Scar Healing (therapy & questions)

Question

At week 9 of scar healing from dog bite sustained on 6/7/24. Persistent swelling under the lip line causing area to seem and remain visibly pronounced. Was told by Surgery dept that. no procedures could be considered until after 1 year. Are there non-surgical procedures that might help reduce swelling and/or will swelling reduce on its own? What non-surgical procedures are recommended, if so and what time frame would be best to increase chances?

Anna Chacon, MD, FAAD · Answer

Thank you for your question regarding scar healing and management following a dog bite.

At 9 weeks post-injury, it's not uncommon to experience some persistent swelling and visible pronounced areas, especially in delicate areas like the lip. Here are some insights and recommendations:

Natural Healing Process: Swelling can gradually decrease on its own over several months as part of the natural healing process. It’s important to be patient, as the body continues to remodel and heal the scar tissue even beyond the first few months.

Non-Surgical Options: There are several non-surgical treatments that might help reduce swelling and improve the appearance of the scar:

Topical Treatments: Silicone gels or sheets can be very effective in reducing scar visibility and swelling. Applying these consistently can help flatten and soften the scar.
Steroid Injections: In some cases, corticosteroid injections can help reduce inflammation and swelling. This is typically administered by a dermatologist or a plastic surgeon.
Massage Therapy: Gentle massage of the scar tissue can help improve circulation and reduce swelling. Make sure to follow the guidance of a healthcare professional to avoid any adverse effects.
Laser Therapy: Laser treatments, such as pulsed dye laser or fractional laser, can help reduce redness, improve texture, and promote collagen remodeling. These treatments are usually considered a few months after the initial injury, once the skin has had some time to heal.
Microneedling: This procedure can help with scar texture and appearance by promoting collagen production. It’s typically performed by dermatologists or trained medical professionals.
Timing: While many non-surgical treatments can be started a few months post-injury, it’s essential to consult with your healthcare provider to determine the best time to begin. Generally, treatments like laser therapy and microneedling are considered once the initial healing phase is complete, which is usually around 3 to 6 months post-injury.

Consultation with a Specialist: It’s beneficial to have a follow-up with a dermatologist or a plastic surgeon who can assess your specific situation and recommend the most appropriate treatments. They can provide personalized advice based on the severity of the scar and your overall health.

Remember, each individual's healing process is unique, and what works for one person may not be suitable for another. It’s crucial to follow the guidance of your healthcare provider to achieve the best results.

Best regards,

Raffy Karamanoukian, MD, FACS · Answer

Fractional laser is an amazing and highly effective treatment in our office. We use the laser treatment to help with acne scars, large pores, fine wrinkles, tissue collagen loss, scars, sebaceous hyperplasia, active acne, and for brightening dark pigmentation. Although there are very strong fractional lasers such as CO2 laser, we use lighter treatments for corrective skincare and maintenance of results. Our Thulium fractional laser, clear and brilliant laser, and Ultra Thulium laser are excellent options in our clinic. We also perform CO2 fractional and erbium depending on skin tone and tolerance for downtime. Patients do have to use a Melarase cream before and after treatment to help further reduce pigmentation after laser.  Melarase AM, Melarase PM, and Melapads can seriously improve surface sun damage and UV related pigmentation. Dark spots can improve with these treatments. I recommend fractional laser for incisional scars as well, especially after plastic surgery.  
Best,
Dr. Karamanoukian 
Realself100 Surgeon

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