Concerned with my revision rhinoplasty scarring, how can I minimize/get rid of them? (Photos)

Question

I had my initial rhinoplasty in 2018 but was unhappy with the overall size and width of my nose and had a revision rhinoplasty in 2023. I have very noticeable scars that can still be seen with makeup on. My doctor did not recommend any scar cream but I just started using one My fear is that the scars are too deep and I want professional advice about what to do next in order to minimize or hopefully get rid of these scars.

Anna Chacon, MD, FAAD · Answer

I'm sorry to hear about your concerns with scarring after your revision rhinoplasty. Scarring can be a challenging issue, but there are several approaches you can consider to help minimize or reduce the appearance of scars. Here are some steps and treatments that might be beneficial:

1. **Topical Treatments:**
   - **Silicone Gel or Sheets:** These are considered the gold standard for scar treatment. They can help flatten and soften scars over time.
   - **Scar Creams and Ointments:** Products containing ingredients like onion extract (e.g., Mederma), hyaluronic acid, or vitamin E can be helpful. While your doctor didn't initially recommend a scar cream, continuing with one can still offer benefits.

2. **Sun Protection:**
   - **SPF:** Protecting your scars from the sun is crucial. Use a broad-spectrum sunscreen with at least SPF 30 on your nose daily, as UV exposure can darken scars and make them more noticeable.

3. **Massage:**
   - **Scar Massage:** Gently massaging the scarred area for a few minutes each day can help break down the fibrous tissue and improve the appearance. Always consult with your surgeon before starting any massage to ensure it's appropriate for your specific case.

4. **Non-Surgical Treatments:**
   - **Laser Therapy:** Fractional lasers or pulsed dye lasers can help reduce the redness and improve the texture of scars. These treatments stimulate collagen production and can significantly improve scar appearance over time.
   - **Microneedling:** This technique involves tiny needles creating micro-injuries in the skin, promoting collagen production and improving scar texture.
   - **Chemical Peels:** Mild chemical peels can help exfoliate the top layers of skin and reduce the appearance of superficial scars.
   - **Steroid Injections:** If your scars are raised (hypertrophic or keloid), steroid injections can help flatten them.

5. **Surgical Options:**
   - **Scar Revision Surgery:** In some cases, surgical revision of the scar may be necessary. This would involve removing the old scar tissue and carefully re-closing the wound to create a less noticeable scar.

6. **Consultation with Specialists:**
   - **Dermatologist or Plastic Surgeon:** Consider seeking a second opinion from a dermatologist or another plastic surgeon who specializes in scar treatment. They can provide tailored advice and treatment options based on an in-person evaluation of your scars.

7. **Patience and Realistic Expectations:**
   - **Time:** Scars can continue to heal and improve for up to a year or more after surgery. Patience is important, and gradual improvement is often seen with consistent treatment.

Next Steps:
1. **Schedule a Follow-Up:** Make an appointment with your current surgeon to discuss your concerns and get their professional advice on the next steps.
2. **Seek a Second Opinion:** If you're not satisfied with the advice from your current surgeon, consider consulting with another specialist.
3. **Explore Treatment Options:** Based on professional recommendations, you can explore the various treatments mentioned above.

Remember, each person's skin heals differently, and what works for one individual may not work for another. Professional guidance tailored to your specific situation will be the most effective way to address your scarring concerns.

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

Concerned with my revision rhinoplasty scarring, how can I minimize/get rid of them? (Photos)

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Concerned with my revision rhinoplasty scarring, how can I minimize/get rid of them? (Photos)

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Everything you need to know about Scar Removal

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