How can I effectively address atrophic dorsal scar persisting after revision rhinoplasty complication? (Photos)

Question

I underwent Revision Rhinoplasty over a year ago to correct asymmetry in my tip & address a small dorsal hump. Unfortunately, inadequate blood flow during the procedure resulted in an atrophic scar in my upper dorsal area. 4 months ago, my surgeon excised the scar & connected the tissue, improving it but still some atrophic scarring returned. Some residual swelling from the revision rhinoplasty is also present. What is the best scar revision procedure(s) from here to address the atrophy? Would a structural fat graft be beneficial to address scar and atrophy?

Nelson Lee Novick, MD · Answer

Since there has already been atrophy that resulted from vascular compromise I would be concerned about any use of fillers, including fat, especially since, even under the best of circumstances, fillers in the region of the nasal bridge may engender untoward vascular reactions. I would be hesitant regarding further revision surgery (especially in a vascularly compromised region) as this may result in the development of a stretch scar and even tram track stitch marks. Subcision, which I have been performing since 1995, would appear to be a very reasonable approach. It is a simple, relatively inexpensive technique, for elevating all kinds of atrophic scars from all causes, including, as in the case, post-surgery. You would be wise to consult an experienced, board certified cosmetic dermatologist, and best of luck.

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

Jeffrey H. Spiegel, MD · Answer

I am a medical professional.  I don't think fat grafting is the right answer at all, personally, as there isn't meaningful fat in that part of your nose normally so it's not the right choice.
Basically, the skin at the top of the nose is thinner than lower in the nose.  As a result when some skin was excised you have skin that is thinner meeting skin that is thicker which is creating a "step off" or level irregularity.  We would want to adjust the skin differences here to blend it in better. There are several ways.

Randal Haworth, MD, FACS · Answer

I'm not a medical professional, but you may want to consider discussing potential options with your surgeon. Procedures like structural fat grafting could be an option, as it may help address atrophic scarring. However, the suitability depends on your specific case, and your surgeon can provide guidance based on your unique circumstances and medical history.

Best of luck !

How can I effectively address atrophic dorsal scar persisting after revision rhinoplasty complication? (Photos)

Answers (4)

Answer: Atrophic dorsal scar

Answer: Atrophic dorsal scar

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How can I effectively address atrophic dorsal scar persisting after revision rhinoplasty complication? (Photos)

Answers (4)

Answer: Atrophic dorsal scar

Answer: Atrophic dorsal scar

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Everything you need to know about Scar Removal

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