Doc. recommended Fraxel for my 3 yr old son who has a small scar on his forehead from a fall two months ago. Dermabond glue was used to treat the cut. It's healed but there is a scar there. Is Fraxel the best treatment to reduce the scar?
Best Treatment of Forehead Scar on a 3 Yr Old?
Doctor Answers (12)
Best Treatment of Forehead Scar on a 3 Yr Old?
The best thing at this early point (2 months out) is to let time take its course. As the scar matures, the bright pink color will fade and it will become much less noticeable. Usually in children this maturation process can take a year or more: the way to judge the scar maturity is the amount of pink that it has. If you don't like the scar after it is mature (ie, it is widened) then you can consider scar revision surgery, as well as possible laser techniques.
Scar treatment in young patients
Since the scar is relatively new, I would recommend over the counter scar treatments like mederma or scar fade gel. While the Fraxel might be helpful, the scar may do fine on its own without any treatment as is usually the case in younger children. You always have time in lets say six months or so to treat the scar if you so desire at that time.
Wait for scar treatment on young child
On a three year old I would wait. The scar might improve on its own and there is no good data on the use of Fraxel in young children.
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Scar revision in a 3 year old is not always warranted
The best option for scar revision is difficult to tell without an examination. In a lot of cases, waiting is the best option. When a scar is evaluated for revision, it is important to determine if the problem is texture, color, or location. Each has a different set of options for repair. If you are talking about erbium Fraxel revision, this is best for color. If texture is the problem and your son has light skin, consider dermabrasion.
In any event, if you are concerned about the treatment, get a second opinion. There is no best treatment and it often takes several treatments over several months combined with letting the body heal itself over time to get the best results possible.
Improving scar texture
Scar texture may be improved by laser or chemical peel resurfacing. Hyperpigmentation may occur with excessive sun exposure after laser, inflammation, genetic tendencies, and hormones. The mainstay of treatment involves prevention, but in the case of hyperpigmentation, treatment is straightforward. Hyperpigmentation can be treated with a topical prescription regimen applied at home.
Hard to say without seeing your son's scar
It is impossible to determine the best treatment for your son’s scar without seeing him. If Fraxel was appropriate, it would take several treatments with Fraxel Re:store and one or two with the Fraxel Re:pair (the latter following the first Re:pair almost one year later). The Re:store may be safer than the Re:pair with less risk of scarring for your young son. However, the pain is the concern. Fraxel does hurt, even despite the application of numbing cream.
There is some absorption of the topical anesthetic and it should be discussed with your son’s pediatrician prior to use. A doctor could numb the scar with local anesthetic first if your son would tolerate this. Regardless, he may be too fearful of the treatment even if it doesn’t hurt! Regardless of the type of scar, some element of it will persist despite whatever laser or surgical revision would be done. Make sure you seek a second consultation.
Fraxel Works Amazingly Well on Facial Scars, Even in Children
I have treated many patients’ facial scars with Fraxel re:store, the youngest being 4 years old. They have all responded well with marked improvement. It takes a series of treatments usually separated by 3-4 week intervals. The child has numbing ointment on the scar for about 30 minutes, and the actual treatment takes a minute or two. Children tolerate the treatment very well. The end point is when we have trouble seeing or finding the scar (usually 3-5 sessions).
You may wait and see how the scar matures if you wish, and if it is not acceptable after a few months, have the child treated. Conversely, I have seen the best results in both children and adults when they are treated soon after (2 weeks) sutures are removed.
Certainly there will be other suggestions for treating scars here, but Fraxel is the best way of minimizing facial as well as body scars (breast scars and abdominal scars) that I have seen in my 25 years experience in facial plastic and reconstructive surgery.
Meticulous closure and care of a wound by a board certified cosmetically trained surgeon (ENT, facial plastic, general plastic, ophthalmic-plastic) will minimize scarring. Fraxel treatment just makes it better. I hope to not ever have to use it on my own children, but I certainly would not hesitate to do so if indicated.
Keep a close eye on that child of yours, and be well.
Better to wait until scar heals properly
I would wait and wait ! Kids tend to heal much better over time. The repair and the scar orientation are important factors but I would still wait. Silicone would be my non surgical treatment but it is not that easy to use on a 3-year-old.
Never heard of Fraxel for improving forehead scar in a child
Most laceration of the forehead heal very well on their own after repair. There will ALWAYS be a scar on the forehead after a laceration (cut). AS I always say, "If you have a hammer, all the world is a nail!" I have never heard of using Fraxel in a child to improve the scar. I would run the other way quickly! If the scar is problematic there are many other non-invasive modalities to choose from.
Not standard therapy
This is not a standard therapy but could provide improvement. Has your doctor shown you pictures of other scars he has treated with this technque?
There are some reports in the dermatologic literature that improvements were seen if a scar is dermabraded about 6- 8 weeks after injury. However, this is a different type of scar revision called a resurfacing technique that removes the top layer of skin. Fraxel is different in that it does not remove the top layer of skin. It creates laser holes in the skin similar to aerating your lawn.
I would advise avoidance of sun exposure with sunscreen and topical silicone preparations commonly available over the counter at the pharmacy.