Matthew J. Mahlberg, MD

Good morning Carrie,

The bands that you are bothered by are called platysmal bands.  The platysma is a paper-thin sheet of muscle that resides just under the surface of the skin on the neck.  Over time, this sheet of muscle separates, thereby creating the appearance of "bands" instead of a smooth appearance.   These bands can be treated with injections of a neuromodulator such as Botox or Dysport along the length of the bands. This will soften the muscle and thereby minimize the appearance of those bands.  It is simple treatment with no downtime.  Be sure to see a board-certified dermatologist or plastic surgeon if you're going to have this treatment done.  

Warm regards,

Matt Mahlberg, MD

 

Thanks for your question about the scars on your nose.  Given that these are relatively shallow scars, they would likely respond well to fractional resurfacing treatments.  We commonly treat atrophic (sunken) acne scars and surgical scars with either non-ablative fractional or ablative fractional (such as fractional CO2) lasers.  The advantage is that you can get more permanent improvement of the scar although it will take some time and a few treatments to get there.  If you would like more immediate improvement (albeit temporary), you could consider a filler such as restylane, juvederm or belotero.  

Thank you for your question regarding the common scenario that dermatologic surgeons face on an almost daily basis.  First, I am glad you chose to have your skin cancer treated with Mohs micrographic surgery.  It is well-established as the standard of care and highest cure rate procedure for non-melanoma skin cancers such as yours.  
Regarding the choice to let the surgical wound heal in on its own, that is a more complex choice, and I agree that every surgeon has their own techniques and reasons for choosing a particular way of healing a surgical wound.  Areas that are concave, such as the area you had treated, are a very reasonable place to consider "second-intention healing", meaning letting it heal on its own.  Sometimes, this provides a superior "repair" than another more involved procedure could achieve, although the healing time is typically longer.  A skin graft is also a reasonable option in this area, so long as there is sufficent tissue remaining over the cartilage.  Ultimately, I often make these types of decisions based on the best alternative after a thorough discussion with the patient to understand his or her expectations.  Before seeking a second opinion, I'd first consider discussing further with your surgeon to further understand why he chose that option.  If you still would feel more comfortable seeking another opinion, I'd suggest a consultation with a fellowship-trained dermatologic surgeon, certified by the American College of Mohs Surgery (ACMS). 

 

Improvement of "crepiness" or loose skin and fine wrinkles around the eyes can be achieved through a variety of modalities.  Based on a number of factors, including the extent of your skin laxity, your skin type, and your acceptable amount of downtime, your physician can decide which treatment will provide you with the best result. 

Non-ablative fractional resurfacing such as Fraxel Re:store can provide very nice results, has the least amount of downtime, but requires a series of treatments.  Ablative fractional resurfacing with lasers such as Fraxel Re:pair can provide more dramatic tightening in one treatment but there is some wounding of the skin and thus more downtime.  Traditional ablative resurfacing with non-fractional CO2 lasers can provide significant tightening as well, but also wounds the skin and carries a significant risk of discoloration or lightening of the skin and has the longest amount of downtime. 

Ultimately, you and your physician should make a decision about which treatment is best based on the above factors.  Just make sure to choose a physician who is experienced in treating this area since any resurfacing treatment around the eyes should be done judiciously to minimize any risk of complications. 

 

The treatment of acne scars works best when individualized for each patient based on the type of acne scars.  Rolling acne scars such as those on your right cheek and forehead respond well to a series of fractional (either ablative or non-ablative) laser treatments.  As Dr. Zimmerman said, I would expect a softening of those scars, maybe by 25-50% based on the number of treatments and treatment settings.  The most common risk of the procedure is temporary darkening of the skin.  I typically prescribe hydroquinone and a topical retinoid prior to the procedure and after the procedure to minimize this risk, but the most important thing is for my patients to be very strict about sun protection. 

 

Deeper scars that are more "ice-pick" or "boxcar" shaped tend to respond better to other forms of treatment. These are the types of scars you appear to have more on the left cheek.  One such treatment is called subcision, in which a physician passes a needle under the scar and breaks the scar tissue underneath, thereby untethering and lifting the scar.  Another treatment for these deep scars is to do small punch excisions of the scars where the scar is removed surgically and the small area is sutured together.  

 

By combining techniques, we are able to individualize treatments for each patient and optimize results.