Help to Remove Facelift Keloids for a "Light Lift"

You will see a common theme among patients who have undergone minilifts: hypertrophic or keloidal scarring.
Why would a minilift result in large scarring?
When incisions are closed after a real facelift performed by an expert facelift surgeon, they are closed with minimal tension. That means not too tightly at the place where the sutures are placed. The reason for this is simple: wounds that are closed under tension stretch, forming thick scars.
So ironically, to avoid the burden of having a real facelift- which in reality is 48 hours of healing time but admittedly much greater pricetag-- patients incur more scarring and deformation, not less.
In the short term, scarring can be minimized by kenalog injections, various creams and gels, and application of topical treatments (each of which has specific therapeutic windows).
After 6 months, scars are usually considered mature enough to be revised.
Revising minilift scars usually involves converting the minilift to a real facelift, reforming the delicate earlobe, tragus, hairline details so they are much less detectable, and sometimes undetectable.
Plastic surgeons who specialize in revision facelifts are your best bet for consultation regarding the above issues.

Hello! Thank you for the question! It is common for scars to fully mature for up to a year. In the meantime, there are a few things that may help to ameliorate your incision/scar. The most proven (as well as cheapest) modality is simple scar massage. Applying pressure and massaging the well-healed scar has been shown to improve the appearance as it breaks up the scar tissue, hopefully producing the finest scar as possible. Other things that have been shown to add some benefit, albeit controversial, are silicone sheets, hydration, and topical steroids. In addition, avoidance of direct sunlight to the incision will significantly help the appearance as they tend to discolor with UV light during the healing process. If unsightly scars are still present after approximately a year's time, other things that your surgeon may consider are intralesional steroid injections, laser, or just surgical revision of the scar itself.Hope that this helps! Best wishes!

Best Scar Management Practice – Advice from Dr. Larry Nichter:

In your particular case it sounds like you have a hypertrophic scar rather than a keloid. Either way my advice is similar. At this late point you may well need a scar revision, a minor office procedure to remove your scar and replace it with a new one. Below are what I feel is important to prevent a future bad scar: 
Best Scar Management is important to minimize or completely hide from view, the tell tale signs of surgery – namely, scars. Both you and your surgeon want you to have the most minimal scarring possible from your surgery.  Patients with scars that are enlarged or not healing well after surgery can be from many causes. 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:
1- Minimize tension on the scar – Steri Strips and/or surgical tape are often placed in non-hair bearing areas 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”.
2– 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 immediately 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”.
3. –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.  .
4. – 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.  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). At the present time I prefer BioCorneum  or Kelo-Cote products and 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.
5. – 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 or injection of a 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.

Scar revision after a facelift procedure often requires a more extensive facelifting procedure to remove enough of the scar.  You need to find an experienced facial plastic surgeon or plastic surgeon to help with improving or eliminating the scar formation.  If the scars are unable to be treated in one setting, a staged, second procedure may be required to get the best result.   Best of luck!

Dear Cantonie, It seems that you have hypertrophic scars rather than Keloids. Hypertrophic scars are simply thicker, wider scars and they start to appear two to three weeks post surgery and stop growing. On the other hands keloid scars are pathological where the scar continues to grow beyond its original borders and they get very large. I would recommend you to see a plastic surgeon in your area. He or she will most likely to inject the area with Kenalog for at least 3 sessions and recommend scar gels such as Kelocote and topical steroid. Laser is a good option as well. If these treatments are not affective, there are other options available that I would leave that to treating physician.

There are a few ways to help with Keloid scars.  Most Doctors first attempt would be to do a Kenalog injection. This can help the scars appearance. Also, using silicone gel or sheeting can help to smooth out the scars. If they are very irritating, I would recommend seeing someone in your area for help. Good Luck!

Keloids and hypertrophic scars can occur for a variety of reasons:


Excessive tension placed on the skin

Failure to anchor the deeper tissue properly

Propensity for poor scarring


Early on, hypertrophic scars can be treated with kenalog injections.  However, once the scars have matured, the likelihood of improvement is less likely.  Excision of the scar, with lifting of the deeper tissue to avoid tension on the skin are steps to improve the appearance of the scar.  Seek a surgeon with experience in making facelift scars look their best.

Keloids are excessive growths of scar tissue that can become quite large.  The can also produce itching.  The usually occur in darker skin individuals and more often occur on ear lobes, chest  and arms.  keloids can be very tough to treat due there tendency to return.  Some options for "LONGTERM" keloid management are removal plus the use of steroid injections.  Medical grade silicone sheeting can be added to apply gentle pressure over the are to help to maintain flatness.  

Dr. ES

Dear Cantonie, I would agree with my colleagues that you likely have hypertrophic scars, rather than keloids, due to excessive tension on the facelift incisions during healing. Many options exist and a qualified facial plastic surgeon can discuss them with you. Depending upon the severity of the hypertrophic scarring, your best option might be revision facelift with tension-free skin closure. I wish you well.Stephen Weber MD, FACS

There is a difference between unsightly large scars and true keloids, but from practical perspective to a patient the difference is not very relevant.  You have two options, one is non-surgical treatment of the existing scars with various medications that are injected into the scars, followed by laser treatments to lessen the color and texture of the scars.  In my practice I have treated a number of poor face lift scars with revision face lift surgery.  In your case most likely there could be still a significant amount of skin that can be advanced over the existing scars, which could be excised,  if a well planned and executed deep structure face lift is performed.

The field of facial surgery is full of gimmicks and sub-par procedures. An experienced and expert facial rejuvenation surgeon will carefully assess each patients individual anatomy and aging process to design a unique surgical approach. Only in this fashion can a beautiful, dramatic, natural and lasting result can be obtained.

If you choose to have a revision surgery, make sure your surgeon carefully explains to you what procedure is being contemplated and what is the expected result. Only then can you avoid disappointment after surgery. You might find it insightful to ready my article on "Fast Tract Facelift" which can be found on my web site under "publications".

 

These keloids need to addressed promptly and aggressively, so that they can be reduced in size and perhaps even eliminated altogether. Note that these may not be actual keloids, but rather hypertrophic or widened scars, in which the treatment may be somewhat different. The first line of treatment of actual keloids is steroid injections. A more involved but perhaps necessary intervention would be complete excision of the keloids, then every 4 to 6 week injections of steroids to prevent them from recurring. In general, a facial plastic or plastic surgeon is able to handle this.