"I wanted to talk today about scar revision. I've had a number of patients that have come-in in recent weeks with scars on their face or scalp, the areas where they're most noticeable, of course. In this case a patient, younger patient came in, with a vertical scar in his chin which was really depressed.
I've talked before about the four conditions that we address when we're treating scars. Whether the scar is level or even with the skin surface or depressed or in some cases, elevated, if it's a hypertrophic scar.
Whether the scar is wide or narrow, we want to make sure that they're nice and narrow. Whether the scar's color is the same as the surrounding skin. The direction or position of the scar, and the direction of the scar's important because if it crosses an anatomic boundary, we'd want to change its direction, there is definitely good ways of doing that, so that it's parallel or even better, in a natural skin line or fold.
So those are ways of disguising scars, and in this case the patient had a deep depressed scar, that was linear, it was vertical, which in the cases around the mouth can be advantageous but it was so deep that it was quite noticeable and something that wouldn't blend in with a little type of line that we will naturally get. He was younger also and I don’t think in his case, he didn't want to wait until he started getting a little wrinkles around his mouth.
So when I have a depressed scar, there's a few strategies that I use. The one that's best and most acute is to take the depressed scar out and re-repair it so that the edges are elevated initially and it will come back to being flat.
In most of those cases, I will concurrently schedule a follow up, and this is usually about 6 weeks after the surgical treatment, where I'll go over it lightly with some type of resurfacing.
In the old days, we'd use sanding or Dermabrasion. Now more commonly, we'll use fractional laser resurfacing
which I’ve described before but with the fractional laser, we're purposefully injuring the skin surface in and around the scar to help it blend with the surrounding skin.
If there are edges or still irregularities of the scar, I can blend them using a combination of small tiny little holes that go deeper into the dermis, the second layer of the skin, and stimulate a lot of collagen formation to help it bind and repair itself and then little bit larger holes which we call active effects, so we also call them holes, they're very superficial type of scalping lesions that go fractions of a millimeter into the skin surface but create a wound, and stimulate remodeling to the scar itself and the surrounding skin which helps to blend that.
We'll often do the resurfacing in sub-unit areas, so in the case of a chin, I will repair the scar and then I’ll resurface the entire lower chin area so that I get a good blending effect, not just on the scar itself but to make sure that the entire skin area is blended and uniform in color and makes the scar surface and texture look much better overall.
So in many cases of surgical scar revision, we're using combination of excision and repair and then some type of resurfacing to blend the area in sub-units of the face and this combination invariably makes scars very difficult to identify. I can't completely erase the scar, a lot of people think that lasers are magic, and there are magic erasers for scars, they're really not, but they are very helpful tools, there are tools that we can use to effectively blend scars and make them much less noticeable. Sometimes that's an isolation and sometimes I do that in combination with surgical treatments to remove or improve scars in general.
A lot of patient will actually up for non-surgical options like filling scars with some of the newer injectable fillers, the HA fillers in particular, Restylane
all of them are fine but they are temporary, they're not something that you give a long term result with.
If you want a temporary improvement, it’s something that you can see for up to a year or so, and in many patients that's totally fine. If you don’t mind coming in yearly and getting a little scar filling if you will that would be a fine option for you too, but for people who want longer term options the surgical and/or laser options often present the best results.
If you have any questions about scar revision in particular, I’m very happy to answer them or facial plastic surgery or just improving your overall appearance, I’m very happy to answer those questions. You can post them at DrMass.com
, a video, a photograph or even a written question, I can do that privately or publicly if you just let me know when you share the image or share your question.
As always, it’s my pleasure to talk about ways to keep yourself "Looking Your Best" This is Dr. Corey Maas.