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Went to a Consultation and the Surgeon Told Me I Was Not Qualified for a Scar Revision but I Do Not Understand Why? (photo)

When I was 10, I'm 18,I got bitten by a dog an the dog tore the right bottom half of my lip and gave me a deep wound on my cheek. The lip scar I do not mind as much but the scar on my cheek bothers me a lot because it has left my eyes looking uneven.Because of this I do not make eye contact with anybody and I constantly look down a lot to avoid being stared at. At the consultation I went to the surgeon told me that he prefers not to do the scar revision on my cheek but I do not understand why.!

Doctor Answers (2)

Dog Bite Scar Revision

+1

Hi Roxana.  You are not a great candidate for scar revision, unless you were interested in decreasing the size of the lip scar.  We would not suggest a surgical procedure on the cheek because the surgical scar may be worse than the original scar.  Instead you should consider a deep fractional laser resurfacing procedure.  Check into the Sciton Profractional or similar.  Good luck.


Los Angeles Facial Plastic Surgeon
5.0 out of 5 stars 6 reviews

Deprressed Scars Respond Well To A Combination of Subcision And Medical Microneedling

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I am not quite sure why treatment options were not discussed with you. However, the photo provided suggests that you might benefit from combining subcision with medical microneedling--an approach I have used successfully for treating dog bites even on the nose. 

There are two components to a depressed scar that must be addressed in order to achieve maximum improvement. The first is to elevate the depressed central portion so that it becomes flush with the surrounding skin. The second is to try to improve the surface texture and coloration to whatever extent possible so that the area blends as seamlessly as possible with the surrounding normal skin.

Subcision is a simple, inexpensive and tried-and-true approach for elevating all kinds of scars (e.g. surgical, traumatic, acne, chicken pox). In this procedure, following local anesthesia, a sterile needle is inserted directly under the scar and moved about in all directions in order to break up the thickened, fibrotic scar tissue collagen fibers resulting in freeing of the bound down, depressed surface of the scar allowing it to float freely to the surface. Being flush with the surface eliminates the "craters of the moon" shadowing that often accentuates the scar defect. During the ensuing four to six weeks, new, normal collagen is synthesized to replace the scar collagen and remains to buttress the surface of the scar.

Generally, two to four subcision treatment sessions are required for sufficient new collagen to be made so that the surface of the scar is at or close to the surface of the surrounding normal skin. Since all the cutting is done below the skin surface, there is essentially no surface wound healing and no wound care or activity restrictions are needed.

Often patients find the improvement or elimination of the depression to be sufficient improvement to warrant no further treatment. However, if the disparity between the surface texture of the scar and the surrounding skin remains troubling, a series of medical microneedling treatments might be considererd. Medical microneedling, which may be performed mechanically using rollers (e.g. Dermaroller) or electrically operated (Dermapen) essentially consists of going over the area with an array of needles that penetrate and break up the surface of the scar and some of the underlying abnormal fibrous tissue.
Disrupting the surface of the scar allows for the possibility healing with a smoother surface texture to the scar. In addition, the use of the needles crossing between normal and scar areas allows for the possibility of micro-auto-transplantation of pigment cells from the normal periphery into the scar area, which may help to somewhat further even out the pigmentation. Following medical microneedling, the treated area may appear sun-burned for about 12-24 hours. There is little to no downtime, however, and I permit patients to return to routine skin care and makeup the following day.

To hasten the results, I frequently perform the subcision and microneedling procedures in the same treatment session. 

I suggest that you seek another opinion from a board certified aesthetic physician trained in all forms of scar treatments.

Nelson Lee Novick, MD
New York Dermatologic Surgeon
5.0 out of 5 stars 13 reviews

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.