the two sides up.

And if you take bigger bytes on the longer side and smaller bites on the smaller side, eventually the two sides will match up and be even.

And if you can distribute that little bit of excess on one side versus the other, then you don’t have to extend the incision too long to compensate for that.

And you won’t notice any noticeable bunching because you’re creating micro bunches all the way across rather than one big bunch.

And what’s unique about the human skin is if you create a lot of little tiny micro differences or bumps or elevations, the body will actually flatten out any of those minor things.

And sometimes I’m trying to cheat and not make an incision too long.

So to chase what’s called a dog ear,

I’m not trying to make the decision too long to chase the dog ear.

I’m compensating through these techniques.

The other thing you can see too, is if you are seeing one side being beveled up and the other side being a little too low.

So one side is higher than the other, the side that’s higher, I’ll take a smaller bite, and the side that’s lower, I’ll take a larger bite and I can actually draw up the lower side to be flush.

Even with the top side, there’s so many things that I can talk about from if I see a trapdoor deformity how I can prevent that, how I fix that, undermining what planes of dissection I do compared to elsewhere.

But the reason I emphasize this is that today there are a lot of people that are calling themselves plastic surgeons or cosmetic surgeons who really have no formal training in facial plastic surgery or plastic surgery, and they’re doing everything willy nilly.

And so without that background in plastic surgery, I think you’re not going to be taking care of wounds appropriately through the sophisticated techniques.

So I’m just talking specifically in this case about how I just a couple of examples really, about the myriad or millions of ways that I do to make a wound close well and beautifully and imperceptibly.

I haven’t even talked about following the transitions and along what’s called subunits.

There’s a million things I could talk about, but I just picked a couple of points that I called sewing 101 of how a wound should be closed precisely and perfectly for optimal disappearance, if you will.