Once I asked a group of first year medical students “what is plastic surgery”. Not surprisingly many answered that it was removing skin from a part of body and putting it elsewhere. This is what a lot of patients believe- that their face can be improved by putting new skin from their thighs.
Skin grafting is often considered synonymous with plastic surgery. This is a misconception which is slightly more educated than the older version when plastic surgery was thought to involve putting plastic in the body. Skin grafting and using synthetic materials like silicon (not plastic) to enhance the body are certainly the techniques used by plastic surgeons, but only occasionally. That is not what plastic surgery is all about.
Let me first explain how the skin grafting is done and why. Skin grafting is done when there is a large area where the skin is lost- because of burns or accidents. Skin from another part of the body (like thighs) can be used to cover the raw area to allow it to heal. The donor area is usually a hidden part like thighs, hips. Only a thin superficial layer of skin is removed from the donor area. The remaining skin of thigh grows back from its roots (sweat and oil glands) and heals in less than 2 weeks time. It’s like taking cuttings from plants to grow more plants. This is called partial-thickness skin grafting or simply skin grafting. Skin grafting is also done when a tumor or large mole is removed and there is a large gap. This can be covered with a skin graft.
Skin grafting is used extensively by plastic surgeons when dealing with burns, trauma, and cancers. Skin grafting is a lifesaving surgery in major burns. After accidents, it allows the wound to heal fast, and the person can go back to work. But skin grafting to improve a person’s skin or for removing scars is another story – with a not-so-happy ending!
Skin grafting is not a good tool for cosmetic plastic surgery because skin from another part of body will never match. After grafting the grafted skin tends to become darker than surrounding skin and has a different texture. This mismatch improves with time and care but never completely goes. So there is a good chance of a patchwork look. To overcome this full thickness skin graft from certain areas of body is used. Matching with full thickness graft is better than partial thickness graft- but still it is never a total match.
Whenever a mole, scar or a tattoo is removed from any part of body stitching the cut ends together with a line like scar, gives the best cosmetic result. Skin grafting can never match this and, therefore, it is done only as a last resort. True skills of the plastic surgeon lies in the ability to close the gap without using graft. Common situations where patient comes asking for grafting are:
- Burn scars on face or body: Sometimes these patients have already had partial thickness grafting and they are unhappy with the look. If the scar is very bad and limited, full thickness grafting can Improve the scar by fifty percent. Still makeup will be required to look completely normal.
- Acne scars on face: Patients who are very distressed about their acne scars request to replace the face skin with grafting. The face may look worse after skin grafting. These patients improve a lot with skin resurfacing procedures like dermabrasion and skin grafting is not required.
- Tattoo marks: Cutting out the tattoo mark and stitching, or Q switched NdYAG laser is the best option. Skin grafting can be done if nothing else is possible.
- White patches (vitiligo): Cutting and stitching is best for small patches. For larger patches thin partial thickness skin graft is used and patients are usually happy to get rid of white patch even if there is now a darker patch instead.
- Pigmented patches: Here again skin grafting is not of much use because graft itself becomes darker. Only in few instances of dark birthmarks grafting is used.