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  • Writer's pictureIoannis Ntanos

Skin Focus with Bernard Ho

When it comes to Top Surgery, knowing how to prepare your skin beforehand, and how to look after it once you leave the clinic, are crucial steps in the journey towards achieving the best outcomes. In a recent episode of the Top Surgery Podcast, Ioannis Ntanos sat down with Bernard Ho, a consultant dermatologist with an interest in LGBTQ health, who shared his expert insights. 


Here are four highlights from their discussion. 


Massage the scars

Scarring can be a difficult space to navigate in dermatology, since the skin’s response to a procedure varies from person to person, and the degree and nature of the scarring will only be apparent after the procedure has been carried out. The chances of scarring, and specifically keloid scarring which is characterised by an overgrowth of scar tissue beyond the original injury, can be reduced through the use of massage and this is highly recommended. It is important to note that the key to success is not necessarily the choice of product, of which there are endless options available on the market, but rather the consistency with which that product is applied to the scar and the associated massage which takes place. Choose a product with active ingredients and apply liberally and often to the affected area.


Reduce binding before surgery

There are multiple conditions that can affect the skin on the chest, and many of these can be worsened by excessive chest binding. Conditions such as acne, dermatitis and folliculitis can cause scarring. These thrive in a sweaty environment which is why binding, while essential for many in the battle against gender dysphoria, can be so problematic. Folliculitis specifically can be caused by friction on the skin, something that is more likely to happen when using a binder. Surgeons recommend taking a break from binding the weeks leading up to top surgery. Doing so improves breathing capacity which is vital ahead of a major operation under general anaesthetic. A break in binding will also result in improved skin quality.


Sunscreen and sun exposure

Patients often describe the euphoria that follows gender affirming surgery and the desire that this evokes to go bare-chested, specifically in warm weather, and soak up the sun. We all know the danger of UV rays in terms of their ability to cause cancer and scars are particularly sensitive to burning. Ideally scars should be covered up. However, if this is not possible, liberally applying a factor 50 sunscreen will provide some protection, minimise discoloration and facilitate healthier scarring. 


Be open about pre-existing conditions 

A thorough discussion of previous skin conditions with your surgeon is important so that they are able to prepare you for possible complications. New sites of Psoriasis, for example, can develop over areas of trauma, or Top Surgery scars. Managing these conditions before they emerge and knowing how to look after them post surgery, is essential for the healthy recovery of the chest.


When it comes to the skin, there are still things that we don't understand and for which there is no definitive ‘cure’. However, we do know that for the best chance of a pleasing aesthetic outcome, committing to a regular skincare routine over the long-term is essential.


If you’d like more in depth insight on any of these topics or a better understanding of dermatology’s role in gender affirming surgery, listen to our skincare special episode of The Top Surgery podcast, with special guest Bernard Ho.

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