Treatment for Indented Surgery Scar?

I think fillers under depressed scars a futile.  The scar is just too rigid to elevate.  Therefore a scar revision is indicated in most circumstances.

Indented scars do well with reexcision or subcision.  Speak to your surgeon about surgical scar revision when the risk of recurrence is low. 

The atrophic nature of your scar is due to contraction of surgical scar. Filler injection to replenish the lost volume would be the best, instantly gratifying option for depressed scar particularly along tear trough areas. In the hands of an experienced board-certified dermatologist or plastic surgeon, a variety of fillers can be considered, e.g. Restylane, Juvederm, or Evolence Breeze.

It is quite common to heal after MOHS surgery without sutures.  Actually in some places on the face the opening heals better if it heals this way.  Without knowing the location and type of cancer treated, I would not jump to revision right away.

3 month is a very short time.  Indentation you see may be more noticable while there is still surrounding swelling and as it subsides, you may not need any additional surgery.

I would wait till 6 month after surgery and then discuss with your MOHS surgeon options for revision if needed and any contraindications based on the type of cancer removed.  There are some studies showing better survival of patients with advanced melanoma and decreased recurrence if the wound heals by secondary intention.

Sincerely, Boris Volshteyn MD

Contraction and depression of wounds left to heal by "secondary intention" (left open) is not uncommon. Depending on the severity of the problem something as simple as massaging the scar daily can be helpful. This will help minimize edema (swelling) and might flatten the tissue surrounding the scar. Dermabrasion can help lower the surrounding skin and reduce the shadowing that reveals depression of the scar. Dermal fillers can help plump up the scar itself. Lastly, the scar can be removed and repaired with local flap - essentially starting over with something similar to but smaller than the original wound.Stephen Weber MD, FACS

From what you describe, it sounds as though the scar is tethered to the underlying tissue. When a wound is allowed to close in on its own, there is a significant amount of contracture which occurs. This contracture is a pulling of the normal skin by the scar which can lead to puckering, indentation, and distortion of the surrounding skin. Treatment options depend on the severity of the indentation. These range from simple dermabrasion to removal of the scar and closure with sutures.

From the sounds of things you probably could use a scar revision. This can be done under local in many circumstances. You should be examined by a good plastic surgeon for a better recommendation.

Best Regards.

The BEST cosmetic results come from controlling all the variables. It is a fair statement that good Plastic surgeons are obsessively focused on details and are "Control Freaks". By controlling all variables and leaving little or nothing to chance we can use the healing processes to our patients' advantage.

Failing to bring "fatty tissue" together under a C-section scar allows the scarring to tent and indent the scar to a deeper layer. Allowing some cheek wounds to heal by themselves draws the edges together resulting in a dimple at best but can also pull the eyelid down or worse.

The correction would depend on the extent of retraction. In mild cases, undermining (pickle fork or subcision) followed by placement of a filler could lift the indentation. In other cases, the scar needs to be surgically re-done.

 Wound Control = Better results.

 

Patients they have many options for scar revision in the infraorbital region. These include the use of thermal fillers, fat grafting, re-excision and repair the scar and the use of local flaps to fill this defect. Consult with your plastic surgeon to see which options may be best for you

Healing from surgery usually involves healing of scar tissue.  Scar tissue undergoes a long process of healing, or scar maturation.  This process can take 12 months or more.  Your indented scar may get much better as the surrounding skin softens and the scar matures.  There are a variety of options available to the plastic surgeon for scar revision.  Since your surgery was three months ago, I would wait before trying to revise something now that may be fine later.  In the meantime, protect the area with sunscreen.  Your surgeon can give you the advice you need.