Keloid scarring after hairline lowering. Will this go away?

Question

I had a hairline lowering procedure just over a week ago and I’ve noticed the end of one side of the scar has a raised bubble and the whole side is raised. Will this go away? What can i do to minimise the scarring?

Ryan Mitchell, DO, FAOCO · Answer

Hello, 
It is normal to have heightened various feelings after undergoing elective plastic surgery.  From joy and pride to worry and even sometimes depression are just a few of the feelings and emotions that can present after a completely successful  procedure.  Good solid advice to give to patients immediately following cosmetic surgery is to strongly urge them to not continuously look at their bruised, swollen, red, lumpy or bumpy surgical site more than is absolutely necessary.  Hyper-focusing or studying every detail of the freshly operated site which is usually also painful to a degree may certainly arouse feelings of anxiety or worry because many times the bruising and swelling might be more than the patient                   was expecting.  
     The fact is that rarely does anybody come right out of surgery appearing anything like they envisioned or nearly what the final outcome will ultimately demonstrate.  It takes time and patience and more time for swelling to settle, bruising to subside and incisions to heal, settle and fade. Hypertrophic or keloid scars will not even present for weeks or sometimes months following the surgery. The best thing to do following surgery is to follow your surgeons wound care directions closely. There are legitimate concerns regarding an incisions appearance following surgery that must be reported if encountered.  Some urgent issues would be dehiscence or wound separation, excessive bleeding from the incision site or unusual discharge such as pus caused by infection. Otherwise the incision when sutured closed and depending on the type of surgery and location on the body will sometimes appear somewhat frightening to some patients. When incisions are closed the edges should be raised to a degree along the suture line. Once the sutures are removed the raised incision edges will settle and flatten with time.  This is not to say that sometimes the closure could be a little bit uneven or at the end of the incision a “dog ear” or what we call “pin cushioning” might initially be present. A dog ear or pincushioning at the end of an incision line occurs during the closure due to the difference in lengths of the upper and lower lines of the incision.  These conditions will ultimately resolve one way or another and many times will settle naturally during the healing process. 
  Fortunately most of the swelling from many procedures as well as the scars are looking much better in 4 to 6 weeks and sometimes sooner. Just as every person has a unique appearance every person also has their own unique ability to heal. Younger and  healthier patients tend to heal faster then older patients who might have some chronic medical conditions. Luckily cover-up and make up can be worn to hide incisions and swelling or bruising usually after about two or three weeks following surgery .  It is of upmost importance that you follow your surgeons postoperative care very clearly.
To answer you question, it would be helpful if a photo was available to see exactly what you are concerned about.  It is difficult to give you precise information without seeing the closure. However, I will try to reassure you that It is too early to judge the closure this early following surgery.  If you were my patient I would have you either send me a selfie of your concern or have you come to my clinic and let me look at the site directly. You should ask your surgeon this question regarding your concern if you haven’t already done so.  
During your postoperative visit if there are cosmetic incisional issues , your surgeon may opt to do nothing and wait for healing to occur naturally or possibly inject these regions with certain types of medications such as steroids. Ultimately,  if it persists and is not satisfactory, your surgeon should, many times at no charge, revise this portion of the scar to create the best aesthetic result possible.  
For many facial procedures the postoperative wound care instructions are quite straightforward. In my practice typically the initial postoperative wound care regimen is to keep the incision out of direct and significant sunlight, keep the incision clean using mild soap and warm water and blot it dry. Occasionally diluted peroxide can be used. It is important to keep the incision clean and coated with the ointment recommended by your surgeon.  Using ointment over the incision acts as a scaffolding for new epidermal cells to cross over the wound edges and heal faster and nicer.  It is not recommended to keep an incision dry which will become flaky and not heal as quickly. It is also very common for antibiotic ointment to create a contact dermatitis after it has been used for multiple days in a row.  Because of sterile technique as well as the use of perioperative prophylactic antibiotics, infection following cosmetic surgery especially on the face and scalp is quite rare. Therefore, in my patients, the regular use of topical antibiotic appointments is usually discontinued three or four days after the surgery. This is stopped once again because overuse of antibiotic ointments or creams many times cause irritation to the incision site and surrounding skin. I then switch to Aquaphor healing ointment.  I will have my patients use Aquaphor for two or more weeks until the incision is closed, clean, dry and intact and the sutures have been removed. After about 2 to 3 weeks following surgery when the incision is completely closed there are many treatment options or  treatment modalities to deal with the present scar.  If a hypertrophic scar begins to present,  this is treated with various options such as intralesional steroid injection, topical steroid cream, silicone sheeting or silicone gel.  Residual scars also may respond to treatments such as micro needling, CO2 laser, or other laser wavelengths that will target excessive vascularity, redness or scar thickness.  Keloid scars are much more rare and are more common in darker skin types.  It is common for patients that develop hypertrophic scars to believe they are keloid scars however these scars are quite different in appearance as well as response to treatment. 
     The truth is that the majority of incisions that are cared for properly will ultimately heal well naturally given sufficient time. The good news is if a scar heels and it is not ideal, a scar revision can be performed typically yielding resolution to the issue and satisfactory results. 
My key message is to please not over analyze your surgical results immediately after your procedure and trust that time and mother nature and following your surgeons directions precisely will typically result in minimal scar appearance.  If you have a concern regarding your closure immediately after surgery you should certainly ask your surgeon if it is normal or not.  Later in the healing process there exists many various modalities to improve a scar further. However these treatments are typically not started for at least 2 to 3 weeks and possibly longer after the surgical procedure. If you are ultimately not satisfied with the scar resulting from your procedure I recommend bringing this up with your surgeon.   
Finally I would like to mention the patient’s role in creating the best environment for better healing following any invasive surgical procedure. I recommend consuming a very healthy diet in the weeks preceding and following your surgery.  Eating nutritionally dense foods such fruits and vegetables and even juicing dark greens and certain fruits, I believe helps to create faster healing and potentially less bruising and swelling.  If you are a smoker, I recommend stopping smoking prior to and following surgery and limit alcohol intake in the weeks preceding and following your procedure.
I hope this information is useful to guide you through your healing process.
Best regards,

Dr. Mitchell

Jae Pak, MD · Answer

Personalized medical treatment advice on the Internet without a good history and examination is inaccurate and may lead to confusion and misinformation.
If you are concerned please follow up with your doctor for an exam. This may or may NOT be a keloid.

Richard W. Fleming, MD (retired) · Answer

By definition a keloid would not form just one week after surgery. However, I recommend you see your surgeon for diagnosis and appropriate treatment if necessary.

William Rassman, MD (retired) · Answer

Keloids are very unusual at this location. I would have to see the scar before giving you an opinion on how to manage it.

Keloid scarring after hairline lowering. Will this go away?

Answers (4)

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