Why did my scars widen after excision, could this be prevented? 1.5 Years post op (photo)

Question

I'm a 27 year old female with fair-medium skin. I had an excision done on two scars about a year and a half ago that. It was done by a plastic surgeon, and he used both under- and overstitches. Unfortunately, I didn't get good results. It looked good the forst two-three months, like a thin line. Eventually the scars started to widen and I ended up with gashes instead. I taped my scars for 6 months.. Why did my scars widen and what could I have done to prevent it from happening?

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

Nelson Lee Novick, MD · Answer

Unfortunately, there is nothing surprising here. I have been cautioning my readers for years that excisions and scar revisiion surgeries in areas subject to static tension (tense muscles at rest) and/or frequent muscular movement are prone to the development of stretch scars and tram track stitch marks, which appears to be the case here. Sorry. As to what could have been done to prevent this, it is hard to say without knowing the history. If, for example, the surgeries were indented scars, like post-trauma or acne scars, then subcision would have been an excellent option. Given what is now, subcision to elevate and smooth the base of the scars, followed by professionally performed microneedling to improve the superficial, surface irregularities would be quite reasonable. You would be wise to consult a board certfied cosmetic dermatologist. Best of luck.

Camille Cash, MD · Answer

I'm sorry that this happened to you.  Unfortunately scars can widen even after revision.  There are certain areas of the body that tend to scar less favorably than others.  You may want to consider other treatments to the area such as Morpheus8.  I encourage you to visit with a board certified plastic surgeon near you for an evaluation and discussion of your options.

David M. Kowalczyk, MD, MBA, FACS · Answer

Hi there! Sorry that you're experiencing trouble with your facial scars. There are options to improve them, though. For depressed scars, we often use subcision to remove any deep tethering. This can be done easily in clinic with an 18G needle. Then, we use micro and nanofat harvested from around the abdomen to improve the texture and quality. These types of fat can produce nice results. It doesn't sound like you did anything incorrectly. Sometimes, scars can widen despite best attempts at alleviating tension. Resurfacing technologies - like CO2 - may also be an option. Hope this helps!

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