Is punch excision /z plasty suitable for forehead scars? (Photo)

Question

I have had an area of scarring for 5 years from picking at a reoccurring cyst. The scar flattens when stretched so I dont think it’s tethered. I’ve had lasers, microneedling regularly, prp, and filler (which just lifted the whole area and didn’t fill out the missing chunk of skin) . Botox helps slightly in the initial month after when brows are slightly lifted. I feel the only way to get rid of it now would be to have it surgically removed. Would z / w plasty or punch excision be a good option?

Nelson Lee Novick, MD · Answer

First, let me say that I am sorry, but not surprised, that you were disappointed with your laser and PRP treatments. I have been cautioning my regular followers for years already that the hard science to support the use of these expensive treatments lags woefully behind the heavy marketing and social media buzz to promote them. Really sorry.  Microneedling, especially professionally performed manual microneedling (no need for for the extra expense and risks of RF microneedling) is best reserved for being a final "polishing" step in order to better blend in both superficial color and texture treated scars with the surrounding normal skin; it is not a particularly good primary treatment for scars. So, once again, sorry, but no surprises there, either.  And when there is tethering, the use of fillers would not surprisingly lift the whole area instead of the indentations. So, again, no surprises. Surgical revision in an area, such as the forehead, under a great deal of static muscular tension and movements runs the significant risk for the subsequent of stretch scars and tram track stitch marks. You would be wise to consult with an experienced, board certified cosmetic dermatologist scar specialist about the use of subcision, a simple technique, which has a proven safety and efficacy record going back nearly three decades, to break up the downward pulling scars tethers of the scars in order to elevate and smooth them. I have routinely been performing subcisions for this purpose in all body locations, including all over the face, and in all skin types since 1995 with gratifying results. The concomitant use of Botox may further help to improve the results of subcision here by temporarily diminishing muscular movements while the subcised areas heal. Hope this helps and sorry for the lost time and money on all the "bells and whistles" gizmos and treatments you have already undergone. Best of luck going forward,

Is punch excision /z plasty suitable for forehead scars? (Photo)

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Is punch excision /z plasty suitable for forehead scars? (Photo)

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