How to treat scar deformity from too tight facelift sutures? (Photo)

Question

I am 5 weeks post lower facelift surgery and I have a very large raised caterpillar like scar in front of my ear due to sutures being pulled too tight and left unchecked by my surgeon for 9 days. This is not a hypertrophic or keloid scar. I don’t believe there is enough skin laxity or lobe left for an adequate surgical revision. Can this be treated with kenalog injections and lasers? Are there any other treatment options?

Anna Chacon, MD, FAAD · Answer

At five weeks after a facelift, I would be cautious about assuming that the current appearance represents the final scar. The scar is still very immature, and collagen remodeling continues for many months. Early scars can be raised, firm, red, tight, or uneven before they gradually soften and flatten.

Your description of a "caterpillar-like" ridge in front of the ear could certainly be related to excess tension, puckering, or the way the tissues were closed, but it is difficult to determine from a photograph alone whether this is primarily scar tissue, a contour created by the closure, or a combination of both.

Would Kenalog help?

Possibly, but only if there is an active raised/hypertrophic component to the scar. Intralesional triamcinolone (Kenalog) can flatten and soften raised scars by reducing excessive collagen production. However, it isn't a way to release a mechanically tight closure or correct a true tissue-puckering deformity.

I would also be conservative with steroid injections this early after facial surgery. Too much steroid or injection into the wrong tissue can cause skin thinning, indentation, pigment changes, visible small blood vessels, or delayed healing.

What about lasers?

Lasers can be very helpful once the incision has adequately healed. Depending on what remains, vascular lasers can address persistent redness, while fractional resurfacing can improve texture, firmness, and scar irregularity over time. Laser treatment is frequently combined with other scar treatments rather than used as a single solution.

Silicone gel or silicone sheeting can also be useful once the incision is completely closed, particularly for a raised or active scar.

The part I would pay particular attention to is your concern that there isn't enough skin or earlobe available for revision. That doesn't necessarily mean revision is impossible, but it does mean that simply cutting out the visible ridge and pulling the skin together again may not be the best answer. Scar revision sometimes requires a more sophisticated approach to redistribute tension rather than simply excising the scar. Techniques such as layered closure or, in selected situations, Z-plasty or other tissue rearrangement can be considered.

At only five weeks, I would generally focus first on allowing the tissues to heal and determining exactly what component is causing the raised appearance rather than rushing into another operation. If the deformity persists as the scar matures, a combination of scar therapy and, if necessary, a carefully planned revision can often provide meaningful improvement.

Most importantly, I would not assume that what you're seeing at five weeks is permanent. Facelift scars can change substantially during the first several months, and the final appearance can take considerably longer to settle.

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

How to treat scar deformity from too tight facelift sutures? (Photo)

Answers (2)

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