Scar Removal: A Patient's Story  

A middle-aged man from the northern parts of Bengal suffered deep cuts all over his face in an accident. He was operated upon in a local hospital but got into depression because of the scars and the social stigma that went with it. He was determined to get over his scars and redeem his face once again.

Image by Aziz Acharki

Falling Face First Into Agony Before Standing Back Up Again.

Bad things sometimes happen to good people. I have always regarded myself as one of the good people. I am friendly and kind to others and animals. Yes, I am your everyday good guy. I adore children. Yet children do not adore me. They see me as a monster, not because of what I do, but because of how I look. It breaks my heart every time I see them instinctively pull away when they look at me. What they see is a face disfigured by ugly red scars.

It all started when I tried to replace a broken window in my office. I tripped, the glass shattered into a thousand pieces, and I fell facedown into those sharp shards of glass. They cut into my hands and face. The pain was excruciating. There was blood everywhere, and at one stage, I passed out from the pain. Luckily a neighbor saw what had happened and immediately alerted my family back in the house.

At the hospital, the doctor worked on me for several hours and stitched my wounds together as best he could. The following day I was back at home. My head was completely covered in bandages, with only my eyes exposed to the scrutiny of the outside world. The painful cuts on my hands made it difficult to perform small actions, such as dressing myself. Inside me was only uncertainty and fear. What did the bandages hide? How bad was it?

The moment of truth finally arrived. It was time to remove the bandages.  When I walked into the doctor’s chamber in my hometown in the northern parts of Bengal, he gave me what I can only describe as a motivational speech. He told me that I was about to get the shock of my life, but that did not mean my life was over. We will take this one step at a time, he said. That is when I knew the news I was about to receive would be devastating.

 

It was.

He removed the bandages and held a mirror in front of my face. I stared at a stitched wound stretching from my hairline through the forehead and the eyes till my lower cheek and a cut that opened my upper lip. It didn’t end there. Numerous stitched cuts of various shapes and sizes were scattered on my face.

The room started spinning. I opened my mouth to cry out, but there was no sound. I was in total shock. The image in the mirror did not resemble me. It was something from a horror movie. I felt myself going numb.

I just sat there and stared at nothing for a long, long time.

 

That was the beginning of a day-to-day struggle to hide my face. Every morning brought the same realization: I did not have the power to get up and face this day.

It was clear from the start that the wounds would leave ugly scars. I had to deal with it and did not know how. The prospect of living life with a scarred face sent shiver upon shiver down my spine.

The emotional scars were the worst. I tried to make peace with the idea that I would never again be the old me. The old me was happy, humorous, and active with a lively social life. Slowly that changed. I became a recluse preferring to hide in the dark where I could find a quiet corner and feel sorry for myself. 

It took several months to drag myself out of the depths of despair. The truth is, I wanted to be me again.  It became an obsession that became a reality.

I decided to seek medical help once again. This time I wanted to have a good talk with a dermatologist or plastic surgeon in the big city. I would find out precisely what it is I could do to get rid of the scars right there and then. A friend referred me to a well-known cosmetic surgeon in Kolkata, Dr. Srinjoy Saha, and I made an appointment.

I had a mixture of different types of scars. In some areas of my face, the scar was ‘depressed’, where it went below the normal skin level. In some areas, it was raised or ‘hypertrophic’, which the doctor explained that this type of scar results when the body has an abnormal reaction to an injury. In a few more areas it was quite dark or ‘hyperpigmented’, where the overlying skin was discolored.

I came back and googled everything, with my interest in scars now reaching an all-time high. After any cut or injury, the skin is supposed to heal itself and the underlying tissues. When it is breached, it sets a process in motion to grow new tissue and fill gaps. The main ingredient it uses is collagen, a protein. The orientation of the collagen as it gets laid in the cut areas determines the final scar outcome.

If the new collagen bundles form and lie parallel to each other, a fine scar would result. If the collagen bundles form a whorl, a hypertrophic scar would form. If there is not enough collagen formation, the scar would appear depressed and atrophic. Again, even if there is good collagen production, but the scar is exposed to sunlight in the early stages of healing, it would get discolored and appear dark.  

Just as important as the operation is the aftercare, which would be entirely in my hands. I understood that I need to give rest to the operated areas, massage my scars very well, apply silicone gel sheets to reduce tension on the scars, and avoid sunlight if I need good results permanently. The wound must at all times be protected from the sun.

I went back to the doctor for finalising my scar surgery. He outlined my options to make the scars less noticeable. It would include a precise incision within the relaxed lines over my face to reduce any tension on the wound's edges. He would then apply tension-relieving sutures deep inside and close the skin with precision microsurgery. A plastic surgeon gets excellent results for skin closure with extremely fine sutures over the face, which are visible only with special magnification.

In some areas of my face, Dr. Srinjoy Saha said that he would prefer not to perform any surgery. Instead, he would treat it gradually with ‘scar normalization therapy’, involving alternate sessions of microinfusion and fractional lasers. He hoped to flatten some of the raised scars and correct the discolored scars in this way, without performing any more cuts and stitches.

I felt relieved after knowing the full details of what lay in store for me. More than the surgery, I was overburdened by the emotional baggage upon my head. The surgery went like breeze. I did not feel any pain during or after the surgery. Dr. Saha was extremely focused all through the process. I took a discharge early morning the next day and did not feel any problem anytime during the hospital stay.

Seven days later, my stitches on the outer skin got removed under magnification. Already, I could see the operated areas being less noticeable. Next, I started on a long arduous journey of aftercare. I was determined to avoid the pitfalls of last time and took extreme care of the new scars, just like it was my new baby.

One month later, I performed a microinfusion over the remaining scar areas. Fractional laser followed 2 weeks later. This cycle of microinfusion treatments and laser therapy went on for the next six months. 3 months into the treatment, I could appreciate major gains in my facial appearance. The newly cut and stitched areas were already not noticeable. The darkness of the discolored scars was much less than before. The raised scars had flattened to a great degree without any surgery already. I knew I was on the right track and in the hands of a good plastic surgeon.

I started receiving appreciative glances from people around me. By now, I understood that people’s reactions are fleeting, so I stopped judging myself from their reactions. I requested the doctor to upgrade and do full face treatments in the final 3 cycles of therapy, and he agreed. I waited with bated breath, as I felt I was getting so close to what I had wanted for so long.

After finishing my sixth cycle of this innovative scar normalization therapy, I was over the moon! People were not able to see more than 90% of the scars at all while talking to me. The few remnant scars had become minuscule by now, adding some character to my face, and not disturbing in any way. The precision plastic microsurgery and advanced scar normalization therapy had worked tremendously well. Finally, I would not scare people away from me anymore.

I went back to the children's park in my neighborhood and sat upon the bench once again. A ball came rolling by, and an angelic child came running after to fetch it. I picked up the ball and offered it to him. He gave me a sweet smile, saying thank you, and took the ball from my hand. As he went back to play, tears streamed down my eyes. I remembered how just a year ago, children would turn their backs to me and run away crying. Life is changing.

Life, here I come!

*****

Credits: The patient's story was transcribed and written for this article by Igert Le Roux.