How would you treat this scar? (Photo)

Question

Scar is 18 months old with skin colored, slightly raised stitch tracks. Steroid tape only works temporarily to flatten. Vascular laser removed the pinkness. Now I want to remove the stitch tracks entirely. One doctor recommended dermabrasion, I’m concerned that it won’t be effective. Another doctor recommended surgical excision (in one sitting, not multiple.) Tracks are 1cm tall, I’m concerned this will raise the eyebrow permanently if it is excised. How would you treat this scar?

Raffy Karamanoukian, MD, FACS · Answer

Our office has many different treatments for scars depending on the depth of atrophy or hypertrophy. Scars require a combination approach using our HI DEF protocol which uses a combination of lasers, topical scar modulation, and RF treatments to pixelate scars, improve contour, reduce hyperpigmentation, and improve the visibility of the scars so that they are no longer visible in ambient light. Everyone has a unique pattern of scarring and we employ our HIDEF technique to improve texture, color, contour, and topography. We often use a combination of treatments that begin with a careful examination to examine the micro texturing of the acne scars. Atrophic scars and indented  scars can benefit from injectable fillers such as Radiesse, Sculptra, and Restylane with or without subcision to remove tethered scars and atrophic depression. Hyper-redness in scars can be improved with V beam laser, Excel V, BBL, IPL, and Venus RF to improve  the redness and reduce the visibility of deep scars. Fractional Thulium laser and clear & brilliant can also reduce the inflammation and redness of the scar when combined with topical therapy. Fractional lasers such as Fraxel, erbium, and CO2 laser can be combined with radio frequency and also fractional RF to improve textual issues and microtopography. Subcision and TCA cross are also used for deep ice pick scars and narrow valley scars in order to improve the micro texture.  Above all, our combination approach with our clinical nurses and board-certified plastic surgeons can improve the quality of your skin by using at home Melarase creams combined with PRP treatments in our office to improve your skin quality and tone. I recommend getting a formal evaluation with an experienced team of experts in order to reduce your scarring.
 
Finally, hyperpigmentation of scars can be improved with at-home Melarase AM, Melarase PM, and Melapads to help reduce active PIH and melanin deposition.

Best, 
Dr. Karamanoukian
Realself100 Surgeon

Anna Chacon, MD, FAAD · Answer

Treatment for an older scar with slightly raised stitch tracks usually involves a combination of non-surgical and surgical methods. It should be made by a board-certified dermatologist or plastic surgeon, who will consider the patient's individual health status and the specific characteristics of the scar.

Non-Surgical Methods:

1. Topical Treatments: These include silicone sheets or gels, which work by hydrating the scar tissue, reducing redness, and flattening the scar.

2. Injections: Steroid injections can help flatten and reduce the appearance of raised scars. However, as you noted, this effect might be temporary.

3. Laser Therapy: You mentioned that vascular laser only removed the pinkness. However, other types of lasers, like ablative fractional lasers, can be used to resurface the skin and improve the appearance of the scar.

Surgical Methods:

1. Scar Revision Surgery: This involves removing the scar and reattaching the skin edges, which can make the scar less noticeable. However, this might raise the eyebrow permanently, as you mentioned.

2. Z-plasty: This surgical technique can reorient the direction of the scar and make it less noticeable.

3. Skin Grafting: In some cases, a skin graft (taking skin from another part of the body) might be necessary.

4. Dermabrasion: This is a type of surgery that can help smooth the surface of the skin and reduce the visibility of scars.

It's important to note that every scar is unique and responds differently to treatment. A consultation with a dermatologist or plastic surgeon is essential for determining the best treatment plan.

Nelson Lee Novick, MD · Answer

Let's start with a fee important points. The ideal time for treating an imminent scar (whether caused by prior surgery, trauma, infection or acne, is between the end of week four after the the initiating event (when the wound is healed enough to withstand treatment) and the end of week 12 (after which the scar is considered "mature" and there is little hope for completely "erasing" it). Since this scar is way passed the twelve week mark, the chance for more than an upwards of 80% improvement is more realistic than complete erasure. 
Surgical revision tends to be expensive, engenders post-treatment downtime, and runs the risk of stretch scars and stitch tracks.  Dermabrasion is essentially an aggressive "sanding" of the skin and, as such also engenders significant downtime, as well as infection and scar formation. 
On the other hand, professionally performed manual microneedling, which I have been performing for almost 25 years, can be used to better blend the area, in both color and texture, with the surrounding normal skin. You would be wise to consult with an experienced, board certified cosmetic dermatologist scar specialist. Hope this helps and best of luck.

Jeff Rapaport, MD · Answer

Using fractionated CO2 laser, fractionated erbium laser, or microneedling, combined with Platelet-Rich Plasma (PRP), can offer several benefits in improving a right forehead scar with prominent stitch marks:
**Reduced Scarring**: By promoting collagen remodeling, the scar tissue can become less visible and blend in better with the surrounding skin.
**Texture Improvement**: Fractionated lasers and microneedling can help to resurface the skin, reducing the rough texture often associated with scar tissue and stitch marks.
**PRP Enhancement**: PRP contains growth factors that promote tissue healing and regeneration, enhancing the effectiveness of the treatment and speeding up the recovery process.
**Minimal Downtime**: While there may be some initial redness and swelling, the downtime associated with these treatments is generally minimal compared to traditional surgical procedures such as excision and dermabrasion.
**Long-lasting Results**: With a series of treatments, significant improvement in the appearance of the scar can be achieved, and the results can last for an extended period.
 **Safe and Effective**: When performed by a qualified and experienced dermatologist, these treatments are generally safe and effective for scar revision.
By combining these advanced techniques with PRP, you should achieve noticeable improvement in the appearance of your forehead scar, resulting in smoother, more natural-looking skin.
Jeff Rapaport MD 
Realself Hall of Fame
Castle Connolly Top Doctor

How would you treat this scar? (Photo)

Answers (4)

Answer: Surgical scar on forehead; Englewood Cliffs NJ

Answer: Surgical scar on forehead; Englewood Cliffs NJ

Recommended reading

Everything you need to know about Scar Removal

Our mission is to create a world where every investment in modern beauty is Worth It.

How would you treat this scar? (Photo)

Answers (4)

Answer: Surgical scar on forehead; Englewood Cliffs NJ

Answer: Surgical scar on forehead; Englewood Cliffs NJ

Browse related questions

Recommended reading

Everything you need to know about Scar Removal

Our mission is to create a world where every investment in modern beauty is Worth It.