Dog bite 2 months ago. What should I do with the red, hyperpigmented scar? (Photos)

Question

I was bit by my dog almost two months ago. I was bit on my right upper cheekbone/under eye and underneath my eyebrow. The wound has closed. It is now a red hyperpigmented area but also a slight painful internal lump around both areas of where I was bit which I assume is scar tissue. My question is, does that soften/go away completely with time and does the red hyperpigmentation go away as well? What products should I use to better help with the scarring process? Will any specific procedure help with removing any sort of scars. I do see a white line forming on one of the cuts I had. I did notice that my cuts did not scab, they just turned red. I have been adding silicone gels and previously also using aloe vera plant but don’t see any changes.

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

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

It's understandable to be concerned about the healing process after a dog bite, especially on the face. Here are some general suggestions and considerations regarding scar management and healing:

Natural Healing Process:

Redness and hyperpigmentation are common in healing scars, and they often fade over time. This process can take several months to a year.
The firmness or lumpiness you feel is likely due to scar tissue, which can also soften as the scar matures.
Topical Treatments:

Silicone Gel or Sheets: Continue using these as they are proven to help flatten and soften scars over time. Consistency is key, so keep applying them as directed.
Vitamin C Serums: These can help with pigmentation and support collagen production, potentially improving the appearance of scars.
Sunscreen: Use a broad-spectrum sunscreen daily to protect the area from UV rays, which can worsen hyperpigmentation.
Professional Treatments:

Laser Therapy: Fractional lasers or pulsed dye lasers can help reduce redness and smooth out the texture of scars.
Microneedling: This can stimulate collagen production and improve the appearance of scars.
Steroid Injections: If the scar is particularly raised or firm, a dermatologist might recommend steroid injections to reduce thickness.
Consultation with a Dermatologist:

Given the location and nature of the scar, consulting with a dermatologist is advisable. They can assess the scar and recommend the best course of treatment, which might include some of the procedures mentioned above.
Pain Management:

If the internal lump is painful, it's important to discuss this with a healthcare provider to rule out any complications such as infection or excessive scar tissue formation.
It sounds like you are already taking proactive steps in your scar management, and with time and the right treatments, the appearance of the scars should improve. Always consult with a healthcare professional before starting new treatments to ensure they are appropriate for your skin type and condition.

Nelson Lee Novick, MD · Answer

So sorry that this has happened to you. 
In spite of the continued recommendations by many doctors to "wait a year until the scar has matured," It has been known since the late 1980s that the actual ideal time for intervention to achieve the best outcome is between the end of week four after the injury (or surgery or infection), when the scar is strong enough to withstand treatments, and the end of week twelve (after which the scar is considered "mature,"  and the chances for optimal improvement in appearance are greatly diminished. 
Dermastamp manual microneedling (no need for the added expense or risks of RF microneedling) performed during that critical interval would be a very reasonable treatment approach. 
Bearing the above time-frame above, you would be wise to make sure to consult with an experienced, board certified cosmetic dermatology scar treatment expert.  Hope this helps and best of luck.

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