For Immediate Release: January 31, 2003

ARLINGTON HEIGHTS, Ill. - With more African Americans having cosmetic surgery, plastic surgeons are developing innovative approaches to reduce and manage unsightly keloid and hypertrophic scarring, says the American Society of Plastic Surgeons (ASPS). This risk of surgery can be a concern for African Americans interested in plastic surgery.

Keloids are raised scars that grow beyond the original wound or point of incision, while hypertrophic scars appear raised but stay within the confines of the initial wound or point of incision. Both keloids and hypertrophic scars occur during the healing process and most commonly happen to people of color.

"The causes and treatments of keloid and hypertrophic scarring are continually being researched and can adversely affect the cosmetic result for African American plastic surgery patients," said Emily Pollard, MD, ASPS member, Philadelphia. Dr. Pollard estimates that 25 percent of her patients are African American.

According to ASPS statistics, 373,478 African Americans had cosmetic surgery in 2001. Additionally, more than 227,000 people had scar revision procedures in 2001.

A study published in the February 2003 issue of Plastic and Reconstructive Surgery® (PRS), the official medical journal of the ASPS, explored the use of electron-beam radiation on keloids and hypertrophic scars. Study results showed patients treated with electron-beam radiation for keloids on their neck, earlobes, or lower limbs experienced a significant decrease in keloid appearance. Radiation therapy, however, is not necessarily recommended as a first line of treatment for keloid scarring.

"The majority of my African American patients are pleased with their results," said Dr. Pollard. "African American patients can have plastic surgery with limited scarring and wonderful cosmetic results. I feel that plastic surgery is definitely a realistic option for this ethnic group."

Although there is no way to prevent keloids and hypertrophic scars, some plastic surgeons perform less invasive techniques for procedures requested by their African American patients. Less invasive techniques produce less trauma to underlying tissue which reduces inflammation of the skin and lessens scarring. According to Dr. Pollard, commonly requested procedures by her African American patients include eyelid surgery, breast augmentation, breast reduction, liposuction, and tummy tucks.

"Less invasive techniques are optimal for some African American patients, but not all," cautions Julius Few, MD, ASPS member, Chicago. He estimates that 25 to 30 percent of his patients are African American and of that percentage the incidence of keloid scarring is 5 to 10 percent. "Patients who choose less invasive techniques because of the risk of scarring could compromise an optimal cosmetic result. For example, a patient who has breast reduction surgery via the less invasive liposuction technique may experience less scarring, but her breasts may not have the desired lift. This problem may not have occurred with traditional breast reduction techniques."

If patients are susceptible to keloids and hypertrophic scars, plastic surgeons can strategically place incisions where the scarring would be less visible. For example, during breast augmentation, the incision could be made in the "natural shadow" of the breast as opposed to the nipple or armpit.

"In addition to intra-operative approaches, there are post-operative measures that plastic surgeons can take to reduce scarring," added Dr. Pollard. "Treatment options include topical and injectable medications, pressure therapy, or surgical removal."

The ASPS offers African American patients considering plastic surgery the following information about keloids and hypertrophic scars:

• Although most common in people of color, not all African Americans develop keloids or hypertrophic scars.
• Keloids or hypertrophic scars can appear anywhere on the body, but are most common around the breasts, chest, shoulders, and ears.
• The chances of developing them may increase if there is a family history of keloids or hypertrophic scars.
• If a patient has keloids or hypertrophic scars from a previous incision or wound, there is an increased chance of developing them again.
• The tendency of developing keloids or hypertrophic scars decreases with age.

ASPS, founded in 1931, is the largest plastic surgery organization in the world and the foremost authority on cosmetic and reconstructive plastic surgery. ASPS represents physicians certified by The American Board of Plastic Surgery (ABPS) or The Royal College of Physicians and Surgeons of Canada. For referrals to ABPS-certified plastic surgeons in your area and to learn more about cosmetic and reconstructive plastic surgery, call the ASPS at (888) 4-PLASTIC (1-888-475-2784) or visit www.plasticsurgery.org.