Mixed Martial Arts MMA and Plastic Surgery

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When most people think about plastic surgery and mixed martial arts (MMA), boxing etc they think of broken noses, facial bone fractures, cauliflower ears, skin abrasions and cuts. In unarmed fighting the skin is torn open when an outside blunt force pushes that skin against the edge of a bone. You see this frequently in boxing matches with skin around the eye socket being torn open. In boxing they put pressure on the tear while the boxer is in the corner to stop the bleeding. Some fighters have a facial bone structure with less edges or flatter surface contour. These fighters are less susceptible to having tears in the skin when struck. For both boxers and MMA fighters these tears are usually sutured by non-plastic surgeons who just suture the outer layer of the skin. After these heal there is a thinner layer of tissue between the skin surface and the edge of the bone. This condition leaves the fighter more susceptible to another tear in the skin when it is struck. The blow could even be an otherwise inconsequential one.

Some of these fighters are now undergoing surgery to rasp or burr down these bone edges. At the same time the deeper layers that separated at the time of the initial injury are repaired and/or the surgeon inserts an acellular dermal matrix (commercially available human skin collagen without skin cells) to increase the tissue between the skin surface and the bone. This so to speak softens the blow.

The question remains whether athletic commissions will allow this or will they consider this performance enhancement comparable to anabolic steroids and ban it.

Aaron Stone MD - Plastic Surgeon Los Angeles
Aaron Stone MD - twitter

Scars, Keloids and Hypertrophic Scars

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This blog covers skin scars only but does not include burn scars or scars related to breast implants.

Virtually everyone who lives long enough will have a skin scar from elective surgery or an injury. There has been a barrage of cosmetic surgery procedure modifications to decrease total incision length in the hope of creating less scarring. The healing of these disruptions in the skin surface follows a specific process. After the injury or cut there is bleeding. Once this stops an inflammatory process starts to get the cells needed for healing into the wound. New blood vessels grow into the area bringing in the energy needed to complete the healing process. You see this as a red color of the scar and the skin immediately next to the scar that blanches white with finger pressure. Within a week or two the healing is sufficiently strong that the wound should not reopen and any sutures that were placed can be removed. Even though the wound is healed it then must mature over the next 6 to 9 months depending on the type of injury, affected body part, age of individual etc. before the redness goes away and the increased blood flow is no longer needed. Once the scar has fully matured it usually does not blanch with finger pressure. Any problems in this process such as an infection, failure to suture a wound closed, certain vitamin deficiencies etc. prolong the healing time and in doing so result in worse more visible scarring. The skin of younger individuals makes strong repairs and tends to over heal, resulting in larger, thicker scars than on older skin. Skin over the jawbone is tighter than skin on the cheek and will tend to increase a scar's prominence. All scars are more amenable to treatment early in their life span before they mature. It is easier to prevent a bad scar from forming by control/manipulation in the early phases of wound healing than to treat one that has already formed.