Dr Mark Hanikeri on Using Strataderm for Abdominoplasty

“I’m prescribing it because I believe it’s in their best interests.”
In this insightful podcast, Dr. Mark Hanikeri will share his views about Strataderm and why he chose to use this, especially in big surgeries like abdominoplasty, and recommend it to his selected patients.
He is a Specialist Plastic Surgeon from Subiaco at Western Australian Plastic Surgery Centre.
@drmarkhanikeri @stratpharma_australia
Transcript – Dr Mark Hanikeri on Using Strataderm for AbdominoplastyTrish

Hello, listen listeners. It’s Trish Hammond here from the Aesthetics Uncensored podcast, and today I’ll be catching up with Dr. Mark Hanikeri. Now Dr. Hanikeri is a Specialist Plastic surgeon who specializes in cosmetic procedures of the body. And today we’re going to be talking about scars and Strataderm and how he uses it in his practice and we’re focusing on the procedure of abdominoplasty. So welcome, Dr. Hanikeri

Dr Hanikeri

Thanks for inviting me, Trish. 

Trish

Lovely, thank you so much for joining us. I’ve been looking forward to this. So tell us first of all, you’ve been using Strataderm on your patients, and I’m presuming to effectively minimise scarring after major surgery. Can you tell us a little bit about why and your view about it?

Dr Hanikeri

Sure, Trish. Silicone topical silicone has been used for 20 or 30 years for post operative scar management. And I guess over the last few years, there’s been a transition away from sheets of silicone to more silicone gels such as Strataderm. The main reason I use silicone is because I think whilst it’s not there’s no randomised control trials because of the difficulty, I suppose, in standardising those trials. But there’s reasonably good empirical evidence that silicone improves the appearance of thick scars and to a lesser degree, there’s evidence that silicone will prevent scars from becoming bad. And I guess that’s a bigger frame shift, I suppose for the thought processes from a plastic surgery point of view because it is something that’s difficult to prove, and many of the studies have been a little bit flawed and potentially biassed. But empirically, I do believe that silicone does improve the appearance of scars in all procedures, but particularly procedures such as abdominoplasty and body contouring where the scars are large and potentially noticeable and potentially unsightly. So firstly, silicone is something I’ve always used and more recently used as a preventative treatment. Why Strataderm? I guess the main reason is, because compliance is a lot easier with a gel than with a tape for a long time, I use silicone tape, and it works very, very well but it needs to be on for it to work and patients find it hard because often the tape rolls up, it loses its stickiness. It’s difficult to fit into their daily routine. It’s expensive, because once it loses its stickiness, I’ve got to replace it with the Strataderm range of silicone gels. And gels like Strataderm are a lot better from a patient compliance point of view, because all I need to do is smear onto the scar, let it dry for a few minutes, and then put on the normal clothes or if it’s on the face put on the normal makeup and so it’s easy to get patients to use it and it’s relatively inexpensive. They feel like they’re engaged in the process of scar management, which I think is really important and I believe and I think the patients believe and I think I can see it in the outcomes, that the long term scars are better.

Trish

And you know what, it’s really funny because talking about the tape, I actually have an allergy to the tape. So I could never use it for more than a day because I’d welt up. But the Strataderm was just so easy. You can’t feel it and like you said it’s easy for patients to apply.

Dr Hanikeri 

Yeah, it’s much less common to get skin reactions with the gels and with the tape. And reactions with the tape are quite common but with the gels, they’re much more uncommon and it’s much better tolerated by the majority of patients. And the important thing is that although it may not have the benefits of pressure, which is what you can get with the tape on a thick scar, the rest of the benefits of silicone are still there. And so from a preventative point of view where the scars aren’t thick, If you’re trying to reduce them becoming thick, the gel is every bit as good as the tape.

Trish

Yep, yep. And tell me so what are the main concerns that your patients have regarding abdominoplasty surgery like, cuz for me, one of my biggest concerns was the scar.

Dr Hanikeri   

Yeah, that is the main concern for patients and especially the umbilicus scar, the belly button scar, which is the one that’s most commonly seen. And there’s a huge range of belly button scars out there. But the bottom line is that they’re nearly all in some way visible, especially in the long term, some of them are very hard to see in the short term, but in the long term, as the tissues relax and stretch, and the belly button skin sort of relaxes, the scar can actually become more noticeable afterwards than it is initially. And so people are concerned that scar, if it’s thick and noticeable, will detract from their confidence and so the belly button scar is a particularly difficult one to apply any other form of silicone to come other than the gel, because obviously, it’s an uneven surface, it’s an irregular sort of round scar and so the gel is very easy to apply in those circumstances compared to types that the height above the pubic region, the distance between the scar and the pubic region, is another concern for patients with abdominal scarring following a tummy tuck, and most Surgeons will try and site that scar as low as they can below the neckline wherever possible and so that helps to conceal the scar but some Surgeons the scar can be high and above the neckline and in those patients, obviously, it’s even more important that the scar is a better quality in the long term.

Trish

That’s so true. And so when you talk with patients about scars, what advice to give them like, whether it’s to do with minimising or like what advice do you give your patients?

Dr Hanikeri  

Well, firstly, I think it’s important that patients understand that there’s very limited control that the Surgeon has, over the long term scarring in terms of what the Surgeon does. We almost, in fact, all Plastic and Reconstructive Surgeons would be using the very gentlest best surgical techniques to minimise the effect of tissue trauma and most of us are fairly well aware of the potential risks of surgical handling of the tissues and suture materials and everything that we can do to minimise scars and yet people still develop a range of different scars. And that’s because different patients have a different tendency to scar based on their genetic makeup on their, the tension on their skin on the quality of their skin, whether it’s been pre stretched by weight loss or pregnancy, whether they’ve got racial predilection to thicker or darker scars, and so the patients have more influence on the long term scar than this Surgeon or choice of Surgeon. Obviously, as a Surgeon, we try to cite the scars wherever possible, where they’re not going to be seen even if they are a noticeable scar. But in some instances, as I said, the scars can be noticeable, they can ride up higher than you expect them to, they can stretch or spread or be thicker and a lot of that is determined by the underlying tension in the patient’s tissues where it finally ends up and the quality of that scar. So the first thing to be said is that patients determine a lot of the time how good their own scars are, all other things being equal. The second thing I’d say is that it takes a long time to see the final outcome. People expect their scars to be good at six weeks or eight weeks and that’s just unreasonable. It can take 12 to 18 months and in some cases even longer for the scars to achieve their final configuration. 

Deeply pigmented scars because some darker skinned people can make very dark scars and those dark scars can persist for a long long time score post inflammatory hyperpigmentation and that can be seen in any skin colour but it’s particularly common in darker skinned individuals, thicker scars that might occur if there’s excessive tension or if there’s any wound healing problems afterwards then typically the scars are thicker and then the Surgeon and the patient wants and if it’s what’s called a hypertrophic scar, which is a thicker than average scar, usually because of a problem like tension or vascularity or infection that can take a long time to settle down 12 – 18 months, sometimes 24 months or even longer, before the scars remodel, silicone can certainly help with that there are other treatments that can help with that, which we can go through if you like later on but at the end of the day, they need to be patient. So the first thing to do, to try and get a good scar is a good surgical technique, which as I said, Plastic Surgeons all around the world, are trained in and rehearsing and would almost, I think, without exception or practice, good choice of sutures, we know that some sutures are more inflammatory than others and again, Plastic Surgeons are well aware of that and then the post awkward initial post operative care so minimising the risk of infection, which is partly to do with the dressings that are used partly to do with the post operative care from the patient, making sure they keep their wounds dry, and clean and avoid excessive activities that are going to put the fresh scars under undue stress. And so that comes down to patient compliance and also patient education. So I educate my patients that for the first few weeks whilst things are healing, they really do need to take it easy no matter how good they feel. They may not know that the scars themselves are still young and prone to tension issues so they have to take it easy whether they like it or not doing virtually nothing for the first two weeks and then very little for another two weeks before gradually reintroducing activities that will put those scars on the more and more tension and so they need to be aware of that initial postoperative period being very important and then in the longer term after the three to four week mark starting things like silicone therapies like therapies, topical pressure treatments, if required garments, massage of the scam. I do use Bio Oil for my patients in addition to the silicone in there’s some empirical evidence that vitamin E is good for the long term scar quality and also just minimising the risk of trauma and and rubbing the scars and anything else that might cause an unexpected outcome so first thing I tell them is post operative management. Second thing I tell them is early scar management and the third thing I tell them is to be patient.

Trish

Yep, yep. And I mean, I guess given that the incision is quite large. When you’re having an abdominoplasty surgery, are there any factors that can affect the scar outcome purely because of the size?

Dr Hanikeri 

Not really, Trish, I think, obviously, the longer the scar, just percentage wise, the more risk there is of somewhere along that scar there being an issue and all of us use sutures to help take the tension off the surface and those sutures are deep, and there’ll be more of them, the longer the scar. So I guess the length of the scar does increase the chances of somewhere along that scar there being an issue, but I don’t really believe that the length of the scar in itself is a risk for bad scarring.

Trish  

Yeah. Okay. And what when you get the pain, a patient who doesn’t fit here to your post op regime, like what do you tell them?

Dr Hanikeri  

Well, what can you say, Trish? I mean, we were human, our patients are human, and we have human frailties and some of those are that we don’t listen to others. We don’t listen to advice, or sometimes we don’t believe that the advice that’s given applies to us and there’s no point being punitive about it. I think we educate our patients as best we can as to what they can and can’t do and at the end of the day, it’s their responsibility to look after their own health. And if patients, if I know pain, I had a patient last week who, you know, she had breast augmentation surgery and very strict instructions not to drive for a week or two and she drove to her initial post operative appointment, because I knew that because there was no one with her and she had her kids and I say, Well, how’d you get in? And she said, I drove and so you know, at the end of the day, people will do what they feel is right for them in their lives and they’ll take chances and they have to live with the outcomes from that and most of the time, fortunately, it will be fine. It’s all about risk management, isn’t it? So you take chances and do things that your Doctor or Surgeon says not to do based on measuring the risk of those actions, then at the end of the day, you have to live with those decisions.

Trish   

Yeah, that’s so true. And like how when you do suggest to your patients that they use a Strataderm for post surgery. How long do you say that they should use that for that? 

Dr Hanikeri  

Yeah. I tell them that the most important time is the first three months, and then to reassess it at the three month mark. So if the scars are still a little bit red or a little bit thick at the three month mark, then I’ll tell them to keep going until the six month mark. Otherwise, if the scars are perfectly good looking at the three month mark, I think there’s a limited benefit from continuing it. Beyond that, I’ll tell what they’ve got left and then stop. So from my point of view, everyone’s instructed to use it for at least three months, and then select patients who might not be 100% happy with the thickness or colour of their scars, or say use it for another three months after that. But I think there’s very limited benefit from silicone over time and particularly after the six month mark, I think, really all they need is time rather than silicone.

Trish   

Yep. And you know, it’s like with Strataderm, why is that your product of choice? Because it’s relatively new? I mean, it’s not new anymore, but I could semi come out in the last I guess, 10 years or so maybe? 

Dr Hanikeri 

Yeah, look, there are a number of them, there’s, I won’t go through all of the names Keller silicone and a whole pile of them. And I don’t know that there’s a benefit of one over another. The thing I do like about Strataderm, is that there’s very good patient education leaflets, they’re very accessible as a company and I don’t have any financial interest in the company, I don’t draw any profits from the Strataderm that I use, I just charged the patients what we pay for it without a markup. So from my point of view, it’s good customer service for both myself as a Surgeon, and for the patients, they can access the Strataderm if they want online, and we just give them a code where they can order it directly from the company for the same price that we pay for it. And it’s all very transparent, those transactions and the patients know that, at the end of the day, I’m not prescribing it to make money out of it, I’m prescribing it, because I believe it’s in their best interests and so, when it comes down to them buying it, it’s easy for them to do it, when it comes to us buying it, it’s easy to do in this reasonably, are very good support from the company. And I believe it’s a good product, which is obviously at the end of the day, the most important thing is that I have faith in the product. And I’ve got good reports from patients who’ve used it about how easy it is to use and how good their results are.

Trish 

You’re so right with regards to the support and the inputs available for consumers that’s from the company because even because I know what it’s like as a patient you like, Yeah, I know how to use it and you go home, like oh my god, how do I use this thing again? And you can just jump online, and you can watch how-to videos and like, yeah, it’d be impossible not to find out how to use it properly.

Dr Hanikeri 

Exactly. And I think that’s really good for a company to have that due diligence to make sure that the end user knows what to do to get the results that they want.

Trish  

Yeah, exactly. And just to talk about the sizing, like there’s different tube sizes that are available. And like they last bit ever, like I know that they last forever, because I’ve got tubes left over from or a tube. And I’ve got a big tube leftover from a surgery and I didn’t even use a tiny bit of it and I used it for a solid four months. So you see a little jarring thing. What is this all job, but it just goes such a long way, doesn’t it?

Dr Hanikeri  

It does. Yeah, you don’t need a lot of it. You just need a thin smear on the wound morning and at night. And obviously the big wounds like body contouring wounds, it goes less than for breast wounds, for example, or a face wound but the 50 gram tube lasts a long time and I usually tell people with body contouring surgery expect to maybe use 250 gram tubes and for most people with smaller surgery, just one of the smaller tubes is almost always enough.

Trish  

Yep. And secondly, because you spend so much having surgery, and you know, it’s worth investing that little bit in a really good quality Strataderm, you know when you do it. So I was just gonna ask you. Do you use that for all of your patients? Like is there anyone that you wouldn’t use it for?

Dr Hanikeri  

Look, I don’t use Strataderm routinely for skin cancer patients and those sorts of things. I think the majority of patients are having skin cancer surgery, the scars are a lesser issue. Then for cosmetic surgery. It’s not a no issue and the majority of skin cancer patients do have good scars in the long term facial scars are less prone to be noticeable long term then non facial surgery scars. But I do offer it to patients. It’s in my room, it’s on the desk they see it and anyone that voice is concerned about the potential scars from any surgery. I will direct them to my secretary Sheree or Alicia for stratagem education and to buy some if they want to. But I don’t routinely recommend non aesthetic surgery but all of my aesthetic patients do get referred to my secretaries for a discussion on Strataderm.

Trish  

Fantastic. That’s been so important and insightful. I really like the fact that you’re using it in big areas as well. And the fact that clients comply with it as well or patients or comply with it as well, because, like, they want a really good outcome as well. And really, you’re getting the best thing that you’ll get the best outcome. And if you’re following the protocol, you’re going to get the best outcome that’s quite for your body. But like you said, it’s an individual person, your job is to do the surgery, and then to educate them on how to look after surgery. Hey,

Dr Hanikeri   

That’s correct. Yeah. And I think engaging the patients in their own post operative scar management, like I said earlier on, is very important, because otherwise they feel what do we do now? We’ve had the surgery, what do we do? Do we just wait and see or, or not? And I think being engaged in that process and being complicit with how the scar management is applied, is really important for them. They feel like they’re  involved in the whole outcome and so I think that’s really important.

Trish   

Yeah, no, I agree with you. 100%. The surgery is up to you. But the final outcome is really up to the patient as well. Yeah, absolutely. Awesome. Well, thank you so much for joining us. I know we were a bit short on time this afternoon. You’ve got some stuff to do, but I want to say thank you so much for taking the time to talk with me today.

Dr Hanikeri

It’s my pleasure, Trish.

Trish 

I really appreciate it, awesome. So listeners, look if you are after an excellent Plastic Surgeon and you’re right in WA or anywhere else really you want to go to WA if they’re letting anyone in and check out Dr. Mark Hanikeri. He’s a Specialist Plastic Surgeon from Subiaco at Western Australian Plastic Surgery Centre. So yeah, do check him out. Thank you so much for joining us today, Dr. Hanikeri.

Dr Hanikeri 

It’s my pleasure, Trish.

Trish 

Thank you so much. You too. Bye

1 comment on “Dr Mark Hanikeri on Using Strataderm for Abdominoplasty

  1. AJane M says:

    Secretaries ? They sound far more qualified than that!! Thk u for this- i was not aware of strataderm and it was great to hear what Mr Hanekiri had to say

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