Scars post facelift - can this be corrected? (photos)

Question

I had a facelift six months ago. The scars on one side of my face healed in this lumpy way. It feels like hard ridges to the touch. Can this be corrected? I have been religiously massaging with scar cream and it’s not improving. Absolutely hates this and want to correct as soon as possible. What are options and cost ?

Martin Jugenburg, MD · Answer

Hello, thank you for your question. Usually takes a full year for the scar to mature and pigment to neutralize. I understand this is not ideal for you after your surgery but you are doing the right thing. Continue with the scar silicone gel and scar massage 5-8 times a day, wear sunscreen and maybe in a few months at the 9-10 m point reassess. Also speak to your plastic surgeon in the mean time for a proper close up look at the scars that maybe we can not identify in the photos. 
Good luck !

Jag Chana, MD, FRCS(Plast) · Answer

Microneedling or fractional carbon dioxide laser can help to remodel the collagen in the scar even at this stage. Often it can take a year or longer after such a treatment to assess the results. Usually the scar has developed hypertrophy due to tension. If it does not settle a scar revision is possible but you would need to wait at least a year

Christopher David Jones, MBBS, BSc, FRCS (Plast) · Answer

The photo you have provided shows that the scar has been placed in a good position and should be inconspicuous. Scars do not mature fully until 18 months after surgery. I would advise that you continue with scar massage therapy. As the scar continues to mature, any lumps or ridges should markedly improve.

Donald Groves, MD · Answer

Hello and thank you for your question. After ANY surgery, the surgical incision goes through multiple stages of wound healing before arriving at the final "mature" scar. Assuming no infection or wound breakdown, during normal healing the incision approaches its final tensile strength 6-8 weeks after surgery, creating an "immature" scar. The immature scar is generally still raised and somewhat pigmented (pink or red), and can be associated with some discomfort or pulling, especially with movement or touch. It takes up to 1-2 YEARS for this immature scar to convert into a "mature" scar, during which time the scar remodels- the collagen becomes more organized, the scar flattens, and becomes less pigmented. It is typically safe to start massaging the scars at this point in the remodeling phase (after 6-8 weeks post-op), which can help break up and fibrosis/adhesions forming between the skin and underlying tissues. Also, it is very important to avoid UV light to the immature scar during the remodeling phase, as UV can cause permanent and irreversible hyperpigmentation (making it more noticeable)- so sunblock and sun avoidance are key until 1-2 years after surgery. If the final scar appearance is cosmetically concerning, this can always be revised electively- just note this will reset the healing process. Given you are still less than 12 months post-op, I recommend just being patient and continuing with the scar massage for now. I hope this helps! 
Best, 
Dr. Donald Groves 
Plastic Surgeon

Raffy Karamanoukian, MD, FACS · Answer

Plastic surgery scars require attention after surgery so that they remain cosmetically-appealing and barely noticeable. In our office, we use a protocol for scars that minimizes their activity in the 6-8 weeks after surgery. If you have late plastic surgery scars, you may also require laser and RF therapy to help reduce the longterm effects of the scarring. Keloids, hypertrophic scars, widened scars, red scars, and hyperpigmented scars all require scar modulation with topical creams followed by lasers and RF therapy. Topical skincare should be directed to a specific need, whether for pigmentation or hypertrophy and our office can guide you through the process to obtain the correct Plato’s Scar cream or Melarase cream for hypertrophy and discoloration. In terms of lasers, we would employ the vbeam laser for redness, Venus Viva RF, PRP microneedling, chemical peels, and Morpheus 8, fractional erbium, or fractional co2. All of these have their individual benefits. Most of all, we recommend you visit a solid plastic surgeon who understands surgical scar revision, laser therapy, and RF therapy for scars. 
 
Best, 
Dr. Karamanoukian
Realself100 Surgeon

Riaz Agha, MBBS, DPhil(Oxon), FRCS(Plast) · Answer

You have some rouching at the scar that hasn't completely settled down.At 6 months, these are unlikely to change very significantly and given your level of dissatisfaction you may wish to consider some treatment options.
A scar revision would be a choice to consider and you can approach your Surgeon about this option.

Yannis Alexandrides, MD, FACS · Answer

This lumpiness potentially represents the presence of deep sutures and maybe some inconsistency of the stitching in the deeper layers of the skin. This is definitely something that can be corrected with Scar Revision.

Ryan Rebowe, MD · Answer

Scars that heal in this fashion typically result from excess skin present at closure. At this point, much of the skin from your original surgery has likely retracted and therefore a scar revision with excision and straight line closure is likely possible. This can even be done utilizing local anesthesia in the office if you wish.

Ajaya Kashyap, MD · Answer

Thank-you for your question.  Your scar does have some pleating which is not unusual. at this time,.Local measures like silicone gel sheeting, creams and massage should help.  If there is some lumpiness a steroid injection may also  be needed. The scars usually take one year to mature and can be revised at that time if not satisfactory. Please discuss your concerns with your plastic surgeon who can help you. All the best!

Richard G. Schwartz, MD · Answer

A personal exam and records of the suture closure of your facelift would allow a more specific assessment, so I can only offer general thoughts.  From your photo it appears that the lumpiness is not actually superficial scar tissue but either probably scar tissue below the surface.  Such scarring sometimes occurs surrounding suture knots.  I would first try steroid injections into any areas of firm lumps,  If that doesn't work, then I would consider surgical removal of the curved line of old scar and any lumpiness, with repeat closure.

Scars post facelift - can this be corrected? (photos)

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