Carrie Underwood's injury brings plastic surgery questions into spotlight

Recently, country star Carrie Underwood shared in a post to her fan club members that she did more than break her wrist when she fell down the stairs this past November. She also suffered serious injuries to her face. She shared in her post, “I’ll spare you the gruesome details, but when I came out of surgery the night of my fall, the doctor told Mike that he had put between 40-50 stitches in,” she wrote, referring to her husband, hockey player, Mike Fisher. “Now, here we are 7 weeks later, and even though I’ve had the best people helping me, I’m still healing and not looking quite the same.” In the emergency room, various stitches can be used on one’s face, depending on the depth and length of the injuries. Stitches help close wounds and cuts and can reduce scarring. Some dissolve, and others need to be taken out within a week or two. However, due to the amount of stitches Underwood received, fans and the media have contemplated if she might have had to have a plastic surgeon involved in her care. “In health care, we have very well trained ER physicians and physician extenders like physicians assistants (PA) or nurse practitioners (NP) in hospital emergency rooms who know how to treat lacerations and injuries,” shares Dr. Stefan Szczerba, plastic surgeon at Advocate Sherman Hospital in Elgin, Ill. “Most standard lacerations can be managed without a plastic surgeon. Follow up the next day can be offered if there is concern about the outcome from a laceration managed by the ER. Alternatively, if you insist a plastic surgeon treat your injury, you can electively see the plastic surgeon for repair of your laceration in the office within 24 hours without affecting the outcome.” Dr. Szczerba goes on to explain that if the injury is a complex wound or laceration, and the emergency room does not feel comfortable managing the closure the patient requires, a plastic surgeon who is on call for the ER is called and can treat the patient in the ER, or if necessary, in the operating room (OR). “We wear special magnifying surgical eyewear that enlarges the area we are looking at so we can see more accurately what needs to be done,” commented Dr. Szczerba. “I try to align the skin landmarks and then place enough sutures to ensure there is minimal gaps or exposed pink tissue at the end of the repair. When the skin is well approximated with minimal gaps, the body produces minimal scarring to heal the wound.” Dr. Szczerba shared that Carrie Underwood having 40-50 stitches does not always correlate to the severity of the injury. It is best practice to have as many stitches as needed to approximate the skin with minimal gaps. “Better to put more in than too few” is a common phrase used by plastic surgeons, says Dr. Szczerba. After the repair of a laceration, there are a few things plastic surgeons do to influence the best health outcome for the patient:
  • Laser treatments to minimize the appearance of a scar
  • Photo Facial or Intense Pulse Lights (IPL) for bruising and color improvement of the scar
  • Good, quality wound care cream that has sunscreen and silicone in the cream. It is typically applied 1-2 x a day for a few months.
  • General Post-care recommendation is the following: Keep the area moist, clean and out of the sun.
“Accidents, like falling down the stairs, with small injuries are no longer typically treated by plastic surgeons; the ER does a great job with those,” states Dr. Szczerba. “We usually get called in for dog bites in tricky areas or larger lacerations from car accidents. These injuries we see for both adults and minors, both being highly preventable.” Dog bites can create complex facial injuries. Dr. Szczerba cautions to not get too friendly with other people’s dogs you do not know. Horrific bites to one’s face can happen when a dog is scared or interrupted during eating. For car accidents, wearing a seatbelt, whether you are in the front seat or back seat, will minimize your chances of sustaining large facial lacerations. Carrie Underwood hesitating on being visible online and in public is not an uncommon move for a person who recently endured a serious injury. There are patients who require more time for recovery and counseling when their appearance is altered due to something unexpected. Dr. Szczerba shares that it is not uncommon for his office to recommend or refer patients to counseling or back to their primary physician for further assistance with managing the emotional component of such an injury. Whether Underwood had plastic surgery or not after her stitches and fall, she is not alone in those who have needed time to heal physically and emotionally after an accident to feel more like themselves moving forward.