COSM13: Complex Cases, High Stakes Pose Challenge for Plastic Surgeons

When there’s a question about whether the lobule needs adjusting after the antihelical fold and conchal bowl are addressed, it’s best to make the adjustment, Dr. Ries said. “If you need to do it, do it,” he said. “If you think you need to do it, do it.”

Ultimately, a deep appreciation of the anatomy is essential, he said. “It’s important to have an in-depth understanding of the underlying anatomy, and the causes of the deformity, to avoid the pitfalls,” he said.

Scar Repair

J. Regan Thomas, MD, professor and head of the otolaryngology-head and neck surgery department at the University of Illinois in Chicago, who spoke about repair of scarring, said both patients and physicians put too much faith in lasers. “The laser is overused and being overpromoted by a number of our colleagues as sort of the panacea of scar revision and scar treatment,” he said. “Unfortunately, I think that’s a fairly widespread conclusion.”

There are a “number of alternatives” based on scar analysis and scar type, he said. Dermabrasion, along with procedures that reposition the scar tissue, can be just as effective as laser treatment, perhaps more so. Additionally, it comes at a much lower cost—hundreds of dollars for dermabrasion equipment versus thousands for a laser.

He said he is careful to let patients know that they can’t simply get rid of their scars. Instead, the goal is develop the “ideal scar,” such as turning a scar that is a straight line into a pattern that is not as easy for the eye to follow, and therefore less visible, especially once it is smoothed out through dermabrasion. “The concept here,” Dr. Thomas said, “is that we’re trying to fool the eye.”