Fat Transfer for atrophic scar on bridge / upper dorsum of nose? (Photo)

Question

Underwent Revision Rhinoplasty in October of 2022. Complication resulted in scar on bridge / upper dorsal area. Seven months ago, the surgeon excised the scar—originally improving it. However, since then, the scar widened and atrophied, resulting in the recurrence of a noticeable contour irregularity. Currently doing CO2 laser resurfacing, but I'm concerned about the anticipated results. Another surgeon suggested Fat Transfer but my surgeon does not believe the fat will survive in this area.

Zoran Potparic, MD · Answer

It takes minimum of 12-15 months in your age group for scar to mature. However, treatment with nano-fat grafts (concentrated fat derived stem cells) have shown to have beneficiary effect in scar healing. Hope this helps.

Mats Hagstrom, MD (license on probation) · Answer

That’s a pretty challenging spot to treat for a few reasons.
The shape of the scar and the position all make treating this a bit challenging.
There is not only contour issues, but also color and texture. That is not a good match for the surrounding skin on your nose.
A well placed skin graft would work if you could find perfect matching skin, but nasal skin is unique and it’s difficult to get a perfect match.
Converting this to a more proper scar revision would most likely require extending the scar substantially.
I really well healed scar that is parallel to natural skin lines on the nose could potentially heal and minimally visible.
Patience are sometimes apprehensive at the idea of making the score much longer but doing that can in fact, increase the success dramatically in some cases.
Exciting all this scar tissue into an elliptical shape that has very acute angles on each side would probably extend the scar and make it 75% longer.
Excision down to periosteum and doing the repair including approximation of nasis muscle should minimize the chance of tissue separation or widening and filling of the scar in the future. I’m curious if you ever had steroid injections into this.
If so, that would explain a lot.
It would be very helpful to see pictures of what this look like early after your surgery and before the scar revision.
I don’t think fat grafting is going to help and I don’t think CO2 laser is going to do much for you either.
In order to get this to look normal, the scar tissue needs to be removed. Doing the scar revision correctly would require making this into a bigger procedure, but one with a better likelihood of a quality outcome.
Sometimes surgeons need to make a stronger commitment to get the right outcome.
I recognize patients may be reluctant, especially after Poor previous outcomes.
It’s never a bad idea to get multiple in person consultations from other plastic surgeons in your community.
Best,
Mats hagstrom, MD

Fat Transfer for atrophic scar on bridge / upper dorsum of nose? (Photo)

Answers (2)