Dr John Flood on Scars & Strataderm

Do you have scars? How do you manage them?
On today’s episode Trish catches up with Dr John Flood, Specialist Plastic Surgery in Sydney, to talk about scars – surgery scars, all scars, especially in patients who’ve got keloid scars, hypertrophic scars, and certain skin types. He gives us an in-depth and easy to understand explanation about nerve regeneration, and how he chose Strataderm to be part of his own treatment protocol.
Click on the link in our bio. To listen to the full episode.
Dr. John Flood is a leading Plastic and Reconstructive Surgeon based in Sydney and he specialises in Cosmetic Plastic Surgery. Dr Flood has particular interest in Liposuction, Facial Reconstruction post Skin Cancer, Blepharoplasty, and Breast Surgery.
Enjoy listening!
Lastly, kindly subscribe to Aesthetics Uncensored Podcast your Apple Podcast, Google Podcast, and Spotify for more exciting podcasts!

Transcript- Dr John Flood on Scars & StratadermTrish

Hey, listeners, it’s Trish Hammond here on the Aesthetics Uncensored Podcast, and today I’m joined by Dr. John Flood. He’s a leading Plastic and Reconstructive Surgeon based in Sydney and Dr. Flood specialises in Cosmetic Plastic Surgery. Now he offers a comprehensive range of surgical and non surgical procedures across multiple Sydney locations and today we’re going to talk about scars and how to minimise them. So welcome, Dr. Flood.

Dr John

Thank you. Nice to meet you, Trish.

Trish

Nice to meet you, too. I’ve been looking forward to meeting you, so this is great. So tell us first of all, we’re going to talk about Stratpharma, Strataderm and you use it in your clinic.

Dr John

Exclusively. 

Trish

Yeah, right. So tell us a little, what do you love about it? What’s the best thing about it?

Dr John

Look, I’ve been using silicone oils ever since I started practice over 20 years ago, having been introduced to silicone and silicone polymers when I worked in Texas as a fellow and what I’ve found over the years is the silicones without question, aid with scar fading much earlier, and aid with scar flattening and there’s good science to back that up. In fact, years ago, there was a product called Scar Five which no longer exists and it was based on the fact that it was scientifically shown that patients who used that silicone oil at three months the scars would have faded quicker than the scars that otherwise didn’t use their credit. And what we also now know it’s just not a matter of having a scar fading because yes, I understand people don’t like scar and having to camouflage with makeup but this data certainly shows that if you look at a scar that fades quicker, that scar in the longer term will always be better than the scar that took much longer to fade and that’s why concepts of vascular laser being brought into hasten the resolution of redness for the long term scar result. You can achieve most of that with a silicone or I’ve used Strataderm because when I was introduced to it, I found it’s a lovely polymer to use, because we’re tactile beings and so you go and put cream on you and it feels tacky and sticky and 10 minutes later, it’s still there, you want to wash it off, or it’s annoying you. Also you don’t want to have something that you put on your skin, especially on your face that looks like you’ve had a snail crawl across your face and a lot of silicone products do that, and they tend to be a little bit thick. I grew up with Perkins paste as a kid and if you got to put Perkins paste on the end of having this thick, white thing that no lovely lady could put a bit of makeup on over the top, line a mile and be like, what did you lift on your face? Strataderm I found of all the products I’ve used in recent years, when you put it on, it disappears within 10 minutes. 10 minutes later, there’s no residual oiliness. Three, you can put some makeup over it and four provides lovely hydration. And then the final thing I thought, well, if it’s got all that it’s going to be more expensive than the other products. In fact, it’s the cheapest one, if not second, cheapest one on the market. So for cost effectiveness, I can, on the conscience side of a patient, use a great product and the pricing is very fair and competitive compared to some other products who have most probably not as similar good qualities, but charge twice the price. So to me it’s a no brainer. 

Trish 

Yeah, you’re right about the way it feels because it is very light and it does feel almost silky, I guess and it doesn’t leave that yucky sticky feeling afterwards, because if you touch it’s a little bit silky.

Dr John

Agree, exactly and I resolve when someone was wondering about ribs rubbed on the back of my hands. How do you feel that less? Oh, yeah, don’t feel tacky and certainly later on that day, after operating, I felt the back of my hand thinking, gee, it just feels actually quite smooth, I can see even as a hydrating agent so that’s the other concept. There’s a lot of science, the smarter people than they understand how it works but what I explained to my patients is, that’s what we’re trying to achieve, reduce the redness quicker. If we can do that we don’t have to camouflage it. Also, when you look in a mirror, you’re not thinking about that operation or there’s that red scar you’ve moved on. You’ve forgotten about it because life is about moving on rather than ruminating still in the moment of that operation three months, six months ago, also flattening that scar and also with the scar is flatter and paler. It doesn’t feel as tight because of that tightness when someone’s smiling. Feeling a bit of pulling is terrible. That woodiness or medical term is induration but woodiness is that firmness in the tissues is terrible. Yeah. And if I saw a lady this morning who forgot to use her Strataderm who was busy COVID anxious, I understand it but even at four months, her tissues were quite woody and she admitted that yes, when we used her surgery with Strataderm a year before and another error on her cheek, she felt within a couple of months it was quite soft, and there’s no question about it, there was still a lot of inspiration. Because the science shows it does seem to stimulate the silicones more mature type collagen to be made and more mature type adult collagen isn’t as vascular. It doesn’t tend to look like a cumulonimbus cloud in the sky, it tends to look like the more cirrus clouds where everything’s laying down as parallel bundles. So that accounts for why the scar tends to be flatter and also just it doesn’t account for the sort of the tightness. 

Trish

And you know, even what you said with the lady that didn’t use it, it is a commitment for the patient as well. You do have to use it, is it morning, is it twice a day or just once a day?

Dr John 

Twice a day. The reason being is that some people might obviously wash, they might put it on and then have a shower in the afternoon and vigorous scrub could you know take it off. So I used to encourage patients to use it twice a day. You don’t need much, it’s very economical. Just put a pin head on and wipe it over 10 minutes later if it feels greasy, you’re just putting too much on wasting it. Theoretically it does hang around on the skin for up to 30 hours so for patients who say, well look, I just put it on after my shower in the morning, then there’s no harm just putting it on once a day. There’s no harm with that at all. You’re not sort of being behind the eight ball. Yeah, I used to say to patients use it for three months because most scars when you use it for three months. By about three months, my scars started to fade and feel soft and people moved on but I do a lot of nasal reconstruction and cheek flat, where those scars can take much longer to sort of fade and heal and I’ve had a run of patients who, where I’ve seen them at the three months say, look, everything’s okay, going great runs. Let’s see at the six month mark, and they’ll come in and think, gee, I really can’t remember I’ve made my incisions now, everything’s blending so well, now and when I’ve asked them go, gee, you’re doing well, they’ll say, I’ll do I need to buy some Strataderm, but you’re still using it. They go, Yeah, I’ve been still using it, you didn’t tell me to stop but okay, it’s interesting. Those scars at six months, the ones who have been using Strataderm to and continue with some massage and percuss I think they get a better result. So I’m telling my patients, three months is reserved, just a stock standard. If you want to continue on that, I would say from my impression of watching patients that prolonged use for up to six months, because in truth scars will take at least a year to fully remodel, there’s no harm, in fact, there’s only an upside, and it’s a pretty reasonable cost a little tube 30 bucks, which allows you for three months. You know, that’s pretty economical.

Trish 

It’s true and I think the secret is as well as it is to not exactly what you said. Don’t put in too much because otherwise it is diggin, and it’s not going to do a better job because you put in more. 

Dr John   

No, that’s it. That’s it just you just need a very thin feel because also, we know sort of maintains hydration tissues, bad scars tend to for whatever reason, the hydrate, lay down all these metallic proteinases in the tissues. As soon as you really hydrate the skin and the scar tissue, all of a sudden, how the scar decides to mature. It’s very different. 

Trish   

Yeah, yeah. Well, that makes a lot of sense. So when you talk about scars with your patients, what advice do you give to them? So like obviously the Strataderm you’re talking about percussion, a musical instrument?

Dr John   

Well, I’m very much that I used to do a lot of hand surgery for us when I worked at St. Vincent’s and a hand surgery is the ultimate in understanding nerve regeneration. You know fingertip injury, where someone can’t use their fingertip is devastating for them so we learn from understanding their hand, and the neural anatomy of the fingertip injuries and how the brain has to rewire ourselves because ultimately, if you think your hands and your face, it has no feeling per se, it’s the brain’s representation of its tentacles extending out into the face and so on a face. Patients who have had injury after an operation, it’s just not the scar, that’s remodeling, there’s blood vessels regrowing into the area and also nerves, nerves have to regenerate. So the problem is sometimes a scar that is quite thick, woody, the soft tissues are integrated, the poor little nerve endings that are regrowing in there to reconnect to the little receptors for temperature, touch, pressure, vibration, pain receptors, they can now fire if they’re caught in this sort of terrible storm of scar. The trick is to get the scar tissue looked after so the storm calms down to calmer waters, so that the nerve endings that are growing in there can sort of grow within normal tissue rather than this woody hard scar tissue. Yeah, things were caught up, they won’t reconnect with proper receptors, and ultimately, the brain, central programmers thinking, well. How do we make do with all this sort of injury here, we’ve got to, we’ve got to put an interpretation, the tissues that some people describe the scars feeling tight, some people describe as pulling, some people describe the furnace, there’s all that name that the brain is trying to work out but unless we re educate the nerve endings, to how they regrow in there, the brain will always default to a pain receptor because the brain just things we don’t want to read through that site. Something’s going on so let’s just make it painful so you know, injured again, moving on, this is a theological point. Yeah. So moving on. We don’t want to be like ancient mammals where that’s a torn injury, we don’t want to tear it again, we want to move on. So if you mess up the tissues, you’re going to stimulate, get rid of the fluid in the tissues, that extra fluid stimulates more immature scar tissue cells to form the very thing that strategy is trying to help avoid so physical message gets rid of the fluid, physical message firm pressure stimulates deep pressure receptors, so the brain is now starting to be aware of the pressure as a sensation. Putting the Strataderm on is like pressure, it’s a light application so pressure receptors are being stimulated. Next thing is the temperature receptors. I tell people to put something cold, put something calmer. You’ll do that when you have a shower, washing your face that stimulates temporary receptors and percussion people often forget vibration receptors. That’s why when we go over a bump in a car, to get it jolt, sometimes something can be sought. That’s a vibration stimulus, so we’re going to stimulate the vibration receptors. So if I take my patients through all that scar modality, the brain will say Thank God, I don’t have to default to pain receptors. Otherwise people can have persistent discomfort in a scar so I encourage them to work through massage, percuss, hot water, cold water, use your Strataderm because ultimately, it’s dealing with an injury. It’s just not the scar, there’s the whole holistic approach that the person’s mind has got to be settled so there’s a scar on the brain, the brains recognize there was an injury to my face, I’m looking at it. The person moves on much better when everything feels okay, it looks okay. They move off, that’s what we should do. Yeah.

Trish

Yeah really, like I love them. No one’s ever explained that about scars to me, by the way, because if someone says, for example, how do I explain this? So, if you do have a scar, that’s old , can you kind of regenerate? And can you kind of fix that pain receptor thing, if you got a scar that’s causing pain that’s years old, can that be fixed? Again, by utilising things or once it’s done, it’s done? So you got to get in early, hey, 

Dr John  

You got to get in early because it’s the odds, you’re getting in early, you’re not behind the eight ball, if you’re behind the eight ball, it is a lot of catching up. Because ultimately, we adapt, and the brain will rewire and I think sometimes it’s so hard that you can have people, I see a lot of people for scar revisions and often it’s not. It’s because the scar is still pink. I think I don’t need to cut the scar and make a red scar again. Did you use Strataderm that you messed it on? I was aware of that. I didn’t have time. So in those situations, get someone to have a bit of laser. If someone sees me says I got this painful scar, then often I will find out that they didn’t do the massage or percussion. It was just they worried about the scar, putting something on it and then that’s it. Yeah. So you got to get that network wiring very early after injury, if not, there’s often an inflammation that’s still going on, or a maladaptive wiring might be like me rewiring my house, and he’s like, where’s the electrician? Yeah, sometimes you’ve just got to go in there, exercise the scar tissue, get into some virginal tissue and restart the process. Again, that’s a big process for people, especially if they’re a year or two down the track to open up Pandora’s box.

Trish 

Yeah. Well, that’s actually quite a mind blowing discovery for me, because I have this thing that’s been happening to me that sounds like, Oh, my God, that’s what it is. So, so tell us with some, when patients don’t adhere to your post op regime? Like, would I mean, I guess you can’t do anything? Can you have cuts back?

Dr John   

My dad was a surgeon, and he said, John, you can only lead a horse to water. Yeah. And he said, our job is, Doctor’s Latin for teachers so we are there to teach our patients. My job is to teach patients what I believe is true, what the literature shows, I believe in evidence based medicine and I impart that knowledge to the patient, if they choose to take that on board. Fantastic. If they don’t,

Trish

You can’t do anything.

Dr John   

And as long as I own it, so I’ll tell everybody, I’ll give you good advice. I believe what I do every year, I try to update that to make sure I’m relevant. But if someone doesn’t take it on board, or say that’s fine but you got to own that. Yeah, if you see me in three months in the scars, this or that, and you haven’t looked after your skincare regimen, if you haven’t done your massage, haven’t used your silicone or like Strataderm, you got to own that.

Trish 

Yeah, exactly. It could have been a better result. That’s so true. I’m guilty of that myself. So, you mentioned before about using it for three months, and some people can have actually used it for six months and it could guess maybe probably have a slightly better result. But when does the person know that they can stop using it?

Dr John    

Your good question. Usually my endpoint is once the scar has faded, and doesn’t feel firm. So as soon as I say I’ve sometimes you’ll see people that sort of eight weeks the scar is literally a pile, it doesn’t feel tight, there is no woodiness in the tissues and also look, this is really just your scar that what I would normally say six months, you’re at two months or say look if you’ve run out of the Strataderm, you don’t need anymore, because it’s now faded and  decoded. If the scar is still pink and until people even at six months who have a bit of rosacea tend to have redness and the scars still pink, I’ll say look, keep up. Your endpoint is for your massage, percussion is when everything feels comfortable. When it doesn’t feel firm the tissues and when you look and say if I don’t see any redness so some people the occasion personnel say look keep using it for up to nine months, especially in kids. Kids take a much longer time to remodel their scar tissue, thank God they do get a good result in the longer term. Often the sad thing for kids is often we tend to think kids, heal the world now bounce back so we tend to do less on kids. That’s where I really tell the parents to look, before Johnny goes to sleep at night, you know, be vigilant. Yeah, just rub that little bit of Strataderm, I mean to his cheek or on his lip scar or nursing the morning before he goes off to school, just a quick little kiss and wipe that on. You’re doing a lot. You’re doing everything you can for him, because he won’t worry about it. Yeah, he’ll worry about the year mark when he looks at you, and you look at him thinking Oh, God.

Trish 

Totally, totally I’ve done it with my kids and should have done better. So because you’re talking a lot that, because I know that facial surgery is a big part of your practice, so it can be used anywhere on the body, though, hey,

Dr John  

Put anything on the body. So for any scar, so for breast reduction, I do breast reductions, tummy tucks, facelift surgery, especially around the chin area. It’s very good. Yeah, my trick is what I used to do for my scars, you got to support a scar early on, the scars take at least 42 days or six weeks before they get sufficient strength. Sufficient strength, meaning bursting strength over four months so if you cut your cheek, for six weeks, the scar is taking its time to build up enough strength before you can form on it not to split it again, even if we’ve got internal sutures. So in that time, I’ll say for patients, if the wound was enclosed under a lot of tension, you can start to use Strataderm straightaway after the sutures come out the next day. For patients where there’s a bit of tension, maybe patients are a bit flippant or clumsy, or use some type some skin color type is micropore there’s a number on the market that we take the scar to support the scar. It also maintains a bit of hydration, similar to Strataderm and then once we stopped that taping, and about four or five weeks or six weeks, once the strength is back straight away as the inside right, they’ll get on to Strataderm.

Trish

Yeah, right and like some people have allergies to tape and stuff like that. Is there such like, could there be an allergy to something like silicone because I haven’t heard of it, but I wondered to myself?

Dr John  

They can be, I tell everybody there’s top of my head, I usually say there’s most probably about a 1% risk because that’s the sort of data for I usually say to patients use a simple moisturizer like Cetaphil Pro and Derma Skin but you know, there’s going to be one and 100 posts that are now I’m sensitive to that silicones a bit different silica itself is an inert substance. Obviously, we use silicones in breast implants, but in some people someone will develop a capsule scar response to that they develop an antibody response and secondary scarring. But silica just on the skin is very rare that’ll create an allergic reaction, but most probably I would say every year almost probably treat you know 1000 patients you know using the Strataderm with of that I can kind of handful or sort of ring me so nice skin gets very red and irritated. I think sometimes what the silicone will do, will block the pores, especially around the nice thick, oily pores around the nose. When I’m telling patients to clean their skin clean, go to a beautician and use a nice exfoliant, keeping everything nice, clean and hydrated. It seems ironic that I’m giving a silicone that may block the pores that’s why they should be put on sparingly. But if patients still keep coming in on whiteheads or blocked pores and irritating in that person I say look most probably on balance you got such oily skin. The silicone is just sort of compounding the fact that it will sort of not use it so I want my patients to feed me back the information.

Trish  

Yeah, because like I’m allergic to tape but I’m not allergic to silicone. I wondered if there was specific art that was okay, awesome. So can I just ask just one last question. I know you mentioned it before, but we talked about flattening out, flattening the scar. Can you explain like in like, that I might understand like, how that actually works to flatten the scar? like how can this layer of silicone help just like it’s not putty or anything, it’s just like I don’t get it.

Dr John 

I know. So we used to use, years ago, silicone gel sheets, they look like gelatine sheets that you’d sort of make and sort of lay on the skin but they were hard, the patient meant and tried to keep a piece of gel stuck to your nose. Well, you got to then use some tape to keep it in place, it falls off when you’re sort of running or sleeping in bed at night so that the oil is silicone applied on. What has been shown is scientifically it gets absorbed in that out alive skin and we have all different types of collagen. Okay, there’s no immature type three collagen, there’s type C collagen, but the mature collagen we’re trying to get is a so called type one collagen. It would appear that the silicones stimulate the collagen the fibroblasts and make the scar tissue produce more of the type one collagen and they hasten that so they go quick, much more quickly from the type three being laid down the immature collagen, which is read into the more mature type collagen. And so when you look at that under a microscope, that’s why I draw the analogy to clouds live in the sky. Cumulonimbus clouds, big swirls and swirls that’s type three, collagen is bulging, it’s huge. Imagine that in your skin and be bulging, lumpy but once you start making more of the type one collagen, cirrus clouds, the flat, streaky clouds, that lays down so everything’s flattened, softens out so one of my analogies is, say the patient’s, when your scars being made, it’s a bit like a brick, like arriving is brickies labor is just throwing bricks down and that’s what your body’s just doing initially trying to have enough product to get itself together and that’s what you’re making and that’s what it’s all just one big lump. Once you get started using the silicone oils, that encourages the bricklayer to come and then get those bricks and make a nice wall laying it down in parallel bricks.

Trish

Yeah, right.

Dr John

And that’s what flattens, yeah. And as it does that the vascularity is not as needed because it’s not an inflammatory stage, we’re in a more mature remodeling phase so we’re trying to get tissue that is inflamed, still battle, to a mature remodeling phase to say, everything’s, let’s get on to a healing process. Yeah,

Trish 

Yep. Oh, that makes sense. I can even understand that. Oh, that’s awesome. I gotta say, like, that’s been so interesting, because like, it doesn’t matter where on your body the scar is, some people are bothered by scars, some people aren’t and especially if it’s something visual that people can see, you do want to be able to get the best result. So you do want to make sure you’re doing the right things and like, even just what you explained about those little nerve endings are there. I had no idea that was the case and I wish someone explained that to me, ages ago, but it makes so much sense. Like I gotta say, thank you so much for giving us the insight today.

Dr John

My pleasure, pleasure. So I think, Strataderm, I use it, it’s a part of my own material. Yeah, I use it now, profile actively on all scars, especially in patients who’ve got keloid scars, hypertrophic scars, certain skin types, which lend themselves to a very thick and persistently risk of use that so I use it just universally people feel empowered that they’ve done everything they can and then my job is to monitor how their body heals. Sometimes it’s some laser, sometimes it’s a steroid injection to help soften the scar. There’s different things that we tweak as we go.

Trish 

And it’s good, because I like it because it’s relatively new on the market. It’s really good that if something better than what you’re using comes along, you’re open to actually trying it and then finding that it’s something great. Like I love that, I love that. Yeah, awesome.

Dr John 

The only thing I wish though there is a little bit of sun protection factor in SP 50+. The product doesn’t have because some UV light does damage collagen regeneration so we don’t want people to have some harsh sun exposure at least three months on the scar early on in Australia, just add a little bit of that one day or so.

Trish

Yeah. Awesome. Well, thank you so much for joining us. I really appreciate you taking the time. Listeners, look if you do want to find out more about Dr John Flood, you can just slide into our DMs and check out the blog here as well and listen to the podcast but you’ll find him in Sydney, Dr. John Flood. Thank you so much for joining us today.

Dr John 

Pleasure. Nice to meet you.

Leave a Reply

Your email address will not be published. Required fields are marked *

Well, like all good quickies it's time to dust off and get back to our day jobs! If you liked the podcast please rate us because we need the validation for our fragile hearts. If you have a story to share or have a burning question you would like us to cover please slide into our DM’s on Instagram at @transformingbodiespodcast. Stay positive, keep your boobs and chins high until we chat again xoxo Trish