How to treat scar tissue lump/thickened skin in my cheek from subcision complication? (Photos)

Question

Hi there, please help: 3+ years ago I had Taylor Liberator subcision performed on my cheeks for acne scarring, it was a very aggressive procedure that left me with a hematoma in my right cheek during the night of the surgery date. In the morning it was drained (manually squeezed out). Ever since then I have a small lump in my right cheek which is making my face asymmetrical because the lump protrudes my right cheek, extending my nasolabial folds on my right side. The area feels like thickened skin/or a small lump in my right cheek. I am 3 years post and this is not resolving by itself so I would really like some advice on treatment options please. I cannot see the treating Doctor as they don't know how to treat this complication. I have attached some clear photos, any help would be hugely appreciated, let me know if you have any questions and I can answer right away. Happy to travel worldwide for solutions. Thank you.

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

Anna Chacon, MD, FAAD · Answer

I'm sorry to hear about the challenges you're facing following your subcision procedure. Here are some potential treatment options that might help address the lump and thickened skin on your cheek:

Consultation with a Specialist: Since your original doctor is unable to provide a solution, it might be beneficial to consult with a dermatologist or a plastic surgeon who specializes in post-procedural complications. They can offer a tailored approach after a thorough examination.

Steroid Injections: Intralesional corticosteroid injections can help reduce scar tissue and flatten the lump by decreasing inflammation and collagen production in the area.

Laser Therapy: Fractional lasers, such as CO2 or Er:YAG, can help resurface the skin and improve the texture by targeting the scar tissue.

Microneedling with Radiofrequency: This treatment can help remodel the scar tissue and improve skin texture by promoting collagen production in a controlled manner.

Surgical Excision: For more prominent lumps, surgical removal might be an option. A skilled surgeon can excise the scar tissue and reshape the area to improve symmetry.

Massage and Physical Therapy: Regular massage of the area might help break down the scar tissue over time. A physical therapist or specialist trained in scar tissue management can guide you on techniques to use.

Silicone Gel or Sheets: These can be applied topically to help flatten and soften the scar over time.

Fat Grafting or Fillers: Occasionally, using fillers or fat grafting can help balance out asymmetry by filling in the surrounding areas rather than directly treating the lump.

Patience and Monitoring: While it has been 3 years, some treatments may take additional time to show results. Regular follow-ups with a specialist can help monitor progress and adjust treatments as needed.

Given your willingness to travel for treatment, seeking out a highly experienced dermatologist or plastic surgeon with expertise in scar management could be very beneficial. They can provide a comprehensive assessment and recommend the most appropriate course of action.

Nelson Lee Novick, MD · Answer

I am sorry that you have this problem. I have been routinely performing subcisions with gratifying results for thirty years for elevating and smoothing all kinds of Indented scars and skin depressions. For subcisions of larger areas, such as the cheeks and/or temples, I opt to perform Field Subcisions, rather than any other more aggressive approach.. 
I have personally treated a number of patients already who have traveled to me from all over with a similar issue to what you are experiencing after having been treated with the Taylor Liberator approach. The problem is likely one of excess fibrous tissue production below the skin as a result of healing from the trauma.  I have had success in treating these individuals using varying combinations, concentrations and amounts of intralesional anti-inflammatory agents.
You would be wise to consult with an experienced, board certified cosmetic dermatologist scar treatment specialist.

How to treat scar tissue lump/thickened skin in my cheek from subcision complication? (Photos)

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How to treat scar tissue lump/thickened skin in my cheek from subcision complication? (Photos)

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Everything you need to know about Scar Removal

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