Can paramedian forehead flap graft scars be corrected? I have two on my forehead. (Photos)

Question

The scarring is particularly bad on the forehead. The grafts were taken for the nose tip which seems to be healing correctly. Is there anything at all I can do about the vertical scars on my forehead with deep dents? Thank you.

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question.  The
best advice you can receive is from an in-person consultation.  You may benefit from a surgical scar revision of your forehead scar. I recommend
that you maintain close follow-up with your surgeon who
can evaluate you in person.
Best wishes and good luck.
Richard G. Reish, M.D.  FACS
Harvard-trained plastic surgeon

Raffy Karamanoukian, MD, FACS · Answer

Our treatments use combination therapy to improve the epidermis and dermis for most deep scars. The options available for acne scars depend on the character of your scars, in terms of topography and contour. We see atrophic and hypertrophic acne scars, as well as scars that have hypo and hyperpigmentation. We begin each scar evaluation with an assessment of scar quality and subtype. Our main concern is rebuilding collagen and that is why we use a HIDEF protocol that includes combination therapy. Morpheus 8, scar subcision, fibrous release, fractional laser, CO2 laser, Thulium laser, PDL Vbeam laser, and fractional resurfacing can be used in addition to TCA Cross and chemical peels to further improve skin. Patients should start Melarase AM and Melarase PM for active hyperpigmentation. Always begin with a consultation to decide whether early subcision should be started.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best, 
Dr. Karamanoukian 
Realself100 Surgeon

Michael Kulick, MD, DDS · Answer

Best advice is to maintain close contact with your surgeon. As you can see from the web reference provided, a lot can be done to improve scars when the time is right. Dr. Kulick, San Francisco

Jason Emer, MD · Answer

These scars can be improved with laser spot treatment, fillers, microneedling/prp and subcision to help texture and blending. I recommend getting a formal evaluation with a scarring expert. Best, Dr. Emer

Johnson C. Lee, MD · Answer

Thank you for your photos. The scars form forehead flaps naturally improve over time. It may take 6 months to a year to see the final results. If you would like faster results or if the scars are already plateaued in their improvement, other options include microneedling with or without PRP, fractionated laser, and radiofrequency make microscopic holes in the scar to stimulate your body to remodel and fill in the scar with new collagen. I especially like a combination of a chemical peel for the hyperpigmentation and acne control, microneedling with PRP for texture and collagen building, and PIXEL fractionated laser or RF to resurface and build even more collagen. For large or more severe irregularities, a scar revision or re-excision may swap out your old scar for a less noticeable one in a single procedure. Not everyone is a candidate for all the treatment options however as certain skin types can get worse from certain treatments. For the safest treatment plan, it is important to visit an expert for an in-person examination. Hope this helps!
Johnson C. Lee, MD 
Board-Certified Plastic Surgeon
IG: @drjohnsonlee

Kristine Brecht, MD (license suspended) · Answer

You had quite an extensive surgery.From car accident or cancer?Make sure you are fully healed and if cancer that it has been fully removed before any resurfacing treatments.Microneedling with prp, fillers and subcision are a few early options.Best. Dr Brecht Seattle, Wa

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