Scars Thick and Red 6 Months After Face and Neck Lift?

Hi Maria, 

Firstly I am sorry you have this complication, it must be distressing for you. In my experience it is unusual for a patient to have inflammed and tender scars at six months. Certainly there is a risk of hypertrophy (thickening) but inflammation is usually associated with infection or irritation from a foreign body / suture. I am assuming that as you PS has injected Steroid these causes have been ruled out. I wonder if you have a history of hypertrophic or Keloid scarring? Have the scars be exposed to strong sunlight or were they under too much tension? Hard to tell without photos. 

At 6 months I would advocate Massage, silcone gel, steroid injections and would consider fractionated laser judiciously. It is a little early to consider revision of the scar in my opinion but this is certainly an option in the future if necessary. 

Good luck and please let us know how you get on.

Kind regards

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

Although it takes a full year to heal completely from a facelift, thick red scars after 6 months and 3 kenalog injections make me think that the possibility of revision is at least moderate.  Thick red scars are usually termed as hypertrophic, usually associated with excessive wound tension or some other adverse wound healing factor.

It would help to see photos of your scars to give you the best advice. In general, scars will respond best to the following:

1) Steroid treatment
2) Scar revision
3) Laser treatment

The best option for you can be determined during an in-person consult, and I would recommend speaking with your surgeon. I hope this helps, and best of luck to you.

Ideally, a facelift wound should be closed under zero tension - your description of your scar quality makes me think that your wounds may have been closed under some tension with resultant scar thickness, redness etc. I find scar massage to be an effective means of improving scar quality. There are some good You Tube videos on scar massage.

Thick scars are usually from tension on the incision at the time of healing.  Your current treatment is appropriate.  If these scars are still thick and raised at one year then a secondary excision and closure NOT under tension may yield better scars.

Dr. ES

Dear Maria7500,

It is unusual to still have very thick red scars 6 months after a facelift.  Scar management with massage, sunscreen, silicone sheets, and taping with paper tape are all options to help improve your scar appearance.  There are several cover-up creams with SPF in them that may help you while your scars are red. If your skin is very fair, it may take longer for your scars to fade.  Generally, it takes at least a year before your scar will mature completely.

You should see your surgeon to discuss your scars.  They need to examine you and ensure that there is no other cause for your prolonged scar inflammation (infection, foreign body, etc.).

Best,

Scar revision for red thick scars is usually what is needed after 6 months. See a revision facelift surgeon for a second opinion

     Thick, red scars 6 months after facelift can be frustrating.  Injections of steroids have been done.  In general, these should get better over the course of a year.  A scar revision could be considered at some point.  There are other modalities that could be used as well depending upon extent and character of scars and your skin pigmentation.  Kenneth Hughes, MD Los Angeles, CA

Most facelift surgeons find thick scars rare but we all have seen them. Steroid injections usually work rather quickly to soften the scars but unfortunately they usuallt create wide, soft, pale scars that require revision anyway. I have found that revisions seem to heal better than primary scars in many instances. Maybe there is less intrinsic tension on the wound after 6  mos. Sometimes it is better to use fewer or a different subQ suture if the patient tended to spit the previous suture. Regardless, if Plan A didn't work don't make Plan B the same as Plan A!