My neck scar is 4" long and it pooches out all the way across. This is a fairly new incision but everyone else's is just a flat line even in the beginning. What are my options for flattening it and making it blend in with the rest of my skin? Which procedure would best address this scar?
Getting Rid of Thyroid Surgery Scar
Doctor Answers (10)
Thick Thyroid Scars - Keloid, Hypertrophic Scar, Neck Scars. Options for Treatment of Neck Scars
Neck scars are unpredictable. In some cases, the scars heal as a thin line while in other cases, they may be extremely thickened.
The goals of therapy are to modulate the scar early on in order to decrease the chance of it thickening. This is accomplished by rigorous massage in the early postoperative period. Other options include application of silicone sheeting, injection of cortisone, and ultimately, reexcision of the scar.
One of the reasons why neck scars do not heal as well is because we cannot completely immobilize the neck during the healing phase. Thus, the body deposits more collagen in the area in order to prevent the incision line from dehiscing.
If you have a poorly healed scar, consider speaking to a plastic surgeon about your options as discussed above. You are always welcome to email our office if you have specific questions.
Time can be an important component
I agree with everything Dr. Wallach has said. In addition there may be a role for a tincture of time. Scars typically take 6 months to fully mature. During that time the body constantly remodels them, changing concentrations of collagen and remodeling the scar structure. Sometimes acting with steroids or additional surgical intervention before the scar has had a chance to mature can cause additional problems.
I hope this helps.
Steven Williams, MD
There are many options but persistence is a key
Scars sometimes have a tendency to come back. Your scar is noticeable given the size and discoloration. It is hard to tell if it is red. Early on, the redness can be improved with IPL or a vascular laser. This will decrease some of the inflammation within the scar. Steroids can do the same as well cause the scar to shrinken a little.
You look young and what that tells me is that you are more likely to form more exuberant scar formation and inflammation. This may hinder your healing for a while until you get older. Ways to improve the scar include re-exision and closing the straight line closure that you have with a geometric type of configuration to break up the straight line that people pick up on.
Laser resurfacing in a very conservative fashion can also help. After closing the incision you may consider having steroids injected in a repeated fashion along with topical steroids.
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Pooching out is a good thing early on!
The best skin closure for neck surgery requires som e pooching out of the incision.
Wound healing works by laying down collagen in the wound and then chewing it up and starting all over again, and again. With each cycle, the collagen becomes more organized- tht is a good thing. Another thing the wound does is contract. Everything gets smaller. Sometimes this contraction will pull the skin inward, creating an indented look. In order to compensate for this contraction, good surgeons will evert the edges (pooching). Over time the eversion flattens out.
Other remedies include;
1) silicone sheets and gels
2) steroid injections and tapes - only for raised ugly hypertrophic scars.
3) avoid Mederma and any treatment that has hydrocortisone in it. Mederma does nothing and daily use of a steroid will weaken a scar excessively.
Treatment of scars
Dear Larue, Now that a few months have passed since your surgery (and your posting) I hope the scar has begun to settle down. I want to add, in addition to all the treatment options discussed by the other physicians, that it is important to let "mother nature" take its course...up to a point. If one interferes with scar production early on, and too aggressively, you might end up with a wider scar. Most scars should start settling down at 2-3 months. If it is still growing aggressively at that point, that is usually when I start thinking about scar interventions.
Yoash R. Enzer, MD
Scarguard and pulsed light therapy are good early scar treatments
While this is a very fresh scar and the tincture of time will definitely make a substantial improvement, that process will take months and even up to a year. Until then this is understandably disturbing to you and you would feel better if you could do something that may offer a speeding up of the natural healing process. At one month after surgery, I would use a topical such as Scarguard. If you are not seeing significant improvement at three months, then I would consider pulsed light therapy treatments to the scar.
Treatment of thyroid surgery scars
Most raised thyroid scars flatten over time. However, there is some interval treatment that can be done to help it heal more flat if it doesn't appear to be doing it on its own. There are two over the counter preparations available, one is mederma and another is scar guard. There are generic ones also that might be effective. I would begin using those products once the scar is healed and follow the directions on the package. Other treatments might include the use of laser or intense pulsed light devices to diminish the redness which will also help the scars to flatten over time. Injections of Kenalog by your doctor may also assist the process. Finally, if after six months to a year the scar is not acceptable it can be surgically revised.
Thyroid surgery and scarring
Think in terms of scar improvement and you will be more satisfied with the outcome.
Often scars improve on their own, in spite of what the doctor does or doesn't do. Here on the neck, I would expect intralesional injection of corticosteroids, every 3 to 4 weeks to make this scar less noticeable. Tape containing steroids (Cordran Tape) can also be prescribed by a physician.
Good luck to you!
Time and treatment for surgery scars
Some people have a tendency toward forming prominent or hypertrophic scars. If you have other scars like this one on your body show your surgeon. Early on, steroid injections and silicone sheeting can sometimes encourage less prominent scars to form. My tendency is to use less invasive things early on to try to get the scar to improve. I do these things over the first few months to a year and watch the response.
If this scar is the only problematic one you have, scar revision surgery after time and other treatments have been tried might be beneficial. Scar improvement requires patience and a bit of time . Get in with a surgeon with whom you can see "eye to eye" (if you don't have one already) and plan on a few visits over a year.
Time and tape
I can't tell from your photo how new your scar is, but initially there is swelling of the scar. Usually the upper portion is more swollen than the lower portion. I usually tape all my incisions for several weeks. I think the tape pressure helps keep the scars flat. It may be the moisture as well. It is all theoretical why silicone sheeting or tape help. This is the simplest form of treatment. Close observation is also key. If the scar is becoming hypertrophic sometimes steroid injections help as well. I think that most of the topical agensts like Mederma and scarguard don't do much.