Red and puckered facelift scars? (Photos)

Question

I had an R facelift 88 days ago and these are todays photos. The scars are red and puckered and my ears are still painful. My surgeon says this is normal. He said it was because this is my 2nd facelift. He also told me to go and purchase some scar cream! Do you agree?

Kenneth D. Steinsapir, MD · Answer

They are wrong because these incisions work best on someone with a more dense hairline.  Personally I do not make my facelift incision this way because I do not think that making incisions along hairlines is any good for anyone.  These will fade but they are not going to completely disappear.  I do recommend consulting a cosmetic dermatologist for laser treatment of reduce the redness of the incision.  Shame on your surgeon.

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

Larry S. Nichter, MD, MS, FACS · Answer

Best Scar Management is important to minimize or completely hide from view, the telltale signs of your surgery—namely, scars. Both you and your surgeon want you to have the most minimal scarring possible. There are many possible causes for scars that are enlarged or not healing well. Unsightly scars are most commonly due to genetics, underlying medical conditions, or improper scar/wound care. The last part is very important and patients can make a noticeable difference in their scars’ appearance by following best scar management practices. Here are some simple tips.
Scar Management tips:Minimize tension on the scar. Steri-Strips and/or surgical tape are often placed in non-hair bearing areas at the time of surgery to minimize tension and keep pressure over the scar.  This minimizes the  stress that  can pull the scar apart (dehiscence) creating a wound and  delaying healing time, and can make the scar wider, or more “ropy”. In the first few weeks after surgery, I recommend the use of Embrace Scar Therapy which is an adherent silicone sheeting pre-stretched when applied so as to offload tension on the scar.Keep your incision site/scar clean to prevent infection. Follow your surgeon’s wound care instructions to the letter with out modification. Never apply different products then recommended without first discussing them with your surgeon. This is especially important during the first few weeks. If there are any signs of infection, contact your surgeon’s office right away and/or see your doctor or his nurse immediately. Typical signs of infection may include redness outside the immediate incision site, asymmetric swelling, and drainage, of pus, fever, chills, and “feeling sick”.Protect your scars from the sun. Staying out of the sun is the best advice. Minimal exposure to sunlight is prevents hyperpigmentation (permanently turning brown) and other problems that can make the scar more noticeable. Sunscreen, at least 30 SPF and an overlying make camouflage make up additionally protects the scar from the suns harmful rays. This advice is especially important the first year following your surgery.Use specific scar maturation products recommended by your surgeon. Patients seem to have their own opinions on this touting everything from Pure Vit E, Coco butter, to Aloe Vera, etc but most have minimal benefit other than keeping the scar hydrated. Although hydration is important there are better, scientifically studied products with greater efficacy. Most of the scientific articles written about this subject indicate that topical silicone gel or silicone sheets work the best. The best product available in my opinion is the Embrace Scar Therapy System by Neodyne BioSciences, Inc. available in many surgeons’ offices. Essentially this is an adherent silicone sheeting pre-stretched when applied so as to offload tension on the scar. For areas that are not applicable for this product (e.g. smaller areas or on the face), I prefer BioCorneum or Kelo-Cote products There are a lot of products to choose from, but silicone should be one of the key ingredients. Although Mederma, an onion extract derivative active ingredient rather than mainly silicone based may help, primarily silicone based products are better and many also contain other ingredients that may be synergistic (hydrocortisone or other steroid, Vitamin E, Sunscreen, etc).. If the reader has problems obtaining these they can call my office. Patient compliance is also critical – use often and according to directions or it will not work optimally. NEVER apply products without first discussing them with your surgeon.Monitor to make sure your scar is progressing optimally. Keep your scheduled follow-up appointments with your surgeon to verify that your scars are maturing as expected.  Occasionally if indicated you may need a topical steroid preparation or even a series of  injections (5-FU and/or Steroids) or laser treatments  to treat or  prevent scar hypertrophy or keloid formation (red raised scars), or other topical medicines to treat post inflammatory hyperpigmentation (brown scars) with prescription creams and possible laser treatments. Tweet

Vincent N. Zubowicz, MD · Answer

It looks as though the skin was closed with considerable tension. I don't think scar creams help anything. A revision aimed it supporting the soft tissues of the cheek and allowing skin closure is no tension in my opinion is the best solution to the problem.

Summit Kundaria, MD · Answer

clapsy,
Thanks for your question and pictures.  I think that your scars will fade from red/pink to just a little lighter than your skin tone once you are done healing, though I agree that the pink coloration has lasted longer in you than it does in many people.  This may be due to your skin characteristics or due to tension on the wound.  My advise to you would be aggressive sun protection, as I do not find scar gel too helpful this far out after surgery, though a silicone based scar gel (they even make this with SPF!) may be worth a try if you want to try something.  Good luck!

Kouros Azar, MD · Answer

It can take anywhere from 6 months to a year for the redness in your scars to fully resolve. For now, I would be patient. If they really bother you, speak with your surgeon about laser to reduce the redness but I would probably suggest that you wait another month or two. Hope this helps --

Michel Siegel, MD · Answer

Since you have had previous surgery, it will take longer for full healing to take place. Your incisions appear to be healing well, there does not seem to be signs of bad scarring 9Hypertrophy, keloid, or widening). The redness may last for several months, but it should resolve on its own. You could do some IPL, to try and reduce the temporary redness.

Val Lambros, MD, FACS (retired) · Answer

patience is a virtue here.  I just bet that in 4-6 months your incisions will be almost invisible. If not

Red and puckered facelift scars? (Photos)

Answers (8)

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