I’ve had really bad scarring from alarplasty and modified lip lift. How can I fix this? (Photos)

Question

Hello, I’m 10 months post op from an alarplasty and a modified lip lift that made incisions higher up, but the scarring has been horrendous and quite distressing to me. I’ve used silicone gel, light scar massaging, several steroid injections, and two IPL sessions. But it still looks so bad. What should I do because I really need help.

Nelson Lee Novick, MD · Answer

At least from the photos provided, your right side appears very much like a string of ice pick-type scars encircling the ala, and your left side a continuous, elevated linear hypertrophic scar encircling the ala. 
If this is indeed so, then use of TCA CROSS CAN BE USED TO TREAT THE ICEPICK TYPE SCARS, MUCH THE WAY IT IS USED FOR TREATING DILATED PORES AND UNWANTED PIERCING HOLES. 
FOR YOUR LEFT SIDE, WHICH APPEARS TO BE A SMALLHYPERTROPHIC SCAR, INTRALESIONAL ANTIINFLAMMATORY INJECTIONS WOULD BE A LOGICAL APPROACH. 
IT IS VERY POSSIBLE THAT YOUR PRIOR LACK OF SUCCESS WITH INTRALESIONAL INJECTIONS MAY HAVE RESULTED FROM THE USE OF TOO LOW A CONCENTRATION AND/OR TOO LOW A VOLUME OF INJECTION OR LACK OF COMBINING ANTIINFLAMMATORY MEDICATIONS TO ACHIEVE THE DESIRED IMPROVEMENT.
I AM NOT AT ALL SURPRISED BY YOUR LACK OF SUCCESS WITH SILICONE GELS, ETC., AND I PERSONALLY DO NOT RECOMMEND THEM FOR THAT REASON. LIKEWISE, NO SURPRISE WITH THE LACK OF SUCCESS WITH THE LIGHT TREATMENT, AS THE HARD SCIENCE TO SUPPORT THE USE OF SO MANY OF THE LIGHT AND ENERGYBASED GIZMOS LAGS WELL BEHIND THE HYPE TO PROMOTE THEM. 
YOU WOULD BE WISE TO CONSULT WITH AN EXPERIENCED, BOARD CERTIFIED COSMETIC DERMATOLOGIST SCAR TREATMENT EXPERT. HOPES THIS HELPS AND BEST OF LUCK. 
P.S. FORGIVE THE CAPS. FOR SOME REASON, MY COMPUTER JUST GOT STUCK IN THIS MODE.

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

I'm sorry to hear about your distressing experience with scarring following alarplasty and a modified lip lift. At 10 months post-op, it's understandable that you want to see improvements. Here are some additional options you might consider exploring:

Laser Resurfacing: Fractional laser treatments, such as CO2 or erbium lasers, can help improve the appearance of scars by promoting new collagen formation and smoothing the skin.

Microneedling: This treatment involves using fine needles to create micro-injuries in the skin, which can stimulate collagen production and improve scar texture over time.

Scar Revision Surgery: In some cases, surgical scar revision might be necessary to improve the appearance of scars. This involves removing the scar tissue and carefully closing the incision to minimize new scar formation.

Dermal Fillers: For depressed scars, dermal fillers can be used to elevate the area and make it more level with the surrounding skin.

Chemical Peels: Depending on the depth and nature of the scars, chemical peels might also help by removing the top layers of skin and promoting regeneration.

Consultation with a Specialist: Consider consulting with a dermatologist or plastic surgeon who specializes in scar management for a personalized treatment plan.

Each treatment option has its own risks and benefits, so it's important to weigh these carefully and discuss them with a specialist to determine the best approach for your situation.

Anil R. Shah, MD · Answer

Hello! My name is Jessica, I am a physician assistant, and one of the providers at Aesthetic Skin - Winnetka & Chicago. This is a great question. I'm really sorry you're going through this—scarring, especially on the face, can be incredibly distressing both emotionally and physically. Given that you're 10 months post-op and have already tried a comprehensive range of treatments including silicone gel, massage, steroid injections, and IPL with limited improvement, I recommend considering CO2 laser resurfacing as a next step. CO2 laser is one of the most effective treatments for improving the texture, color, and overall appearance of surgical scars, particularly when they are raised, thickened, or red. It works by removing damaged skin layers and stimulating collagen remodeling, which can significantly smooth and soften the appearance of scar tissue. Multiple sessions may be needed, and downtime is expected, but many patients find it well worth the investment for long-term results. I hope this helps and best of luck!

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