Punch Excision on Old Chicken Pox Scars Only Created New Scars

Question

My surgeon used a dermal punch and closed each excision with 2 stitches. I am concerned that after six months the new scars are depressed and actually look very much like the scars that were excised, except that new scars also have lines running through them from the stitches. I was told that six months is too soon to be worrying, but I cant help it. I have been hoping that they may still fill in,but it doesn't seem likely, there hasn't been any improvement for 2 months. What is your advice?

Nelson Lee Novick, MD · Answer

In my experience, chicken pox scars are especially tightly bound down fibrous scars that often require a combination of treatments to successfully improve them. Treating these kinds of scars can be especially challenging when they are located in areas under tension, such as the forehead.

	If the scar is approximately the size of a pencil eraser and is located in one of these high tension areas, a punch-excision is likely to yield a scar that will ultimately stretch again to about the same size of the original scar. In such circumstances, a punch-elevation technique would be preferable. Instead of cutting out the scar and stitching the remaining wound together, as is done with punch-excision, punch-elevation consists of freeing up the base of the scar with the punch instrument and then, instead of cutting this base entirely out, letting it "float" upwards toward the surface where it can then be stitched into place FLUSH with the surrounding skin. Tiny plastic surgical sutures must be used and removed in three to four days in order to avoid stitch tracks. At a later date, when the wound is completely healed, a manual dermasanding of the surface of the healed site can be performed to even out the color and smooth the surface still further.

	Subcision followed by medical microneedling is another combination approach that I have found helpful for certain chicken pox scars. Subcision, performed under local anesthesia,  consists of inserting a needle under the scar and cutting the surface of the scar free from the dense fibrous bands pulling it downward, allowing the base to rise up toward the surface. Sometimes subcision needs to be repeated about six weeks later to obtain the desired result. Once this is achieved, the surface coloration and irregularities can be blended by a series of medical microneedling treatments. Medical microneedling using the Dermaroller employs a roller bearing numerous tiny, sterilized, stainless steel needles that create microchannels in the skin that break up discolorations and abnormal collagen and allow it to be replaced naturally by more even skin pigmentation and new healthy collagen. This procedure, which takes only a couple of minutes to perform and may be done under local or topical anesthesia, may be repeated two to four times until the desired result is obtained.

Andrew Kaufman, MD · Answer

It really takes 6-12 months to get the final cosmetic result followng any type of surgery. I would follow up with the surgeon that performed the scar revision and ask how much improvement he/she is expecting. Sometimes another procedure, like dermabrasion, can improve the result after scar revision surgery.

Elan B. Singer, MD · Answer

6 months is still a bit too short on the scar maturation timeline.  I suggest waiting another few months and going back to see your original surgeon.  Unfortunately, there are never any guarantees regarding scar revision.  There very well might be a way of improving the scar but you just have to wait until the scar matures a bit more.  Good luck!

Elizabeth F. Rostan, MD - Account Suspended · Answer

I also think it is a little early to judge final result and I would bet that you will continue to see improvement over the next 6-9 months as collagen healing continues. It may not be completely gone but typically after punch excisions, the outcome is much better than the original scar.

Punch Excision on Old Chicken Pox Scars Only Created New Scars

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Answer: Punch excision for scars

Answer: Punch excision for scars

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Punch Excision on Old Chicken Pox Scars Only Created New Scars

Answers (4)

Answer: Punch excision for scars

Answer: Punch excision for scars

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