Facelift and upper blepharoplasty scars - how can they be reduced? (photos)

Question

Had a facelift and upper bleph ~ 4 months ago. Scars behind the ears are still red and very raised in portions with bands or tethering visible at the upper junction on both and also at the lower junction with scalp on one side. This is concerning because it is tender and obvious with a ponytail for work outs. (A) are these scars normal and (B) how can they be reduced? Also - have visible scars on upper eye lids, particularly where suture lines opened after suture removal. Attaching pics

Randal Haworth, MD, FACS · Answer

Hello !

It is not uncommon for scars to appear red and raised in the early stages of the healing process after facelift and blepharoplasty surgery. However, at 4 months post-surgery, it is possible that the scars behind your ears and on your eyelids may be exhibiting hypertrophic scarring or keloid formation.

Hypertrophic scars are raised, red, and thickened scars that remain within the boundaries of the original incision, while keloid scars are raised, thickened scars that extend beyond the boundaries of the original incision. Both types of scars can be itchy, painful, and tender to the touch.

To reduce the appearance of hypertrophic scars and keloid formation, there are several treatments available. One option is to apply silicone gel or sheets to the affected area to help flatten and soften the scars. Additionally, corticosteroid injections may be used to help reduce inflammation and promote healing.

In some cases, laser resurfacing or dermabrasion may be recommended to help smooth out the surface of the scar and reduce its appearance. However, it's important to note that these treatments may not be appropriate for all patients, and a consultation with a qualified plastic surgeon would be necessary to determine the best course of action.

Regarding the visible scars on your upper eyelids, it's possible that these may improve with time as the healing process continues. However, if the scars continue to be a concern, a consultation with your surgeon may be necessary to determine if any additional treatment is needed, such as scar revision surgery or laser resurfacing.

In summary, while some redness and raised scarring is normal in the early stages of healing after facelift and blepharoplasty surgery, it's important to monitor the scars and consult with your surgeon if any concerns arise. There are several treatment options available to reduce the appearance of scars, and a qualified plastic surgeon can recommend the most appropriate course of action based on your individual needs and concerns.

I hope this helps,
best of luck !

Donald Groves, MD · Answer

Hello and thank you for your question. After ANY surgery, the surgical incision goes through multiple stages of wound healing before arriving at the final "mature" scar. Assuming no infection or wound breakdown, during normal healing the incision approaches its final tensile strength 6-8 weeks after surgery, creating an "immature" scar. The immature scar is generally still raised and somewhat pigmented (pink or red), and can be associated with some discomfort or pulling, especially with movement or touch. It takes up to 1-2 YEARS for this immature scar to convert into a "mature" scar, during which time the scar remodels- the collagen becomes more organized, the scar flattens, and becomes less pigmented. It is typically safe to start massaging the scars at this point in the remodeling phase (after 6-8 weeks post-op), which can help break up and fibrosis/adhesions forming between the skin and underlying tissues. Also, it is very important to avoid UV light to the immature scar during the remodeling phase, as UV can cause permanent and irreversible hyperpigmentation (making it more noticeable)- so sunblock and sun avoidance are key until 1-2 years after surgery. If the final scar appearance is cosmetically concerning, this can always be revised electively- just note this will reset the healing process. You are still only 4 months post-op so I would recommend just be patient for now. I hope this helps! 
Best, 
Dr. Donald Groves 
Plastic Surgeon

Cem Berkay Sinaci, MD · Answer

Hello. These scars seems normal after the operations. But If you are unhappy with the scars there are some steps that you can follow. First of all the scars will go on healing for at least 8 months more, which means they will bother you less by time. But if you want to do something my first suggestion would be a co2 laser treatment, may be followed by botox and steroid injection into the scars. Regards.

Raffy Karamanoukian, MD, FACS · Answer

Plastic surgery scars require attention after surgery so that they remain cosmetically-appealing and barely noticeable. In our office, we use a protocol for scars that minimizes their activity in the 6-8 weeks after surgery. If you have late plastic surgery scars, you may also require laser and RF therapy to help reduce the longterm effects of the scarring. Keloids, hypertrophic scars, widened scars, red scars, and hyperpigmented scars all require scar modulation with topical creams followed by lasers and RF therapy. Topical skincare should be directed to a specific need, whether for pigmentation or hypertrophy and our office can guide you through the process to obtain the correct Plato’s Scar cream or Melarase cream for hypertrophy and discoloration. In terms of lasers, we would employ the vbeam laser for redness, Venus Viva RF, PRP microneedling, chemical peels, and Morpheus 8, fractional erbium, or fractional co2. All of these have their individual benefits. Most of all, we recommend you visit a solid plastic surgeon who understands surgical scar revision, laser therapy, and RF therapy for scars. 
 
Best, 
Dr. Karamanoukian
Realself100 Surgeon

John Reilly, MD, FACS · Answer

Hello, it is possible to see Improvement in facial scarring for up to one year which is the acceptable time frame for most surgeons. At that point consideration can be given to excising the scars. In regards to scars behind the ears since they are not visible at a conversational distance but any extra thickness of the scar can be treated effectively with steroid injections into the scar. Good luck.

Jose Segura, MD, PhD - Account Suspended · Answer

Good morning, when reviewing your photos you have an excellent result from your surgery, if scars are still a problem today but what can be solved by probably applying a cream to modulate their response in this phase, I suggest looking for Kitoscell Q gel , and apply every 12 hours on the scars and for a minimum space of 30 to 45 days and you will notice the difference. I hope you consider the suggestion

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