What is the best way to get rid of scars from my deep plane neck and facelift? (photos)

Question

I had a deep plane neck lift and mid facelift on March 6th, 2023. I had open wounds behind and below my ears which I was told looked necrotic. They are now painful itchy scars.

Manish H. Shah, MD, FACS · Answer

Hello ai62,
You have hypertrophic scars that are under too much tension as shown by your postop wound healing issues. You will need the scars surgically removed and revised under minimal tension. It is important that you avoid smoking/smokers, eat well before and after surgery, and have all of your medical conditions under strict control before and after surgery. I also recommend avoid too much head/neck turning in the first 2-3 months after revision surgery to reduce tension on the new incisions as they heal.
I hope this helps?
Dr. Shah

Carey Nease, MD · Answer

It look like you developed hypertrophic scarring, which is fairly common. I would treat that with a combination of steroid injections (kenalog) and fractional CO2 laser, likely a series of 3. This usually helps a lot. Light massage my help a bit also. Good luck!

Raffy Karamanoukian, MD, FACS · Answer

Plastic surgery scars require attention after surgery so that they remain cosmetically-appealing and barely noticeable. In our office, we use a protocol for scars that minimizes their activity in the 6-8 weeks after surgery. If you have late plastic surgery scars, you may also require laser and RF therapy to help reduce the longterm effects of the scarring. Keloids, hypertrophic scars, widened scars, red scars, and hyperpigmented scars all require scar modulation with topical creams followed by lasers and RF therapy. Topical skincare should be directed to a specific need, whether for pigmentation or hypertrophy and our office can guide you through the process to obtain the correct Plato’s Scar cream or Melarase cream for hypertrophy and discoloration. In terms of lasers, we would employ the vbeam laser for redness, Venus Viva RF, PRP microneedling, chemical peels, and Morpheus 8, fractional erbium, or fractional co2. All of these have their individual benefits. Most of all, we recommend you visit a solid plastic surgeon who understands surgical scar revision, laser therapy, and RF therapy for scars. 
 
Best, 
Dr. Karamanoukian
Realself100 Surgeon

Lucian Ion, FRCS · Answer

Thank you for your question. I am sorry to see that you have experienced difficulties with your facelift scars. 
The images show scar hypertrophy rather than keloid, which should respond relatively quickly to steroid injections. Silicone gel applications can also assist in the process.

Once the scars have softened, it should be possible to revise them under local anaesthesia.

Zachary Farhood, MD · Answer

I think the best option for you would be a scar revision. The scars would be excised and resewn. you would likely need to have extensive skin undermining to reduce tension on the incisions.

James M. Economides, MD, FACS · Answer

It appears you have superficial skin flap necrosis and skin slough.  The best medicine here is time.  Allowing your body to heal the tissues naturally will give you the best outcome in the long term.  Kenalog injections may help with the itching and if any scar revisions are necessary it is best to wait about 12 months from surgery for this to be done properly.

Bryan Brandon, MD · Answer

Thank you for the photos and question. I'm sorry to hear that you are dealing this. It appears you had superficial skin slough. This will in general heal with time and you will be surprised how much better it looks in 3-6 months. Injections with kenalog or 5-FU can be beneficial to help calm down the itching and burning and may improve the appearance of the scar as well. Sometimes, after enough time as passed, it is possible to do a scar revision to further improve the appearance of the scars. Best of luck!

Brian M. Harmych, MD, FACS · Answer

Thank you for sharing your questions and photos. It appears you've had some skin flap necrosis near the hairline behind the ears. Generally, these still heal very well over time. Although, the wounds will need to be managed throughout the first year. Redness and inflammation in that area may indicate some hypertrophic scarring (or keloid formation). This generally responds well to steroid injections and/or light based therapy such as IPL or laser treatment. Be sure to continue to follow up with your surgeon so that every attempt may be made to avoid surgical scar revision in the future. I hope this information is helpful.
Kind regards,
Dr. Harmych

Ronald J. Edelson, MD · Answer

Those scars are too low. Wait about a year and then have it redone so the scars are higher and placed better by someone who will put the scars where your hair will cover them

Jacob Tower, MD · Answer

Hello, hope you are well. Sorry to hear about your poor experience with wound healing. Applying silicone gel routinely and scar massage will help. You may also contact your surgeon for consideration of kenalog (steroid) injections to help with the itchiness and pain. Ultimately relief may come from scar revision, but I would try the less invasive options first.
Best,Dr. Tower

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