What can be done to minimize the appearance of scars 10 months after lower face and neck lift? (photos)

Question

I had a lower face lift/neck lift 10 months ago. I have very red scars in front of my ears, and hypertrophic scaring behind both ears, and scaring from the skin stretching (not even where I was cut). I’ve had multiple rounds of Kenalog injections and laser to try and help with the redness. Scars are tight and itchy and embarrassing. Dr talks about scar revision. I think he pulled my skin too tight and scared it could happen again. Advice is appreciated. Thanks

Anna Chacon, MD, FAAD · Answer

Dealing with scars after a lower face and neck lift can be challenging, especially when they are hypertrophic, red, and causing discomfort. Here are several strategies that might help minimize the appearance of your scars and address your concerns:

1. **Scar Revision Surgery**
   - **Consultation:** If you are considering scar revision surgery, seek a second opinion from a board-certified plastic surgeon who specializes in scar management and revision. They can provide an objective assessment and discuss the risks and benefits.
   - **Timing:** Scar revision is typically considered once the scar has matured, usually around 12-18 months post-surgery. Since you are 10 months post-op, it might be beneficial to wait a bit longer.

2. **Non-Surgical Treatments**
   - **Silicone Gel Sheets/Creams:** These can help flatten and soften scars. Products like Mederma or silicone gel sheets can be applied regularly.
   - **Pressure Therapy:** Wearing pressure garments or using pressure earrings for earlobe scars can help reduce hypertrophic scarring.
   - **Topical Treatments:** Steroid creams, onion extract gels, or other scar-reducing topical treatments might help reduce redness and soften the scar tissue.

3. **Laser and Light Therapies**
   - **Pulsed Dye Laser (PDL):** This can reduce redness and improve the texture of the scar.
   - **Fractional Laser Resurfacing:** This can help improve skin texture and reduce the appearance of scars.

4. **Microneedling**
   - **Collagen Induction Therapy:** Microneedling with or without platelet-rich plasma (PRP) can help improve the appearance of scars by stimulating collagen production.

5. **Massage and Physical Therapy**
   - **Scar Massage:** Regularly massaging the scar with a moisturizing cream can help improve flexibility and reduce tightness.
   - **Physical Therapy:** If the scars are causing functional limitations, a physical therapist specializing in scar management can provide specific exercises and techniques.

6. **Injections**
   - **Steroid Injections:** While you've already had Kenalog injections, sometimes additional sessions or different steroid formulations can help.
   - **5-Fluorouracil (5-FU) Injections:** These can be used alone or in combination with steroids to reduce hypertrophic scars.

7. **Medical Grade Skincare**
   - **Retinoids:** Topical retinoids can help improve skin turnover and may assist in scar remodeling.
   - **Hydroquinone:** This can help with hyperpigmentation associated with scars.

8. **Lifestyle and Home Care**
   - **Sun Protection:** Protecting your scars from the sun is crucial. Use a broad-spectrum sunscreen with SPF 30 or higher to prevent pigmentation changes.
   - **Healthy Diet and Hydration:** Maintaining a healthy diet rich in vitamins and minerals can support skin healing.

9. **Psychological Support**
   - **Counseling:** Dealing with noticeable scars can be emotionally challenging. Speaking with a counselor or joining a support group can provide emotional support and coping strategies.

Given your concerns about the initial surgery and the tightness of the scars, it would be prudent to seek a second opinion from a highly experienced plastic surgeon. They can offer a fresh perspective on your situation and discuss all potential options, including less invasive treatments before considering another surgery. Continuing non-surgical treatments like laser therapy, silicone gels, and possibly more tailored steroid injections might provide additional improvement while you consider your next steps.

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

Hypertrophic scars, as these appear to be at least from the photos and from the history provided can be typically red, itchy and cause uncomfortable tightness--all of which you describe. In general, these kinds of scars can be shrunk and flattened (resulting in flat off-white or ivory colored patches) and the symptoms alleviated by the use of a series of Kenalog injections when appropriate amounts and concentrations are used. Sometimes the addition of other anti-inflammatory agents may be needed to achieve the desired cosmetic and symptomatic improvements. I share your concern for recurrences of these problems if scar revision surgery is performed. You would be wise to consult with an experienced, board certified cosmetic dermatologist scar treatment specialist and best of luck.

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