Advice About A Good Plastic Surgeon In Bkk Please

[BoonToong]

Hi folks.

I wonder if anyone can help me please?

My wife (Thai) has a 10 year old scar that is located in the centre of her chest, right above the joint of the manubrium (thanks Google!) and main body of the sternum. She got the scar about 10 years ago in a road traffic accident. The scar tissue covers an oval area of about 2 inches across and 1 inch high.

One small area of the scar (shown at the end of her forefinger) has become uncomfortable, sometimes itchy, and looks as though it has grown very slightly in size. My wife would love to have surgery done to remove the scar but certainly, first off to have the scar looked at to examine the itchy part that she thinks might be growing.

I don't think it is a good idea to visit a cosmetic surgeon in the first instance (because they usually are looking at skin that is in relatively good condition) but rather a plastic surgeon who has experience of working with scar tissue.

Firstly, am I right in my thing of a plastic versus a cosmetic surgeon (I know sometimes they are the same thing)?

Secondly, can anyone please recommend a good specialist in BKK to approach?

Thank you in advance for any help.

[lopburi3]

I am no medical authority but suspect a good dermatologist should be consulted first and they will refer to surgeon if required. I would agree go to medical rather than cosmetic facility. Be aware plastic surgeon fees can be rather high but understand for beauty it can be important. But for now exam is the priority I would think.

[jrtmedic]

Boon Tong

Judging ONLY from the small picture and your description, particularly of itching, I would hazard a guess that part of your wife's scar has become keloid in nature. (You can Google for "Keloid Scar" !)

Keloid scars are common amongst people with darker skin complexions and can be challenging to treat. Your wife would, as suggested above. be well advised, in the first instance, to seek guidance from a Dermatologist. These scars are common amongst Thai people and a Thai Dermatologist will have knowledge and experience of the treatment options for keloid scars.

[BoonToong]

Thanks Lopburi and jrtmedic,

Yes, I will ask her to visit a dermatologist when she gets back to TL this week. Know of any good ones please?

[lopburi3]

I have used three different doctors over the years at Vejthani Hospital and currently (for last 3 years or so) use

http://www.vejthani.com/web-english/Our-Physicians/Our-Physicians.php?id_sr=73

I can not really say she is a specialist for your wifes condition and most dermatology is cosmetic to some extent but she has treated me for several years including BCC and SCC (skin cancer) and many keratinocytes (pre-cancer) by laser and Aldara and plastic surgeon removals. Last pathology required 4 and 3 stitches and she did herself. She is very careful to be sure no pain and to explain everything but admittedly has little experience with skin cancer (which may be good as she is very careful not to assume and to make sure).

[frozin1]

Unfortunately your wife had an injury in a high tension area of skin, her sternum. Skin tension is the major factor that determines scar size, incisions along the tension lines yield the smallest scars and those made at 90 degrees across the skin tension lines yield the largest (all other things held constant). Based on the photo you provided it appears as if a portion of the skin may have been lost (avulsed) during the original trauma. The body responded by filling in that portion of missing skin with scar tissue. Scars cannot be removed they can be resected or revised to improve it's (the scars) appearance. W-plastys and Z-plastys work by chopping up the scar in smaller sections that cross the skin tension lines at less acute angles. These techniques work best with linear scars not the type of pancake scar that your wife has. A full ellipitical excision of a 1" width scar would need to be at least 3" in length in order to bring the skin edges together without "dog ears" at the edges of the revision. That would be possible on the back or abdomen but a very big risk on the sternum. Many different options for dermatology, pulsed laser, intralesional steroid injections, etc. There are also some very good makeups to help minimize the scars visual appearance, such as CoverMark^tm. Based on the photo, surgery should be the last resort as your wife could possibly end up with an even worse cosmetic outcome.

In Bangkok if you want high end work you will pay high end prices. BG would be my personal choice for this type of consultation as they are JCAHO accredited and have to maintain high standards to achieve that status.

Good Luck!

[BoonToong]

Thanks frozin1 (are you a fellow Scot?).

Thank you for the advice and I think you are right about surgery not being able to get rid of the scar. The skin over her sternum is so thin too and already looks stretched.

I think as long as we get a skin specialist to check that the small, itchy, areas are 'safe', then she will continue to live with it.

What is 'BG'? And would you still recommend them if we don't go down the scar-removal route?

Thanks again everyone for your input, it has helped.

[lopburi3]

I suspect he means (BH) Bangkok Hospital (Bangkok General). It is one of the most expensive hospitals in Thailand and a member of the huge Bangkok Hospital Group.

[frozin1]

As to you first inquiry, sorry I'm a (humble..lol) Yank of Irish ancestry.

About the second question I meant Bumrungrad Hospital. Bangkok Hospital Group is good too if it's what used to be called Bangkok Pattaya Hospital (in Pattaya).

Sorry for any confusion!

F1

[yannic]

frozin1 gave a great detailed advice. I can only say out of own experience from my wife, she had a kelloid scar and was treated by the best known scar specialist in my home country, a Professor Dr. Dr., and even he did say in the beginning what will be the outcome, nevertheless my wife wanted to have the surgery. The outcome is a bigger scar. Now she gets injections mentioned above which helps to a certain degree. DO NOT go for a surgery!

[BoonToong]

Update.

We had to leave Thailand before my wife had the chance to have this looked at. In the past months, however, she has every day been sticking a clear silicone patch over the area. These patches are advertised as being for the improvement of scars.

I admit to being highly sceptical at first but I have to say that the results are amazing; the small growth has almost fully disappeared and the scarred area overall looks much smoother.

She's a happy bunny about it