“I had a question today that was brought to me from a patient that had had a previous brow lift surgery about improving the scar. This patient had gone from basically a full headed hair look to a shaved head look and was concerned about the appearance of a depressed scar.
It’s very similar to a patient that I treated that was injured in Vietnam with an explosion of a hand grenade or a rocket propelled grenade, and a numbers of his platoon members were actually killed, and he had a number of scars on the top of his head, many of them depressed, widened or elevated. Those scars, when he lost his hair, became quite noticeable and brought back memories to that Vietnam error injury, the post-traumatic depressed, disorder. We were able to help him enormously by revising the scars.
In the case that was brought forward today, the scar was relatively small compared to that case, but the principles were the same, and that is that the scar was depressed, meaning that it was not even with the surrounding skin and thus, there is a shadow created in certain lights which brought attention to the scar.
In general, I’ve talked about, the four principles of scar revision or four things that make them noticeable whether the scar is depressed or flat or even elevated in some cases.
The color of the scar, and does it match the surrounding skin? The width of the scar, is it really far apart from the edges of the normal skin or is it really close? It should be within a millimeter or two. The edges themselves. Then, the direction or position of the scar. In these cases, where there’s light creating a shadow effect which brings attention, what we like to do is typically revise the scars, and there’s a couple ways of doing that.
There’s a newer product called Bellafill out on the market, which a permanent correction or filler that lifts it. Its Poly(methyl methacrylate) and it’s been around for many years under different names but for isolated conditions like a scar, a product like Bellafill, which is microparticulate synthetic, can be injected in very small amounts, and creates collagen in the place where we inject, elevating the scar.
Any filler really, Restylane, Juvederm, the Belotero product, can be use in these areas to lift the scar however those are not permanent, but they are excellent ways of testing the elevation using a filler, which is a nice way of non-surgically improving a depressed scar.
Typically the surgical approach is to take out the depressed area. Obviously we use numbing, and in cases where people are nervous or it requires a little more surgical intervention, we can actually have them lightly sleeping or sedated, but it can be done in office in most cases with local anesthesia.
We’ll elevate and take out the scar and elevate the edges and close it so that the edges are everted, sort of like a steeple, and then when it heals it comes back to being nice and flat. We can do that and keep the scar width within a millimeter or two. We can make a depressed scar, like a gentlemen that had brow lift, and have a scar that’s much less noticeable.
Other factors in hair bearing areas like the scalp include the loss of surrounding hair. Often I’ll have patients come after brow lift and tell me they’re unhappy because they lost hair around the scar, and in many of those cases that’s just a simple, temporary or transient condition called hair shock and we’ll do a little steroid injections to reduce the inflammation and encourage the hair roots if you will, the follicle of the hair, to start growing again.
In other cases where its long standing, we can take non hair bearing areas of the skin out, the scalp that’s basically bald which represents the region of the scar, and bring the hair bearing areas very closed together again, they’re within a millimeter or so it’s very difficult to see a spot that’s bald even if it’s a scar on the scalp, a very narrow scar like I’ve just described.
So those are a couple of options that are available for people that have scalp scars. Whether you have hair on your head and it represents a bald spot, or you’re going with a very short look, which is very popular now, the treatment will depend on the condition that you have. They range from surgical options including excision and repair.
There’s lots of different types of excisions and repairs but I described one of them, and there’s also the option of using fillers. Now, permanent fillers and synthetic fillers that are non-permanent like the long chain sugars, the hyorlonic acids known as Juvederm, Restylane or Belotero, which are commonly used.
All these are of great benefit to people who are bothered by scars on the face or scalp, but if you have any questions about them, I encourage you to send in photographs or pictures of them. I’m happy to respond to you privately or publicly, if you don’t mind sharing the image of the scar. I think it benefits everyone if we can share this information and I’m always welcoming questions about things we can do to improve our appearance and our well-being.
This is Dr. Corey Mass on Looking Your Best.”
