Are you having back pain with any of the following?

  • Severe pain, weakness or tingling in your leg(s).
  • Difficulty stopping urination or loss of control of bladder or bowels.
  • Unexplained fever, nausea or vomiting.
  • A history of cancer or unexplained weight loss.

We understand that you are experiencing one or more of the health issues that might be impacting your back pain.

We recommend that you discuss these health issues with your doctor before proceeding with this program.

Once you are cleared by your doctor to do this program, we hope it helps you find relief from your back pain.

Provider photo for Alexandra McSpadden

Alexandra McSpadden, PA-C

Plastic Surgery

Welcome to My Doctor Online, a web site that my colleagues and I developed to make it easier for you to take care of your healthcare needs. On this site you will find answers to many of your questions about my clinical practice. Also included are several online features that will allow you to e-mail me, check your laboratory results and refill prescriptions. I hope you find its content informative and useful.

My Offices

Santa Rosa Medical Center
Appt/Advice: 707-566-5288

See all office information »

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Scar tissue that forms on the skin is a normal part of the healing process after surgery, an injury, a burn, or other trauma.

Factors affecting scar formation include:

  • Depth and size of the wound or incision.
  • Location and cause of the injury.
  • Age, heredity, gender, and ethnicity.

We will recommend treatment options based on the type and severity of scarring. Treatment may include:

  • Topical treatments, such as topical skin care creams and other products.
  • Less invasive procedures, such as injections.
  • Surgery, such as skin grafting.

Treatment may improve appearance. However, the scar may never go away completely.

Types of Scars

The kind of scar you have will influence the treatment we recommend. The various types of scars include:

Uneven skin color or texture. Caused by acne, minor injury, and prior surgical incision, the appearance of scars are more likely to improve with non-surgical treatments, such as topical skin care creams and other products.

Hypertrophic. These are raised red areas over the wound. They develop when your body makes too much collagen, a normal process in scar formation. The scar tissue may be red or discolored. These can be seen a few months after an injury or surgery and often go away over time.

Keloid. These are larger and thicker than hypertrophic scars, extend beyond the original wound, and may continue to grow. Keloids may itch, pucker, and be uncomfortable. They are more common in people with darker skin and more likely to appear on certain parts of the body, such as the ears or chest. Although they can grow quite large, they are benign (noncancerous).

Contracture. Scarred skin can cause the skin and tissue beneath it to tighten, which may limit movement around the injured area. This occurs most often from burns and other injuries where a wound covers a joint.


Scar revision surgery helps improve the appearance of a scar or restores tissue function in certain cases. 

For the surgery, we’ll give you: 

  • Local, intravenous (IV), or general anesthesia, depending on the size and location of the scar.
  • Medication to manage pain after surgery. 

The risks of surgical scar revision include bleeding, infection, complications of anesthesia, and healing problems. There is also a chance the  surgery won’t improve the appearance of your scar. 

We’ll explain the tradeoffs and risks of your surgery. 

Types of surgery

Surgical treatments for scars include:  

Scar excision and revision. This procedure is sometimes used for deeper scars. The old scar is removed, and the skin around it is carefully repaired. The new scar is usually thinner and may be in a slightly different location than the original scar. 

We may also give you steroid injections or radiation therapy to help prevent hypertrophic or keloid scars from coming back.

Skin grafting. This method is used to replace skin if scars are very large to the area needs more repair after the scar is removed. Skin can be moved from a healthy part of the body and attached to the injured area.

Tissue expansion. This surgery places an expandable silicone implant under the skin that will be slowly filled with sterile saline solution to stretch healthy skin. After this, the implant and the scar are removed and the stretched skin replaces the scar tissue. 

More than one surgical method may be needed to treat the scar.

You will be given specific instructions to follow after your surgery. It is very important to follow them so you can successfully heal.

What to Think About

You will have to decide if scar revision surgery is right for you. It may be a good option if you are:

  • Bothered by the scar and there is a greater chance it would be less visible after surgery.
  • Healthy and do not have a condition that would affect healing, such as diabetes or an active skin disease.

The best time for scar revision surgery varies. It can take time for a wound to heal, and a scar can continue to improve for as long as one year. 

We will recommend the best time for surgery based on the type of scar and your healing process.


Treating your scar will depend on many factors. Not all scars can be improved. We will work with you to develop the best treatment for your type of scar.

Topical treatments

Prescription or over-the-counter skin care creams or other topical treatments will help a scar heal and may improve its symptoms and appearance. 

These can be used on surface scars and discolorations or after scar revision surgery. Do not begin using them until the wound is well healed, or until your doctor prescribes applying it.

Topical treatments we recommend include:

  • Corticosteroids, anesthetic ointments, and antihistamine creams, to reduce itching and tenderness.
  • Silicone gel sheeting or ointment, to help soften and heal thick scars.
  • Plant-derived creams, such as Mederma, to decrease redness, thickening, and dryness, and to increase softness and flattening.

Injections can also be an effective treatment option. They include:

  • Steroid injections to reduce scars that are raised, thick, or red. Steroids are injected directly into the scar to break down collagen cells inside. These may also ease pain or itching. Injections usually need to be repeated on a monthly basis, and are often used with topical treatments.
  • Injectables to fill scars. Collagen or synthetic medicine are injected into the scar to fill in the area. Filler injections are not permanent, so they will need to be repeated every few years. This type of treatment is usually cosmetic so it may only be available on a fee-for-service basis.
Surface treatments

Surface treatments can reduce skin roughness  and improve uneven coloring..

Skin resurfacing removes the top layer of damaged skin allowing new skin to form. This can be done with a special device that scrapes the skin, or by using a chemical peel, a laser procedure. 

Dermabrasion uses a device that removes the outer layers of dead skin cells. It promotes the growth of new healthy cells and improves your skin's appearance by reducing pores, fine lines, acne scars, age spots, and sun damage. Dermabrasion has recently been replaced by laser resurfacing.

Chemical peel uses a chemical solution to remove the outer layers of skin, which can improve uneven texture and color. In some cases, chemical peels may even control acne and soften scars caused by acne. 

Laser skin resurfacing removes the top layer of damaged skin, allowing new smoother skin to form. This procedure can be very effective for small facial and acne scars.

Additional surface treatments include:

  • Vascular laser treatment to improve a red scar by reducing the blood vessels that supply blood to the area.
  • Skin bleaching using topical medications to lighten the skin. The medication interferes with pigment production wherever it is applied. 

All of these procedures will be done by your doctor at the clinic.

They are often considered cosmetic treatments but may be covered in combination with procedures that are reconstructive. We can help direct you for appropriate coverage and care.

Your Care with Me

If you have a scar that concerns you, your first contact will typically be with your personal physician, who will evaluate your health and symptoms.

If specialty care is needed, your personal physician will facilitate the process of scheduling an appointment in my department. If appropriate, she or he might call me or one of my colleagues while you are in the office so we can all discuss your care together.

During your office visit, we will discuss your medical and family history and I will examine your scar. We may take confidential photographs for your medical record. I will explain the findings of your exam and answer any questions or concerns you may have. We will discuss treatment options, including likely outcomes and risks or complications, and together we will create a treatment plan that is right for you.

If you need to talk with me after your visit or procedure, please call my office. You can also e-mail me with nonurgent issues from this website whenever it is convenient for you.

If you have urgent concerns or issues while my office is closed, or need general medical advice, you can call the Appointment and Advice line, available 24 hours a day, 7 days a week. You will be connected with a nurse who can give you immediate advice.

If you are experiencing an emergency, call 911 or go to the nearest Emergency Room.

Coordinating Your Care

Having all of our Kaiser Permanente departments located together or nearby, including pharmacy, laboratory, radiology, and health education, makes getting your care easier for you.

Another major benefit is our comprehensive electronic medical record system, which allows all of the doctors and clinicians involved in your care to stay connected on your health status and collaborate with each other as appropriate.

When every member of the health care team is aware of all aspects of your condition, care is safer and more effective.

If you come to an office visit

At the beginning of your visit, you will receive information about when you are due for your next test, screening, or immunization. We can discuss and schedule any preventive tests that you need. 

  • At the end of your visit, you may receive a document called the "After Visit Summary" that will summarize the issues we discussed during your visit. You can refer to it if you forget what we discussed, or if you just want to recheck your vital signs and weight. You can also view it online under Past Visits.
  • To help you prepare for your visit, please see additional details under Office Visit. 
If I prescribe medications

We will work together to monitor and assess how your medications are working and make adjustments over time. Prescriptions can be filled at any Kaiser Permanente pharmacy. Just let me know which pharmacy works best for you, and I will send the prescription electronically in advance of your arrival at the pharmacy.

If refills are needed in the future, you can:

  • Order them online or by phone. Order future refills from my home page or by phone using the pharmacy refill number on your prescription label.
  • Have them delivered to you by mail at no extra cost. Or you can pick up your medications at the pharmacy. If no refills remain when you place your order, the pharmacy will contact me regarding your prescription.
If lab testing or imaging is needed

For lab tests, I will use our electronic medical record system to send the requisition to the Kaiser Permanente laboratory of your choice. For imaging procedures, we will schedule an appointment with the Radiology department. When the results are ready, I will contact you with your results by letter, secure e-mail message, or phone. In addition, you can view most of your laboratory results online, along with any comments that I have attached to explain them.

If I refer you to another specialty colleague

If we decide together that your condition would also benefit from the care of other types of specialists, our staff will help arrange the appointment(s) with one or more of my specialty colleagues.

If surgery or a procedure is a treatment option

I will recommend that you review educational information and tools to help you prepare for your procedure or surgery. The information will often help you decide whether surgery is right for you. If you decide to have a surgery or procedure, the information will provide details about how to prepare and what to expect.

If we proceed with surgery, I will have my Surgery Scheduler contact you to determine a surgery date and provide you with additional instructions regarding your procedure. Once your surgery is scheduled, a medical colleague of mine will contact you to conduct a preoperative medical evaluation that will assure that you are properly prepared for your surgery.

Convenient Resources for You

As your specialist, I have a goal to provide high-quality care and to offer you choices that make your health care convenient. I recommend that you become familiar with the many resources we offer so that you can choose the services that work best for you.

My Doctor Online is available at any time that is most convenient for you. From my home page you can:

Manage your care securely

• View and compose secure e-mail messages.
• Manage your prescriptions.
• View your past visits and test results.
• View your Preventive Services to see whether you are due for a routine screening or updated immunization.

Learn more about your condition

• Read about causes, symptoms, treatments, and procedures.
• Find interactive health tools, videos, and podcasts to help you manage your condition.
• View programs to help you decide on or prepare for a surgery or procedure.

Stay healthy

• Locate health education classes and support groups offered at every medical center.
• Explore interactive programs, videos, and podcasts that focus on helping you stay healthy.
• View your Preventive Services to see whether you are due for a routine screening or updated immunization.

Related Health Tools:

Prepare for Your Procedure

See more Health Tools »

If you have an emergency medical condition, call 911 or go to the nearest hospital. An emergency medical condition is any of the following: (1) a medical condition that manifests itself by acute symptoms of sufficient severity (including severe pain) such that you could reasonably expect the absence of immediate medical attention to result in serious jeopardy to your health or body functions or organs; (2) active labor when there isn't enough time for safe transfer to a Plan hospital (or designated hospital) before delivery, or if transfer poses a threat to your (or your unborn child's) health and safety, or (3) a mental disorder that manifests itself by acute symptoms of sufficient severity such that either you are an immediate danger to yourself or others, or you are not immediately able to provide for, or use, food, shelter, or clothing, due to the mental disorder.

This information is not intended to diagnose health problems or to take the place of specific medical advice or care you receive from your physician or other health care professional. If you have persistent health problems, or if you have additional questions, please consult with your doctor. If you have questions or need more information about your medication, please speak to your pharmacist. Kaiser Permanente does not endorse the medications or products mentioned. Any trade names listed are for easy identification only.

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