Should I massage an atrophic scar on my forehead that I got from falling and not getting stitches when I should have? (Photo)

Question

My scar is depressed and red. The outer layer of skin never fully connected because I didn’t go get stitches. The cut wasabout a half inch deep so I think the fat layer was damaged.3weeks after the injury I went to see a plastic surgeon and he has me deep tissue massaging it 3minutes3times daily and applying a silicone sunscreen combo gel twice a day. The gel says it’s for raised red scars and mine is not raised. Afraid I’m preventing the sunken scar from filling in to surface level by massaging

Ellen A. Janetzke, MD · Answer

Hello! massaging scars can help especially with a product such as Silagen with sunscreen. There are various ways to help not only remove the pigment from the scar but also to even out and remodel the tissues themselves. Lasers and micro-needling are wonderful options. Good luck!

Raffy Karamanoukian, MD, FACS · Answer

Our treatments use combination therapy to improve the epidermis and dermis for most deep scars. The options available for acne scars depend on the character of your scars, in terms of topography and contour. We see atrophic and hypertrophic acne scars, as well as scars that have hypo and hyperpigmentation. We begin each scar evaluation with an assessment of scar quality and subtype. Our main concern is rebuilding collagen and that is why we use a HIDEF protocol that includes combination therapy. Morpheus 8, scar subcision, fibrous release, fractional laser, CO2 laser, Thulium laser, PDL Vbeam laser, and fractional resurfacing can be used in addition to TCA Cross and chemical peels to further improve skin. Patients should start Melarase AM and Melarase PM for active hyperpigmentation. Always begin with a consultation to decide whether early subcision should be started.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best, 
Dr. Karamanoukian 
Realself100 Surgeon

Nelson Lee Novick, MD · Answer

Since the late 1980s, we have known that the ideal window of time for improving a wound from any cause (injury, surgery, infection like chicken pox, or post-acne) is between eight and twelve weeks following the insult. At this point the wound is strong enough to withstand treatments, but not yet fully "matured," so more likely to respond the most optimally to treatments. Frankly, I haven't been terribly impressed with the usual recommended topical scar treatments, like Mederma or silicone gels and sheeting, although the latter don't seem to do any harm, either. I am also skeptical about the issue of massage at this point, which, as you correctly noted, is best reservd for elevated scars. It is not clear from your question just how far along you are from the original time of injury. In the late '80s, "scarabrasion," i.e. dermabrasion or manual dermasanding was recommended during the eight to twelve week window mentioned, and in some cases almost complete obliteration of the potential scar was achieved in this fashion. More recently, I have substituted medical microneedling for manual dermasanding with gratifying results and much less downtime. You would do well to seek consultation and treatment by a board certified aesthetic physician as soon as possible. Best of luck to you.

Jason Emer, MD · Answer

I recommend getting a formal evaluation with a cosmetic dermatologist for after care. I recommend Silagen + Bioshield to promote healing. This scar can be improved with lasers (ProYellow, Excel V, VBeam) and microneedling/prp. See an expert. Best, Dr. Emer

James Bowers, MD · Answer

You can wait longer to see if the scar fades on its own, but if you want it gone, then fractionated laser is the procedure that you will want to do.  It will take several sessions of fractionated laser to lessen the scar but it will work

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