sinovels Chapter 1410 There is no such miracle in medicine.
Chapter 1410 There is no such miracle in medicine.
Chapter 1410 There is no such miracle in medicine.
Sisi's surgery was very successful. Not only did she not have any scars, but her skin color gradually became the same as the surrounding skin, and even the lines looked natural and harmonious. To the naked eye, it was impossible to tell that she had undergone surgery.
The tiered lecture hall at the Sanbo Hospital International Conference Center was already full. People were standing in the corridors, sitting on the steps at the back, and even the doorway was crowded with young doctors holding notebooks. This was no ordinary academic lecture; the name on the poster made everyone look forward to it: Ivan Kovalenko, the magician of plastic surgery. But more importantly, the subtitle on the poster read: "Scar Prevention and Treatment Technology Based on Three-Dimensional Guided Gene Theory: From Macroscopic Surgery to Microscopic Regulation."
This is the first time Ivan has publicly and systematically presented his findings. In the past few years, he has sporadically mentioned these ideas at conferences around the world, but never presented them in their entirety. This time, he chose to present his latest theories at Sanbo, on Yang Ping's turf, as a tribute to Professor Yang Ping.
Sisi sat in the third row, the scar on her right thigh having faded to almost invisible. She was no longer a patient, but a listener, her notebook filled with questions from her pre-study: about the behavioral regulation of fibroblasts, about the relationship between tension and collagen arrangement, and about the technology she had personally experienced that was about to be revealed.
Yang Ping sat on the edge of the first row, not in the center. He insisted on this, arguing that Ivan was the protagonist today. But his very presence was an endorsement, a silent confirmation of the theory's validity.
At nine o'clock in the morning, Ivan walked onto the podium. He wasn't wearing a suit, but a simple light blue shirt. He turned on the projector, and the first slide wasn't a title, but a photograph: Sisi's right thigh, before and after surgery. It wasn't an ordinary photograph, but a high-resolution image showing the skin texture.
“This is my business card,” he said in Chinese with a slight accent, “not text, but an image.”
He clicked on the next page, which showed a cell micrograph.
“Let’s start with the basics,” Ivan said, his voice becoming deep and clear. “What is a scar?”
Two lines of text appeared on the slide:
Scar: A product of fibrous connective tissue replacement and repair after tissue damage.
Normal healing: complete replacement of the same cell type without structural changes.
"To put it simply, the ideal normal healing should involve the original cells participating in the repair of the damaged area. Scars, on the other hand, are caused by fibrous connective tissue replacing the original cells in the repair process."
"The key difference isn't whether there's any repair, but what kind of repair is used,"
Ivan displayed masterful demeanor, speaking fluent and mature Chinese.
"In normal healing, the original cells participate in the repair, and the structure and function are fully restored. In scar healing, fibroblasts proliferate in large numbers and secrete disordered collagen fibers, forming tissue that lacks normal skin appendages and has abnormal elasticity and tension."
He showed a histological comparison image: on the left is the collagen fibers of normal skin, arranged in a regular wavy pattern, interwoven into a network; on the right is the collagen of scar tissue, which is thick, straight, and arranged in parallel, like randomly stacked steel bars.
“Look at this picture,” he pointed to normal skin, “the collagen fibers follow the direction of the Langer’s lines on the skin’s surface tension. This arrangement is not random; it’s the result of the cells ‘knowing’ which direction they should align themselves. But in scars,” he pointed to the right, “this ‘knowing’ is lost. Fibroblasts just blindly pile up collagen, regardless of direction, tension, or function.”
A young resident physician raised his hand: "Professor Ivan, is this 'knowing' a mechanical signal or a chemical signal?"
“Good question,” Ivan said. “Both are important, but the key is their integration. Traditional theories emphasize the regulation of collagen synthesis by growth factors such as TGF-β, which is important, but not enough. Professor Yang’s three-dimensional guide gene theory tells us that cells not only need to be ‘told what to synthesize,’ but also ‘told where to synthesize it and in what spatial direction.’”
He clicked on the next page, which showed a complex signal path diagram.
"This is the Wnt/β-catenin pathway, a classic morphogenetic signal. But Professor Yang's contribution lies in discovering that the gradient distribution of this pathway in the spatial dimension determines the cell's 'positional identity.' In embryonic development, this identity lets the cell know what it should differentiate into; in adult tissues, maintaining this identity allows the skin, bones, and nerves to maintain normal structure; in damage repair, the loss of this identity leads to scar formation."
Sisi quickly took notes. She had read about this in the literature, but Ivan's explanation brought it to life. She thought of her own scars, and of Ivan's words about "map redrawing" during the surgery. He wasn't using a metaphor; he was describing a real biological process.
“Now, let’s talk about the classification and assessment of scars,” Ivan said. “While this knowledge may seem simple and dry, and not at all sophisticated, proper treatment begins with proper diagnosis.”
Slideshow transition:
Superficial scars: These only involve the epidermis or superficial dermis, are flat and soft, and have pigmentation or depigmentation.
Hypertrophic scars: These involve the deep dermis, are red, raised, and itchy, but do not extend beyond the original lesion boundaries.
Keloids: They invade the surrounding normal skin, extend beyond the original lesion boundary, continue to grow, and have a high recurrence rate.
Atrophic scars: scars that are lower than the surrounding skin, such as acne scars or subcutaneous tissue defects after trauma.
Contracture scars: These cross joints or the body contour and cause functional impairment.
Ivan emphasized: "The key difference lies in boundary behavior. Hypertrophic scars are 'disciplined'; they know where the original injury is and will not cross the boundary. Keloids are 'aggressive'; they forget their location and expand indefinitely. This difference is essentially the presence or absence of a three-dimensional guiding gene mechanism."
He showed Sisi a photo before the surgery, showing the main incision scar on her right thigh.
"This is a typical hypertrophic scar because the surgery at the time prioritized tumor treatment and limb preservation. The incision was designed to be straight and long, with concentrated tension. There was no systematic tension management in the early postoperative period. But it did not turn into a keloid because Sisi's constitution is not prone to keloids. Her fibroblasts were just 'chaotic,' not 'out of control.'"
“Professor Ivan,” a head of plastic surgery asked, “how do you predict whether a patient will develop keloids? Are there genetic markers?”
“There are currently no clinically available gene biomarkers, and I am exploring them. I believe the underlying logic must lie in the genes,” Ivan frankly stated. “However, in our research, we have found that the expression of certain three-dimensional guidance genes is significantly reduced in the fibroblasts of keloid patients, especially those related to cell polarity and matrix arrangement. We are developing a risk assessment model based on these biomarkers, which may enter clinical validation within the next two to three years.”
He paused for a moment and looked at Yang Ping, who nodded slightly. This was a tacit exchange between them: the theory was moving towards practice, but it would take time.
The lecture then moved to its core part: scar prevention.
"Prevention is better than cure, and this is especially important in the field of scar treatment. Once a scar forms, especially a keloid, the difficulty of treatment increases exponentially. Based on the three-dimensional guided gene theory, I propose a 'three-dimensional prevention strategy'."
The slide shows three concentric circles: First dimension: Mechanical environment control.
The second dimension: regulation of biochemical signals.
The third dimension: cell behavior guidance.
“The first dimension is the mechanical environment,” Ivan explained in detail. “This is the level that surgeons can intervene in most directly. The incision design should follow Langer’s line to reduce tension; the suturing technique should be layered and aligned to eliminate dead space; tension-reducing tape or skin adhesive should be used in the early postoperative period to maintain the stability of the wound edges. Traditional methods stop here, but the three-dimensional theory tells us that this is not enough.”
He presented a set of comparison photos: the same surgical incision, the postoperative results of traditional suturing and "tension-guided suturing". The latter's scar was significantly thinner and flatter.
“What’s the key?” he asked. “It’s not about sewing tighter, it’s about sewing smarter. When I suture, I consider the three-dimensional tension vector of the skin. It’s not just about closing the incision, it’s about rebuilding the skin’s ‘structural memory.’ It’s about letting the cells at the wound edge ‘remember’ which direction they should be facing and how much force they should be able to withstand.”
A chief surgical resident asked, "How long does this 'memory' last? Won't it disappear after the stitches are removed?"
“Good question,” Ivan said. “The role of mechanical signals is triggering, not sustaining. After the sutures are removed, we need second- and third-dimensional interventions to take over.”
He clicked on the next page, which displayed a transparent silicone patch.
"The second dimension is the regulation of biochemical signals. The role of silicone patches is not only to moisturize and apply pressure, but more importantly, it creates a low-oxygen, high-humidity microenvironment, downregulating the expression of TGF-β1 and TGF-β2, while upregulating TGF-β3, the latter being a key factor in promoting normal healing and inhibiting scar formation. However, traditional silicone treatment is 'blind'; we don't know when to use it or when to stop."
“Based on the three-dimensional guidance theory, we have developed ‘responsive silicone therapy’,” he showed a graph, “and by monitoring changes in scar hardness, blood flow, and temperature, we can determine the activity status of fibroblasts and dynamically adjust the treatment intensity. When cells are ‘quiet,’ we reduce intervention; when cells are ‘aggressive,’ we strengthen inhibition.”
Sisi thought about her post-operative care. Ivan had indeed asked her to record the changes in scar hardness daily, taking photos with her phone and uploading them to a specialized assessment system. At the time, she thought it was routine follow-up, but now she understood it was part of a research project.
“The third dimension, guided cellular behavior,” Ivan’s voice deepened, tinged with awe, “is the most cutting-edge and challenging level. Professor Yang’s three-dimensional guided gene theory plays a central role here.”
The slide shows a complex diagram: the behavior of fibroblasts in a three-dimensional matrix, the spatial gradient of gene expression, and the nanostructure of the extracellular matrix.
“We are developing a ‘bioactive scaffold,’” Ivan said. “It is not a passive filling material, but an active guidance system. The nanofibers of the scaffold are aligned in a specific three-dimensional orientation, mimicking the collagen structure of normal skin. When fibroblasts migrate into the scaffold, they ‘sens’ this orientation and align themselves and secrete collagen along a pre-set path.”
“It’s like,” he searched for a suitable analogy, “like giving cells a map and telling them where north is and where south is. In normal development, this map is drawn by genes; in scar repair, this map is lost; our scaffold is an artificially drawn temporary map that helps cells find their way again.”
The conference room was silent. This was the true cutting edge, a perfect combination of theory and technology.
“Currently, this scaffold is still in the animal testing phase,” Ivan frankly stated, “but we have already used a simplified version in clinical practice—the ‘directional collagen-inducing patch.’ It uses an electric or magnetic field to induce collagen fibers to align in an orientation during the early stages of healing, creating the correct pathway for subsequent cell migration. Sisi’s last surgery used this technology, combined with fractional laser, to achieve a final, almost perfect, smooth surface.”
He clicked on the next page, which featured a striking headline: "Scar Treatments on the Market: What Works and What Doesn't."
"Before discussing cutting-edge technologies, we must honestly face the reality: scar treatment is a huge market, which has spawned various treatment methods, such as ointments, patches, and essential oils. Whether these things are effective or not, I regret to inform you that most of them lack sufficient evidence. But this is not the answer they want. So today, I want to give you an evidence-based guideline that you can pass on to your patients."
The slideshow displays a categorized table:
Category 1: Supported by clear evidence
“Silicone preparations,” Ivan said, “are the gold standard in scar treatment, with the most robust evidence. These include silicone patches and silicone gels. Their mechanism of action is multifaceted: occlusive moisturizing, gentle pressure, and regulation of keratinocyte hydration, thereby downregulating collagen synthesis. For surgical scars, burn scars, and hypertrophic scars, early application after wound healing for 3-6 months can significantly improve scar height, hardness, and itching.”
"What's the key? Apply it as early, consistently, and correctly. Many people give up after a few days because they don't see any results, or they only apply it when they remember. Silicone needs to be used for 12-24 hours a day for several months. This isn't magic; it's the cumulative effect of physical and biochemical processes."
He presented a chart of research data: "Systematic reviews show that silicone treatment can reduce scar thickness by an average of 30-50% and reduce itching scores by 40%. This is not a cure, but a significant improvement. For hypertrophic scars, it is the preferred non-surgical treatment; for keloids, it is part of a comprehensive treatment plan."
"Pressure therapy is an irreplaceable method for hypertrophic scars after burns. By applying continuous pressure of 20-30 mmHg, local blood flow is reduced, and fibroblast activity is inhibited. Custom-made pressure garments are required, which are worn for 23 hours a day for 6-12 months or even longer. Patient compliance is the biggest challenge, but the effect is certain."
"For hypertrophic scars and keloids, topical triamcinolone injection is the standard treatment. It is administered once a month for 3-4 times as a course of treatment, which can flatten and soften scars and relieve itching. However, there are significant side effects: skin atrophy, telangiectasia, pigmentation changes, and even the risk of systemic absorption. Precise injection and dosage control are required."
Category 2: Some evidence exists, but the effect is limited.
“Onion extract preparations,” Ivan clicked on the next page, which showed a common brand of gel on the market, “with Mederma as a representative product. In vitro experiments show that onion extract has anti-inflammatory effects and inhibits fibroblast proliferation, but clinical research results are inconsistent. Some studies show slight improvement on new scars, but it is basically ineffective on mature scars. My assessment is: it can be tried, but don’t have too high expectations, and certainly don’t use it as a primary treatment.”
He continued, "Vitamin E is the most widely circulated 'scar-removing miracle' in folk medicine. But the truth is, high-quality clinical studies have failed to confirm its effectiveness. On the contrary, some studies have shown that vitamin E may cause contact dermatitis and even worsen scars. My advice is: not recommended, especially not for use on wounds that have not fully healed."
"Aloe vera," he said, "has a soothing effect on sunburn and mild skin irritation, but there is no reliable evidence for its effectiveness on pathological scars. It can be used as a moisturizer, but don't expect it to remove scars."
Category 3: Insufficient or invalid evidence
Ivan's tone turned serious: "Lavender oil, tea tree oil, rosehip oil, and all sorts of 'natural' essential oils," he said, "these products, touted on social media as 'miracle scar removers,' lack rigorous clinical research support. They may have some moisturizing effects, but they cannot change the histological structure of scars. More seriously, essential oils can cause allergic reactions, and for new scars, this stimulation may be counterproductive."
"Oral collagen supplements represent a huge market, but their logic is flawed. Orally ingested collagen is broken down into amino acids in the digestive tract, making it impossible for it to reach the skin scars. Even if it does reach them, it cannot integrate into the existing scar tissue. This is a waste of money; don't waste your money. I apologize, but I have no intention of targeting anyone; I am simply stating an objective fact."
“Various scar removal patches, scar creams, and scar-free creams,” he showed several product photos, with exquisite packaging and exaggerated advertising. “Most of these products contain unknown ingredients, and some even secretly add hormones. They exploit patients’ anxiety, charging exorbitant fees, but their effectiveness cannot be verified. My warning is: beware of any product that promises ‘complete scarlessness’ or ‘rapid scar removal.’ There are no such miracles in medicine.”
The meeting room fell silent. These blunt words touched the hearts of many present, who had seen far too many patients deceived by false advertising.