Z Plasty or linear closure for atrophic scar on bridge of nose / upper dorsal area? (Photo)

Question

Underwent Revision Rhinoplasty in October of 2022. Complication resulted in scar on bridge / upper dorsal area. Seven months ago, the surgeon excised the scar—originally improving it. However, since then, the scar widened and atrophied, resulting in the recurrence of a noticeable contour irregularity. Did two laser resurfacing treatments. Most suggest re-excision but differ on the approach. Z-plasty or linear closure?

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

Nelson Lee Novick, MD · Answer

Any of my regular followers would attest to the fact that I have been cautioning them for years to think twice before having revision surgeries, particularly for scars in areas subject to a great deal of dynamic or static muscular tension, such as the nose due to concerns for the subsequent develop of unsightly stretch scars , as appears to be the case here. I would once again have this concern for another round of surgical revision. 
You may wish to consider the use of submission to elevate and smooth the depressed portion of the scar followed by the use of professionally performed medical micro needling (accompanied by the application of prescription pigment promoting agents, such as topical tyrosine and latanoprost), to help better blend the treated area in both color and texture with the surrounding normal skin. 
You would be wise to consult with an experienced, board certified cosmetic dermatologist scar specialist. Hope this helps and best of luck.

Z Plasty or linear closure for atrophic scar on bridge of nose / upper dorsal area? (Photo)

Answers (2)

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