Can scar revision help fill in an indented scar left from tension after a deep plane facelift? (Photos)

Question

Can scar revision help fill in an indented scar left from tension after a deep plane facelift? I was told my doctor will simply cut out the scar & restich the area. I just don’t see how reopening the wound and simply re-stitching it together will help fill in the dip that’s left. I am not looking for temporary filler approach. I need something more permanent. Also, not sure if this is relevant to the indentation, but a steroid was injected to discolor the bright pinkish skin that was left on the scar. So now that area is a bit discolored/whitish.

Anna Chacon, MD, FAAD · Answer

Yes, scar revision can sometimes improve an indented scar after a deep plane facelift, but I understand your concern that simply cutting out the scar and stitching the skin back together may not seem like it would address the actual depression.

The important point is that an indented scar is often caused by more than the visible scar itself. There can be tethering or loss of soft tissue beneath the scar, particularly when there has been significant tension during healing. If the underlying tissue is pulling the skin downward, simply removing the scar and re-closing the skin does not necessarily correct that deeper contour problem.

A scar revision can, however, be designed to release the scar from the underlying tissue and reposition the tissues so that the depression is improved rather than simply exchanging one scar for another. Depending on the depth and cause of the indentation, techniques such as subcision or release of the scar tethering, local tissue rearrangement, or placement of the patient's own tissue may be considered. In selected cases, fat grafting can also provide a more lasting way to restore volume because it uses your own tissue rather than a temporary filler. The best approach depends on whether the indentation is primarily from scar tethering, volume loss, or both.

I also think your comment about the steroid injection is relevant. Steroid injections can help certain thick, raised, or overly inflamed scars, but they can occasionally cause localized loss of fat and/or lightening of the skin. If the area became whiter and more depressed after the injection, some of the indentation may potentially be related to steroid-associated tissue atrophy rather than the facelift scar alone. That distinction matters because the treatment strategy can be different.

In terms of permanence, I agree that it is reasonable to distinguish between a temporary filler treatment and an actual structural correction. A well-planned scar revision can provide a more lasting improvement, although no scar revision can guarantee that the area will become completely level or that the scar will disappear. Scar maturation also takes time, and the final appearance depends on how the tissues heal and how much underlying volume or tethering is present.

So, your concern is valid, if there is a true depression underneath the scar, simply cutting out the visible scar and re-stitching it may not be enough by itself. The underlying cause of the indentation needs to be addressed for the contour to improve meaningfully.

Nelson Lee Novick, MD · Answer

Surgical revision that involves cutting out the scar and restitching runs the risk for the subsequent developing of a stretch scar and stitch tracks, particularly in areas subject to static tension or muscular movement.
Subcision on the other hand, which is used for elevating and smoothing indented scars, does not involve cutting out any tissue and placing any sutures. You would be wise to consult with an experienced, board certified cosmetic dermatologist scar treatment specialist expert in performing Subcision. Hope this helps and best of luck.

Laser Skin Solutions - Portland · Answer

It is completely understandable to question how simply cutting out an old scar and re-stitching the area can fix an indentation, especially when you are looking for a permanent structural solution rather than a temporary filler.
As an advanced licensed aesthetician in Portland, I often consult with patients navigating complex post-surgical healing concerns. When an indented scar forms due to tension following a procedure like a deep plane facelift, the underlying issue is typically tethering or a lack of structural support beneath the surface. Simply re-approximating the skin edges without releasing that internal tension or addressing sub-surface volume loss may indeed risk repeating the same depression.
To achieve a more permanent improvement for a tension-related dip, a comprehensive scar revision protocol often requires more than a simple linear closure:
Subcision or Release of Tethered Tissue: Freeing the fibrous bands pulling the skin downward allows the base of the scar to lift back up to the level of the surrounding skin.
Structural Support or Grafting: In some cases, surgeons utilize deep dermal adjustments, autologous fat grafting, or dermal substitutes to rebuild the missing volume permanently, avoiding the need for temporary dermal fillers.
Meticulous Tension-Free Closure: Re-stitching only works effectively when layered closure techniques are used to shift the tension away from the surface skin entirely, preventing the wound edges from pulling apart or sinking again during healing.
Regarding the whitish discoloration from the previous steroid injection, localized hypopigmentation can sometimes occur as the steroid reduces inflammation and melanocyte activity. Fortunately, this pigment loss often softens over time, though modalities like fractional lasers or microneedling can sometimes help stimulate healthier surrounding tissue blend.
Because surgical revisions require a precise physical assessment of your skin's elasticity and tension vectors, consulting with a board-certified plastic surgeon or a specialized revision expert is essential to determine if your current surgeon's plan includes these underlying release techniques.

Can scar revision help fill in an indented scar left from tension after a deep plane facelift? (Photos)

Answers (3)

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