All patients who undergo a surgical procedure would prefer to have a scar that’s as inconspicuous as possible. This is especially true for procedures that are performed in visible areas on the body. In fact, many physicians will defer or refuse to do a procedure because they’re afraid of making a bad scar. But plastic surgeons and dermatologists who routinely produce clean, unobtrusive scars don’t have a secret way of suturing. Paying attention to three basic surgical principles is the way to ensure a good cosmetic outcome.

Soft touch

The first principle is to respect the tissue edge. Be as gentle as possible when manipulating the wound edge. Crushing the tissue between forceps, cutting jagged edges with the scalpel, and leaving gaps between wound edges will impair wound healing and create a suboptimal wound. If the wound is a laceration and there’s compromised or nonviable tissue at the edge, it’s better to debride the wound edge to healthy viable tissue and then plan your closure.

Ease the load

The second principle is to offload as much tension on the wound edge as possible. If there’s no tissue loss, such as with a laceration, then consider closing the wound in two layers. Use a buried absorbable suture to carry the load, and a subcuticular or interrupted nylon suture to appose the skin edge. If there’s loss of tissue, as in an excision, then the wound edge should be undermined at the subcutaneous fat plane. This action will break the vertical connective tissue bands that will try to pull your wound apart. The depth of undermining should be enough that the wound edge doesn’t snap back when the edges are pulled together gently.

Clear the line

The third principle is to keep the suture line clean of eschar. Dry scab acts like a wedge between the wound edges. Keeping it moist with either an ointment or covering with a hydrogel wound dressing will keep the wound moist and clean. It will also make the suture removal much simpler, as you don’t need to chip away the eschar to get at the sutures.

With care and rigorous enforcement of these three principles, your scar appearance could rival that of your local plastic surgeon.