Help! Puffy scar 9 months post scar revision (Photo)

Question

I had a large basal cell carcinoma removed via MOHS surgery in 2019. The plastic surgeon was incredibly sympathetic to my condition and agreed to close the deformity with a flap. Unfortunately, the rounded part of the scar formed a pincushion (or trapdoor) deformity. I had a surgical scar revision with multiple z plasties to correct the pincushion. However, 9 months post op the area around the incisions is very full and divots from the stitches remain. I’ve tried steroid shots and lasers. Help!

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

Anna Chacon, MD, FAAD · Answer

Hello,

I'm sorry to hear about your ongoing struggles with your scar after your revision surgery. Dealing with persistent issues like a puffy scar and divots can be frustrating. Here are some considerations and potential next steps:

Continued Steroid Injections: Sometimes multiple sessions are needed to see significant improvements. Your dermatologist or plastic surgeon can help determine the appropriate frequency and dosage.

Silicone Gel Sheets or Ointments: These can help flatten and soften scars over time. Consistent use is key, typically over several months.

Massage Therapy: Gentle massaging of the scar with a suitable ointment can help in breaking down scar tissue and improving its appearance.

Microneedling: This procedure can help with textural irregularities by promoting collagen production and can be particularly effective for divots.

Surgical Revision: In some cases, another minor surgical procedure might be necessary to further refine the scar. This is usually considered after all non-invasive options have been exhausted.

Consultation with a Specialist: Given the complexity of your case, a consultation with a dermatologist who specializes in scar treatment or a plastic surgeon with extensive experience in scar revision may provide additional options tailored to your specific condition.

It's important to have a comprehensive discussion with your healthcare provider to determine the best course of action based on your individual case.

Wishing you the best in your recovery and treatment journey.

Help! Puffy scar 9 months post scar revision (Photo)

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Help! Puffy scar 9 months post scar revision (Photo)

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Everything you need to know about Scar Removal

Our mission is to create a world where every investment in modern beauty is Worth It.