Sept 2007 I had a Light Lift where the surgeon cut in front and behind my ears and pulled the jaw bones up. This was in Houston. I have moved away from Houston and I have keloids in front and behind my ears and they itch and are sensitive. I have ask two dermatolgist what to do and they don't know. Please help me. Will the lumps just keep getting larger or should I try to find a plastic surgeon
Help to Remove Facelift Keloids for a "Light Lift"
Doctor Answers (33)
Scar revision after a facelift procedure often requires a more extensive facelifting procedure to remove enough of the scar. You need to find an experienced facial plastic surgeon or plastic surgeon to help with improving or eliminating the scar formation. If the scars are unable to be treated in one setting, a staged, second procedure may be required to get the best result. Best of luck!
Minilifts often = maxiscars
You will see a common theme among patients who have undergone minilifts: hypertrophic or keloidal scarring.
Why would a minilift result in large scarring?
When incisions are closed after a real facelift performed by an expert facelift surgeon, they are closed with minimal tension. That means not too tightly at the place where the sutures are placed. The reason for this is simple: wounds that are closed under tension stretch, forming thick scars.
So ironically, to avoid the burden of having a real facelift- which in reality is 48 hours of healing time but admittedly much greater pricetag-- patients incur more scarring and deformation, not less.
In the short term, scarring can be minimized by kenalog injections, various creams and gels, and application of topical treatments (each of which has specific therapeutic windows).
After 6 months, scars are usually considered mature enough to be revised.
Revising minilift scars usually involves converting the minilift to a real facelift, reforming the delicate earlobe, tragus, hairline details so they are much less detectable, and sometimes undetectable.
Plastic surgeons who specialize in revision facelifts are your best bet for consultation regarding the above issues.
Treatment of Keloids and Hypertrophic Scars after Facelift
Best Scar Management Practice – Advice from Dr. Larry Nichter:
In your particular case it sounds like you have a hypertrophic scar rather than a keloid. Either way my advice is similar. At this late point you may well need a scar revision, a minor office procedure to remove your scar and replace it with a new one. Below are what I feel is important to prevent a future bad scar:
Best Scar Management is important to minimize or completely hide from view, the tell tale signs of surgery – namely, scars. Both you and your surgeon want you to have the most minimal scarring possible from your surgery. Patients with scars that are enlarged or not healing well after surgery can be from many causes. Unsightly scars are most commonly due to genetics, underlying medical conditions or improper scar/wound care. The last part is very important and patients can make a noticeable difference in their scars’ appearance by following best scar management practices. Here are some simple tips.
Scar Management tips:
1- Minimize tension on the scar – Steri Strips and/or surgical tape are often placed in non-hair bearing areas to minimize tension and keep pressure over the scar. This minimizes the stress that can pull the scar apart (dehiscence) creating a wound and delaying healing time, and can make the scar wider, or more “ropy”.
2– Keep your incision site/scar clean to prevent infection. Follow your surgeon’s wound care instructions to the letter with out modification. NEVER apply different products then recommended without first discussing them with your surgeon. This is especially important during the first few weeks. If there are any signs of infection contact your surgeon’s office immediately and/or see your doctor or his nurse immediately. Typical signs of infection may include redness outside the immediate incision site, asymmetric swelling, and drainage, of pus, fever, chills, and “feeling sick”.
3. –Protect your scars from the sun - staying out of the sun is the best advice. Minimal exposure to sunlight is prevents hyperpigmentation (permanently turning brown) and other problems that can make the scar more noticeable. Sunscreen, at least 30 SPF and an overlying make camouflage make up additionally protects the scar from the suns harmful rays. This advice is especially important the first year following your surgery. .
4. – Use specific scar maturation products recommended by your surgeon. Patients seem to have their own opinions on this touting everything from Pure Vit E, Coco butter, to Aloe Vera, etc but most have minimal benefit other than keeping the scar hydrated. Although hydration is important there are better, scientifically studied products with greater efficacy. Most of the scientific articles written about this subject indicate that topical silicone gel or silicone sheets work the best. There are a lot of products to choose from, but silicone should be one of the key ingredients. Although Mederma, an onion extract derivative active ingredient rather than mainly silicone based may help, primarily silicone based products are better and many also contain other ingredients that may be synergistic (hydrocortisone or other steroid, Vitamin E, Sunscreen,etc). At the present time I prefer BioCorneum or Kelo-Cote products and if the reader has problems obtaining these they can call my office. Patient compliance is also critical – use often and according to directions or it will not work optimally. NEVER apply products without first discussing them with your surgeon.
5. – Monitor to make sure your scar is progressing optimally. Keep your scheduled follow-up appointments with your surgeon to verify that your scars are maturing as expected. Occasionally if indicated you may need a topical or injection of a steroid preparation or even a series of injections (5-FU and/or Steroids) or laser treatments to treat or prevent scar hypertrophy or keloid formation (red raised scars), or other topical medicines to treat post inflammatory hyperpigmentation (brown scars) with prescription creams and possible laser treatments.
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Removal of Keloids after Mini Lift
Keloids or hypertrophic scarring can occur after a mini lift if there was too much tension, or stretch, along the incision, if a suture material that is irritating to the skin was used, or if there was a separation or infection along the incisions. Occasionally, patients have a genetic tendency to make excess scar tissue, but with meticulous surgical technique, Mini Lift incisions generally heal very well.
If you have visible scars, especially if they are older than 6 months, a scar revision is generally needed. This may involve simply cutting out the old scar and suturing the skin together, or may involve a revision Mini Lift to lift the muscle up so that the skin won't be too tight when sutured together. A qualified facial plastic surgeon should be able to help with recommendations.
Keloid or Hypertrophic scaring what to do?
Dear Cantonie, It seems that you have hypertrophic scars rather than Keloids. Hypertrophic scars are simply thicker, wider scars and they start to appear two to three weeks post surgery and stop growing. On the other hands keloid scars are pathological where the scar continues to grow beyond its original borders and they get very large. I would recommend you to see a plastic surgeon in your area. He or she will most likely to inject the area with Kenalog for at least 3 sessions and recommend scar gels such as Kelocote and topical steroid. Laser is a good option as well. If these treatments are not affective, there are other options available that I would leave that to treating physician.
Rare to have true keloids after face lift surgery
I take care of numerous revision face lift patients in my practice. I find that face lift incisions rarely leave true keloids. If incisions are not closed properly, they do leave hypertrophic scars. In these instances, excision of the scar and removing tension from the incision lines with reclosure solves the problem. If there is truly a keloid, then other options exists including steroid injections with re-excision all the way to radiation therapy (something I do not recommend).
Keloid scars after facelift surgery
Fortunately, facial scars in most cases heal extremely well and rarely form true keloids. A lot of people call thickened scars keloids even though it may not be the case. Thickened or tender scars are treated with either excision of the scar or injections. Radiation is commonly used for other locations, but in view of collateral damage I would rarely use it for facial scars.
Traditionally I use steriods such as Kenalog 10 or 40 for reduction of scarring. I have been successful in treating resistent scars with injections of Kenalog and 5-FU. Sometimes when patients present with complaints of painful scars it may relate to absorbable sutures that have failed to go away on their own. That is why my first choice is usually the excision of the scars. If the excision is not adequate then a combination of excision and steriod injection will usually do the trick.
If your procedure was performed by a qualified surgeon, most likely the deep tissues have been properly elevated and there is rarely the need to lift up deep tissues just for the purpose of scar correction. Utilizing a different kind of suture material can decrease the chances of keloids or thickened scarring in suseptible individuals. However, there are some patients that are more sensitive or prone to scar sensitivity. Most likely a plastic surgeon in your area will charge you more to have a surgery done than if you fly back to the original surgeon. However, the final decision is obviously up to you. However, I strongly feel that most surgeons will be happy to assist you.
Keloid Scars After a Facelift
There are a few ways to help with Keloid scars. Most Doctors first attempt would be to do a Kenalog injection. This can help the scars appearance. Also, using silicone gel or sheeting can help to smooth out the scars. If they are very irritating, I would recommend seeing someone in your area for help. Good Luck!
Keloids after "Facelift"
Keloids can be treated with steroid injection, scar revision, compression, or radiation.
The most practical techniques around the ear include steroid injections or cutting out the old scars.
Help with Face lift Scars
You likely have hypertrophic scars in the back of the ears as opposed to true keloids. Hypertrophic scars are simply thicker, wider scars, while keloid scars are a pathological phenomenon where the scar continues to grow beyond its original borders.
If you have hypertrophic scars, the treatment may range from steroid injections to removal of the scar through surgery. The steroid helps to break down the scar tissue and will alleviate the itching very effectively. If surgical removal is performed, the entire scar can be removed; recurrence of the hypertrophic scar is less likely because the area is no longer as tight as it was just after the face lift.
If you have keloid scars, the treatment is more difficult because there is a significant risk of the keloid scars occurring again. Steroid injection is usually only minimally helpful. If surgical removal is performed there usually needs to be additional therapy involved to prevent recurrence, such as steroid injection with surgery or even low dose radiation therapy. Consult with your plastic surgeon about your options.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.