Revision of Misaligned Upper Lip Scar? (photos)

Question

Traumatic scar leads to following due to the misalignment of the wound edges 1. Right philtral column is disrupted 2. Left philtral column is distorted (shifted to right) 3. Philtral depth is lost 4. Vermilion border is disrupted What I expect from the revision "IN ORDER OF PRIORITY" 1. Restoration of "ANATOMICAL LANDMARKS" 2. Decreased scar width without tissue distortion 3. Minimal excision of healthy tissue (minimal volume loss) to prevent distortion Is it attainable and how?

Thomas P. Sterry, MD · Answer

Yes, all of the things you ask for are possible.  Remember, at the time of injury it can be very difficult to identify landmarks you mentioned.  Now, with proper pre-operative planning, I think you should be able to get most of what you are asking for.  The only possible exception is the scar quality because frankly, we can't predict how you will heal no matter what.I must say, you seem to have done a lot of research and have a good plastic surgery vocabulary.  Don't stress so much, just find yourself a good plastic surgeon and have the tissues re-arranged.Good Luck!

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

Jason Emer, MD · Answer

Subcision and laser can make this better with some filler placement.  However, a mild scar revisions can be performed properly to reapproximate.  Nothing will be curative, but a combination approach can be used to give improvement.  Best, Dr. Emer.

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