I got into a bike accident 4 weeks ago and got a large laceration above my left eyebrow on my forehead. It was sutured up in the ED and I had the stitches taken out 5 days later. Now I am trying to avoid the sun and have been applying silicon gel ScarAway serum to it twice a day. I realize surgical scar revision is not an option until the scar has matured (6 mo) Is that correct or should I wait longer? Are there other treatments (laser/etc) or meds I can use for an immature scar now?
What Options Do I Have to Help Alleviate Forehead Scar from Trauma? (photo)
Doctor Answers 5
Scarabrasion Works Well For Post-Traumatic Scars
It's been known for two decades already that early intervention following injury or surgery, etc. may go far in minimizing significantly the ultimate appearance of the scar. Traditionally, it was recommended to wait six months, sometimes even a year, to allow scars to mature. Unfortunately, mature scars are much more difficult to treat than those in the very early stages of collagen deposition and remodeling.
Publications in the dermatologic surgery literature in the late eighties on a technique called "scarabrasion," which I have used ever since, demonstrated that early intervention, via conventional dermabrasion (using a motorized device) or manual dermasanding, performed during a critical, optimum window of opportunity of between eight and twelve weeks following the injury could lead to significant final improvement. It seems that younger, fresher non-scar collagen is capable of being made and remodelled at this time and this ability diminishes with each passing month beyond that critical window.
The procedure itself is quite simple. The area is numbed with local anesthetic and then abraded to create a fresh wound. The edges of the traumatic (or surgical) wound is then sanded and blended with the surrounding area and then left to heal.
I have used this technique for twenty years and have found the resulting scars to be nearly imperceptible--but only if the procedure is performed within that critical eight to twelve week window following the injury. Recently, I have found medical microneedling in place of manual dermasanding to yield nearly comparably gratifying results.
Finding a comprehensive scar solution for the forehead.
I would treat this scar aggressively with pulsed dye scar laser and then plan percutaneous scar release followed by FUE follicular unit extraction and hair transplant to the eyebrow.
You seem to be on the right track
You're right-the scar will need more time to mature before you decide to undergo an invasive treatment to correct it. In the meantime, the most important consideration is sun avoidance. Silicone gel products can be effective, as they are felt to maintain hydration of the healing scar by creating a negatively (-) charged surface condition, which draws water to the surface. You can also try using a silicone sheeting (cimeosil, etc) which is felt do do the same thing (and the sheeting is reusable). Since the scar appears to be reddened, conservative IPL treatments can help while you are healing.
Things that work in your favor are the irregular nature of the scar, and it also seems as though the surgeon who performed the repair did a good job at aligning the edges well. Give it a little time and then discuss with your Plastic Surgeon in a few months. Options will range from dermabrasion to laser resurfacing to surgical revision.
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Scar Revision Options After Trauma
From your photo, it appears that the scar is very early in its recovery. Time will make a significant difference in the appearance. A scar revision may be possible, but it is best to wait at least 6 months to make that decision. Interventions are possible sooner if the scar begins to show problems. But no interventions will make you heal in a "scarless" fashion.
You should see a board certified plastic surgeon in your area to get a formal opinion through and in-person consultation.
Best of luck,
Vincent Marin, MD
San Diego Plastic Surgeon