We Took Our Son to the ER (What Every Parent Should Know About Cuts, Stitches & Scars)

[00:00:00]After 5 years of parenting, we finally had our first trip to the emergency department with one of the kids.

[00:00:05]>> Yeah, and honestly, it's a little surprising it took this long.

[00:00:08]>> It is. It is not surprising that it was number three, Hank, our little bit of our wild child.

[00:00:13]>> Yeah, so today we're going to talk exactly about what happened, how ED physicians decide how to treat facial cuts, and what we did when we actually disagreed with the ED physician about what to do.

[00:00:23]>> Yes, so if your child hasn't needed stitches yet or hasn't been to the ED, this episode is for you so you can know what to expect. Good chance they will someday.

[00:00:32]>> Yeah, and if this is your first time meeting us, I'm Kurt, I'm a board-certified pediatrician, dad of three.

[00:00:36]>> I'm Sarah, I'm a board-certified OBGYN, mom to those same three, and we are the doctors Bjorkman.

[00:00:48]>> So, let's start with what happened. You know, this was a few weeks ago. I was at work, it was a Friday. All of a sudden, I'm getting a FaceTime from our nanny, which is not a standard middle of the day thing. I was like, I should probably pick this up cuz it's probably important. Um, and there on the camera is Hank, sitting in her lap, um, with blood just kind of gushing down his face. And so, yeah, I got the story.

[00:01:08]He'd been kind of running around the house and tripped and fell and hit his forehead on the edge of a low window sill.

[00:01:14]>> That kid's always leading with his head, you know, top-heavy toddler.

[00:01:17][clears throat] >> facial lacerations, wounds do, it was bleeding a lot. He had some blood coming out of his nose, too, and so like it was clear there was there was a lot of blood going on. Our nanny had done a great job of hey, she grabbed a towel, she was holding pressure to it. Everything looked clean, but I said, "Hey, you know what? This looks like it's probably deep enough it's going to need some stitches."

[00:01:35]>> So, at this point, Kurt calls me. I'm also at work. I picked up the phone between patients and said, "What's going on?" He said, "Don't panic. Hank fell.

[00:01:44]The nanny's going to bring him to the emergency room. I think he needs stitches." Great, you think he's okay?

[00:01:49]And he's fine. It sounds like Cece was more worked up about it than anything.

[00:01:53]Just so >> Our 5-year-old daughter I very emotional that her little baby brother had got hurt. Yeah.

[00:01:58]>> Yes, and so she was just worrying and and upset about that and I said, "All right, I have a couple I have a couple transfers left. I'll meet you there after." Kurt was like, "I think I need you to bring the insurance card." I said, "Great." So, the hilarious thing is I go to do this transfer and the patient says to me, cuz she had heard me on the phone, she said, "Is that your son who eats dog food?"

[00:02:20]>> [laughter] >> And as it turns out, it is it is now.

[00:02:22]>> "That's his little brother. He He started doing it now, too, but we had a good chuckle." And then I headed to the ED.

[00:02:28]>> Yeah, so with that, let's just pause for a minute from the story and talk about if your child has ever had a facial laceration, a lack, a wound, you know, the amount of bleeding doesn't necessarily reflect how bad the injury is. There's a lot of blood vessels kind of near the surface of the scalp and the face and so just in general, there's going to be a lot of bleeding. The biggest things, first and foremost, is to stay calm. Your child's going to take their emotional cues from you.

[00:02:53]>> Next, apply firm, direct pressure with a clean towel or some gauze. Try not to keep lifting it every few seconds to look, but I know you're going to want to. Just give it a few uninterrupted minutes of holding pressure. This is something we think about in surgery.

[00:03:09]Pressure, platelets, and patience will help that bleeding stop.

[00:03:14]>> Platelets are the little kind of blood cells that actually help form a clot, that get the bleeding to stop. And then patient just being give it some time.

[00:03:21]Other things that can sometimes help, sometimes a cool pack, like a nice pack wrapped in a towel, can actually help some of the swelling, can help slow down some of that bleeding, too. You know, you're going to be thought mindful like, "Oh, is there dirt? Is there something in the wound?" There's going to be time to like do some gentle rinse for that later, but the first thing is just to get the bleeding to stop and to give you time to kind of assess the situation, allow you to calm down, allow your child to calm down. Some other things that were kind of were important about Hank's story is he cried right away. The things that you're going to want to have in your mind that the doctor's going to want to know as well how far did they fall? Did they cry right away? Was there any has there been any vomiting, any seizure, any loss of consciousness?

[00:04:00]These are going to be big things that are going to help the the provider who's seeing you know like hey do they need to get a CT scan to look for a bleed deeper inside the head and brain bleed or is this just a laceration that's going to need stitches or special bandages, steri-strips to pull it together.

[00:04:14]>> Once the dust has settled a little bit, the bleeding has stopped, you do want to look and assess hey what's going on here? How long is this? Does this look deep? Is it dirty? All of these things.

[00:04:26]If there is some dirt in the wound, sometimes a gentle rinse with clean running water is perfectly reasonable.

[00:04:33]We don't want you to scrub aggressively.

[00:04:34]If there's a large object in the wound, don't pull it out. You're going to want to leave that for the medical professionals. But if they fall, it's a big scrape on their head, there's some dirt in it, fine to kind of rinse that off.

[00:04:45]>> And as Sarah said, just cool water, a flush is exactly what they're going to do in the emergency department. They're going to use a flush. Sometimes that that actual water makes it look like it's bleeding more. Sometimes it can actually make a little bit more bleeding, but getting some of the dirt out. If you feel uncomfortable with that and you're on your way to the emergency department anyway, you can let the emergency department team do that. Maybe sometimes they'll have some extra numbing medication involved or some things at that time too that's going to make it more comfortable for your child.

[00:05:09]>> So does my kiddo need to go to the ER?

[00:05:12]This is probably the biggest question parents have out there because not every cut needs an emergency department visit.

[00:05:18]We generally recommend immediate evaluation if the bleeding won't stop after you've held direct pressure for two to three minutes. The wound is deep or kind of gaping open. If you can see fat, muscle, bone, that is head her right to the ED. If the wound is on an eyelid or involves the lip border, we call this the vermilion border. We care about those cuz you want them to heal correctly in a straight line.

[00:05:42]>> very much a easy cosmetic thing to make sure that this border lines up so it's not kind of a jagged thing that everyone's going to see.

[00:05:49]>> Yes, or if you are worried about the head injury itself. Hey, they fell from a height, you know, they lost consciousness, they seem dizzy, they're vomiting, always go.

[00:05:58]>> So just to say that again, repeated vomiting, a loss of consciousness, severe sleepiness, seizure, or abnormal behavior after a fall deserve to be evaluated right away. Now fortunately as we said, Hank didn't have any of these, but our concern for this was that I could see in the video is like, "Oh, that's actually a pretty big gash. Oh yeah. He's going to need a couple stitches in that to bring everything together."

[00:06:18]>> Yes. We got to the emergency department.

[00:06:20]I got there around the same time you guys did.

[00:06:22]>> Yeah, and actually it was it was nice actually, you know, we had some milk for Hank. He was calm, he was in his car seat. I was able to pull him out of his car seat, bring him in. Right away when you get there, the people in the front of the ED, their job is to do triage.

[00:06:33]Hey, how sick are you? Do you need to go directly to the trauma bay? Are you someone who can wait in the waiting room for a while? Fortunately we got there at a time when there weren't a lot of people around. Then with going through triage, they get vitals right away. They need to get your weight for dosing medications for your child cuz everything is based on how big they are.

[00:06:50]They get their height, what's their heart rate, what's their respiratory rate, what's their oxygen saturation, getting all of the normal vital signs to really say, "Okay, hey, is this patient stable?" Again, helping that triage process.

[00:07:01]>> Right. They're not just looking at that cut, right? They're trying to evaluate the whole child. How did it happen? How far did they fall? How are they acting now? Do we need imaging? Is this just, "Hey, a little kid fell."

[00:07:12]>> Again, these are the questions that the emergency physicians trying to think about. Hey, is this more than just a cut or is this just, "Hey, we need to clean this out and get this put back together." Again, as we mentioned for Hank, reassuringly he didn't have any of those signs of serious brain injury. So then it came back to, "Hey, how do we repair >> How do we put that little thing back together?" So before anyone starts sewing, that wound needs to be cleaned.

[00:07:32]This usually means irrigating the wound with lots of water or saline to remove any dirt or debris. Sometimes trimming away tiny pieces of damaged tissue if needed if there's dead tissue there. So, really good wound preparation is more important than people realize for good healing.

[00:07:50]>> Yeah, like I've seen lots of kind of what's called an avulsion where like someone gets a big scrape and kind of peels skin back and there's a piece of tissue there that doesn't have any good blood supply. Like things like that need to be cut out so that that is not going to just die later and so that you can have a nice good clean wound to approximate bring those edges together.

[00:08:09]>> Part of all of this a very important piece especially for kiddos is controlling pain which there are some tricks I think you can talk about that pediatricians and pediatric EDs have.

[00:08:21]Often they do this before like they did all this before they did Hank's irrigating. They did this thing where they just irrigated a lot of saline using a special little device but they had gotten him very comfortable before we did that.

[00:08:34]>> like a medical squirt gun with water which you know, having a three and five-year-old toddler there too to like play with the water guns after was really fun. The the biggest piece though is like with pain with anxiety. Many children's hospitals which is great we have child life come in for some distraction and other things.

[00:08:49]>> life is employees, people they've hired who come and hang out, play with your kids, distract them, bring them toys.

[00:08:55]>> They've got games to play, sometimes it's iPads, things like that. This is something that you could think about yourself if you're not going to a children's hospital and if your child loves screens like well, you've got a screen in your pocket pocket maybe or maybe their favorite toy. This might be a time where you're going to let them use that extra screen time.

[00:09:10]>> Indeed. Indeed. But tell them all about, you know, Hank was this kind of like a little drunk toddler. He got some anxiety stuff. He got some pain meds. He was >> Yes, and so what are the medication pieces of this? So, there both topical pain medications. This is like lidocaine which sometimes they can use a needle to inject or often times they use kind of let gel LET which is lidocaine, epinephrine and tetracaine that really help to decrease the bleeding and make that area numb. And then the anxiety portion. A lot of pediatric emergency departments will use something called Versed, midazolam, which is an anxiolytic. It helps anxiety. And there's lots ways to give that. You can give it through a tab or a liquid that the child drinks, intranasal spray, actually can spray it in the nose, that works even faster. Or if the patient has an IV, they can give it IV, too. A lot of times, and what they did for Hank, it was just a little drink that he drank, and then it was working within 20 or 30 minutes. And it's >> And they put that They did put that let that lidocaine It was a jelly kind of thing. They put it on his wound and then taped like a plastic bag over his face so that it would really sit there and get really numb for half an hour or so.

[00:10:18]>> protects the toddler's hand from swiping it away.

[00:10:20]>> Yes, yes, they got taped down.

[00:10:22]>> So, um and then then we just got to sit, we got to relax, we got to like have big brother and sister help and participate.

[00:10:29]>> lights off. I think we put a show on.

[00:10:30]They were sitting in the bed together.

[00:10:32]>> Everyone got snacks while we waited. It was a nice time to calm down and get ready for the decision of, "Hey, how are we going to put this together? Glue, stitches, or what?"

[00:10:41]>> Parents often ask, "Is glue better than stitches?" And the answer often depends on the wound itself. So, tissue adhesive works beautifully for small, straight cuts that aren't under much tension.

[00:10:53]It's fast, it's painless, and the cosmetic results are pretty excellent when used appropriately.

[00:10:58]>> Yes, and often times you're going to combine like a Steri-Strip, like a little specialized piece of tape to pull that wound together, adding glue on top.

[00:11:06]I can say as someone who's had multiple lacerations on my face, I've had both.

[00:11:09]But the wounds that are deeper, gaping, irregular, or under more tension are going to need sutures. So, some of this also depends on, "Hey, how important is that cosmetic result? Is it in a spot that's going to be really visible?" And if we don't have stitches in the right place, it might not heal right. Which is kind of where Hank landed.

[00:11:25]>> Hank's right in the center of his sweet little forehead, his little Harry Potter scar that he has now. We wanted this one to heal as nicely as possible.

[00:11:35]>> Yeah, and it was deep enough and just going to be under just enough tension that probably it was on the border of was it okay for glue or not and so we said, "Hey, let's go with stitches."

[00:11:44]>> the emergency [clears throat] physician recommended, "Hey, let's sew this up."

[00:11:47]This is where it got a little interesting where we don't often really play the doctor card and really defer and trust our care teams incredibly and this doc wanted to use a a specific kind of suture. He wanted a fast absorbing what we call gut suture and basically this is great because it dissolves, okay? So, you don't have to you put the stitches in and then it'll just dissolve on its own. You do not have to go back to have the stitches removed.

[00:12:14]>> And this is, you know, as Sarah mentioned just to say, the physician was doing what is standard of care. This is actually very well studied. Use five-o fast-absorbing gut suture. It is the standard of care in emergency departments and for those reasons of, "Hey, it does a really nice job. It's a good strong suture and you don't have to make the patients come back."

[00:12:31]>> Right.

[00:12:32]>> Um, which is also a big thing especially in thinking about kids in pediatric care of coming back, coming back to another procedure, having another provider coming at their face with tools to pull stitches out is actually pretty important.

[00:12:44]>> However, we both kind of threw back to, you know, Kurt has worked in the pediatric ED, sewed lots of lots of face lacs. I am a surgeon as well and I wanted to use a nylon non-absorbable suture.

[00:12:58]>> There is evidence about this here and it's actually pretty interesting.

[00:13:01]They've done some randomized controlled studies comparing absorbable sutures with nylon or proline and found that generally parents rate the cosmetic appearance between these similarly. They perform great. They both do very well and so in terms of like what is the healthiest option for your child, they're both great. But then it comes down to, "Hey, do you need another procedure to remove non-absorbable sutures and what is that cosmetic appearance?" So, as I said here, in this study shows parents didn't notice a difference after healing. They look the same. Um the interesting point here though is physicians actually do sometimes score those nylon suture repaired lacerations slightly better using standardized photographs months later. So, like this is kind of the piece of well, actually there's a little data that maybe the cosmetic appearance of using using non-absorbable sutures going to be slightly better. I have to say kind of the big point there though is if you leave sutures in and don't remove them on time, the suture themselves, that stitch is going to leave a scar. And so, that's that's part of that problem that like, you know, for the ED physician, they say, "Hey, the cosmetic appearance is about the same. I can avoid this child having to come back and they don't have the they don't have the risk of having the sutures left in to mark. Yep." The infection rates are the same, wounds stay together the same, other complications are all very same.

[00:14:20]And so, in many ways, the ED physician was making a great decision as standard of care to say, "Hey, we can use absorbable suture. It's going to go in and so on and it's going to heal great.

[00:14:28]It's going to look great." For us >> the surgeon mom and pediatrician dad were being helicopter parents and were just slightly neurotic and said, >> "Hey, can would you mind using >> so nice and so non-confrontational and everybody was happy about it and he didn't mind at all. I was like, "Oh my gosh, he's going to hate us." And you know.

[00:14:47]>> And so, this comes to like, "Hey, how do you go about like you may not be a physician. You're in the emergency department. You're like, 'Hey, you know what? I'm not certain about this.'" You can ask. Um something that I tell patients and families all the time is hey, "If you're uncomfortable, if you've got questions, I need to know about it.

[00:15:03]Because if you're uncomfortable with the plan, well, either there's something I'm missing that I need to know that's going to help me provide better care or I need to help you feel comfortable that what we're doing is the best thing." And sometimes it's going to be like, "Hey, this is what we use all the time. Here's why. It means you don't have to come back. It I don't have to worry about scars from the suture itself." All of those things. And so, if you've got a question, respectfully say, "Hey, I'm wondering about this. Is non-absorbable an option?" Like, >> Right. You may not have a question on suture or something selection, Prolene versus catgut or whatever, and that's okay, but there will be things in your kids' care along the way that you're just not certain of. Or even to say, "Hey, I'm really concerned about scarring on my kiddo's face. Is this the best thing to do? Is there a plastic surgery team? Is skin glue okay? Is what can we do to minimize scarring?" And even sometimes just having that conversation with your doc will make you feel better because you say, "Hey, I know they're thinking about this." And you just feel so reassured that, "Hey, we're on the same team. Our goals are the same." And it's really valuable to have that conversation.

[00:16:07]>> Yep. And just to say, it's since you mentioned it, we did not ask for plastic surgery. Like, if you have a complex scar or something that is in like a particularly high cosmetic area that's really important, you can always ask about that, but the ED physicians suture all the time. They do standard laceration care all the time. They're very good. They did a great job. We had a great cosmetic result with Hank. And so, >> I was like, I I could just do this. He needs two stitches. This is >> And so, the math for us in this particular instance was like, "Hey, we're really comfortable removing these sutures ourselves. We're going to take a suture removal kit home with us. We'll watch this laceration. We'll watch it heal, and then we'll pull them out at the appropriate 5-day mark when it's time. We don't have to come back." And so, it made sense to say, "Hey, maybe we'll get a slightly better cosmetic result, and we feel really comfortable handling all the other pieces."

[00:16:54]>> Okay, so we're going to try to take these stitches out. Um this is what we got from the ED. They gave us a pair of uh pick up and scissors. Often times there's a there's a special pair of scissors that has a hook on it that you slide underneath the suture to cut it. We're going to have to do this. It's a little less safe.

[00:17:11]>> And often, always, they would schedule a follow-up visit for you to go see your pediatrician or someone to take these out.

[00:17:17]>> Yeah, this is just a little bit different cuz the pediatrician's at home.

[00:17:21]You know, what I'm what I'm trying to do is try to slide this under the stitch and cut then you're going to pull it out.

[00:17:26]>> We had our one chance when the baby was happy. He was great. He was doing great.

[00:17:31]Lift it a little bit. There you go, Dad.

[00:17:33]Got it. Pull out. One out.

[00:17:35]>> And so there now that's going to focus on there. You can see it's just This is what was under the skin and that's the tie that's on top.

[00:17:42]So that's one. Let's try the other one.

[00:17:44]>> You're doing so great, Hanky. One more.

[00:17:49]>> Do a little bit tighter.

[00:17:52]>> Just make sure you I'm not seeing the stitch you're getting under yet.

[00:18:00]There it is.

[00:18:02]Get under that. Snip. Pull it out.

[00:18:03]>> Got it. Same thing.

[00:18:04]>> Good job.

[00:18:06]>> I mean you can see that, but there's the stitch that was under the skin and the knot that was on top.

[00:18:09]>> knot and thanks going for the scissors.

[00:18:11]Keeping Vaseline on it for moist wound healing and >> That's really good. And it kept the scab from forming over the suture.

[00:18:18]>> Yep. And really important now sunscreen, keeping it out of the sun while it heals. Now comes the part that every parent cares about and that is how do you give your your child the best chance at that scar healing really well and minimizing the cosmetic effect?

[00:18:35]>> Yeah, so this is hey, the repair went well. Everything got cleaned really well first. Everything got approximated well.

[00:18:41]The the the pieces came together nicely.

[00:18:44]You had a nice repair. Now it's what do you do for that wound? Well, you want to keep it clean and keep it moist.

[00:18:49]>> Keeping it moist with a thin layer of petroleum jelly, Vaseline has much better evidence than actually letting wounds dry out and scab over. Moist [clears throat] wounds heal faster and more predictably.

[00:19:02]>> And with that too, just to say like the moist wound healing, this is like the it's still open. We're not like put a covering it up with a bandage. We don't don't to have like hold infection in. We want to make sure that if there's something there, some pocket, that it's easy for anything to come out of that wound if it needs to. And so, we're not talking about putting a bandage on, but just a thin layer again of Vaseline, petroleum jelly.

[00:19:22]>> Put a little a little a little dab of a little daba Vaseline on his little little scar. So, let's talk about why scars happen in kind of simple terms. Parents hear the word scar cream all the time, but don't always understand the biology. So, wounds heal by laying down collagen.

[00:19:41]During the first few months, collagen is disorganized. It make the scars kind of appear red and raised and firm.

[00:19:49]>> Mhm.

[00:19:49]>> Over the next 6 to 12 months, that collagen remodels and aligns along kind of natural skin tension lines.

[00:19:56]>> Yeah, which is amazing how that happens.

[00:19:58]And you'll see like that that area is going to look red and raised and kind of beefy. And then, if we do the right things in that first year, we can do a lot to prevent how much scar happens after that.

[00:20:08]>> when I was first putting some scar cream on Hank's scar, it was there was a very big bump. It was very tight, like you couldn't move it up and down very well.

[00:20:18]And even in now a couple weeks post, there's a lot more movement. It's not as red. We're getting there.

[00:20:24]>> Things like silicone then is going to help regulate hydration and help collagen remodeling.

[00:20:28]>> Right.

[00:20:29]>> Other big things are sun prevention. UV radiation from the sun actually does a whole lot to cause damage or to disrupt this collagen remodeling and lead to long-term discoloration. And so, avoiding sun for a whole year as much as possible. So, the face is always hard, but hey, a great time to invest in a hat for your kiddo.

[00:20:48]And then, also thinking about other things that like reduce tension across the scar.

[00:20:52]>> Once the skin has completely closed, the wound is completely healed, this is where the evidence becomes pretty clear and we're going to talk about silicone gel or silicone sheets. So, prior to hey, you still have a wound, stitches are in, things like that, you are using Vaseline, petroleum jelly. Once it's healed, there is a lot of data about silicone.

[00:21:12]>> [clears throat] >> Not vitamin E, not onion extract, not Bio-Oil, oil, silicone. It [snorts] is one of the few over-the-counter scar treatments that consistently supported by randomized trials and clinical guidelines.

[00:21:24]>> And then as mentioned, sun protection is another huge one. New scars darken much more easily under that UV radiation exposure. So whenever possible, protect the scar, use sunscreen, use hats, or shade at least for that first year.

[00:21:37]>> Your goal is you protect the scar from the sun and over the course of that first year, it's really going to fade.

[00:21:42]You don't have this big beefy red scar anymore. Scars fade over time, but even Hank got a little extra sun there when we were out over the weekend and that scar just glowed. So it's really, really important and it will help minimize long-term cosmetic appearance.

[00:21:57]>> And then the other thing is once it's appropriate, once things have really healed well, and you maybe want your pediatrician to say, "Hey, it's appropriate." Gentle scar massage can really help soften that tissue over time. And remember that remodeling of that tissue happens slowly. Again, 6 to 12 months for it really to fully remodel.

[00:22:13]>> What you see at 6 weeks after the injury is not what the scar is going to look like a year later. This is what we have been doing for Hank. This is Biocorneum Advanced Scar Treatment. It's a silicone scar gel. Anyway, I put one little dot on my finger. He has scars right here and I rub this in and then I massage his little scar and it is mobilized so much even over the first 3 weeks of doing it. And so twice a day, the silicone gel and massaging his scar and it's looking really great.

[00:22:47]>> Well, again, the initial moment if when this happens for your child, when this happens for your child, um you know, control the bleeding, take a deep breath. You can remain calm so they can remain calm. Um we talked a little bit about making sure you do some gentle cleaning just with flush at home. Just use water, spray it over that. You can even use like a clean washcloth with water in it and gently dab that. Um, and then making that decision, do you need to go to the emergency department? Reducing scar in the long term, again, a good initial healing repair.

[00:23:18]>> Yep.

[00:23:18]>> Um, once it's well healed, you're protecting it with Vaseline petroleum jelly up front and then once well healed, thinking about silicone and gentle massage and water.

[00:23:28]>> sun protection. Don't let the sun see that scar as your goal.

[00:23:32]>> Yeah. Um, and anyway, so when this happens for you, good luck. Hopefully this helps prepare you a little bit. Um, maybe you've got great experience already that you can share in the comments.

[00:23:41]>> Yes.

[00:23:41]>> Um, you know, Hank is had a lot of great healing already. We're going to see it's like now just part of him. A little crash keeps running into stuff.

[00:23:49]>> crash. Well, it's so funny. I remember, should we tell the story? When we were dating, Kurt has this scar on his forehead and we were talking about scars or birthmarks or who knows. And I said, "Oh, what hap- what happened? How'd you get that scar?" And he said, "I got bucked off a horse, Stormy."

[00:24:06]>> Yeah, cowboy.

[00:24:07]>> Well, when I went home to meet his family, at some point, I we relived this. I said, "Yeah, he that time he got bucked off his horse, Stormy." And his sister starts laughing because Stormy was his stick horse when he was about 4 years old. He ran into a coffee table while he was riding his little stick horse, Stormy.

[00:24:29]>> Yeah.

[00:24:30]>> So >> When you're early dating, you you tell stories and maybe you leave out a couple details that get flushed out later.

[00:24:36]>> is certainly taking after his dad.

[00:24:39]Um >> So, Stormy was a great stick horse, by the way. We went on many great adventures. Um, and you know, it's healed okay.

[00:24:46]>> There's a scar, but it's it's pretty subtle. So.

[00:24:48]>> Anyway, um, hopefully this was helpful.

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[00:25:02]>> See you guys.

[00:25:02]>> Bye.

[00:25:07]>> We're doctors.

[00:25:07]>> But not your doctors.

[00:25:09]>> Anything we've said in this video is for education or entertainment purposes only.

[00:25:12]>> It is not medical advice.

[00:25:14]>> Any specific medical questions you have should be directed to your provider.