Hi James, Breaking it down etymologically, "cytologic" basically means "of or relating to cells" and "atypia" means, well, "atypical." In the setting of a nevus, this means that there wasn't a significant proportion of the cells that showed an abnormal appearance consistent with atypical growth, division of cells, or transition to a type of cell inconsistent with what was taken out (like finding gut cells in a skin mass, which is relatively rare). If you cut out skin from a variety of people, there would likely be some cells that look atypical, but as long as the relative proportion of atypical cells is small, there's nothing to do but watch closely, as the body generally does a really good job of killing of cells that are trying to act up and divide without being told to do so. Unfortunately, there's no such thing as a "100% guarantee" when it comes to the human body, but there being "no significant cytologic atypia" means that, per the guidelines of the pathologist, the nevus removed was benign.
As plastic surgeons, we classify abnormal scarring based on the growth of the scar relative to its original borders. Scars that grow thick and/or discolored over time but stay within the boundaries of the original scar are labelled hypertrophic, while those that continue to grow beyond those margins are labelled keloids. Semantics aside, in your case, you appear to have an immature scar that is continuing to undergo the process of scar maturation. Unforunately, this process takes weeks and continues for as long as a year and a half, during which the scar flattens and lightens in color as the body sends less blood and supplies to the area. Luckily, your scar does not appear to be growing outside its original boundaries, so I would recommend optimizing scar care and lots of patience. You can massage the scar with light pressure (enough to push the blood out of the scar and make it change colors) for a few minutes 3-5 times a day to expedite the softening of the scar and regular sunblock application to avoid hyperpigmentation of the scar. Self-adhering silicone sheets can also be applied, but they need to stay on the scar for at least 12-16 hours a day to be helpful. It's a little early to think about scar revision, which usually entails excising the ugly scar and reclosing the healthy edges. I think you'll get a good result with some observant management. Luckily it's winter and the sun's not as intense, especially up there in Maine. Good luck!
I'm sorry to see you didn't achieve the result your were looking for with your filler. With the development of white bumps in the subacute period, there are several possibilities for what could be happening depending on what type of filler you received. Many fillers that are based on hyaluronic acid will absorb additional water after their initial placement, and this may create a volume of filler large enough to blanch the overlying skin. On the other hand, any filler can cause an inflammatory nodule if the body reacts to it either because of scant amounts of bacteria that make it into where the filler is or the filler itself. I would return to where you received the filler for an evaluation, diagnosis and possible hyularonidase injection to break up the filler, as likely these white areas won't improve significantly if they're related to nodule formation. The lip is a relatively high risk area for filler, as it is so mobile, the vermillion skin so thin, and the vascularity so robust.
