Small scar revision on scalp? (Photo)

Question

Hello, I had some skin removed from my scalp nine months ago. It’s healing really well, but the end of the scar has a small bump and small depression. I’ve been using silicone and massaging since 1 month post-op. Is there any procedure that could fix this small irregularity, such as subcision or will it need to be excised? My original surgeon has moved practices, and I’m no longer able to discuss with them. Photos attached.

Raffy Karamanoukian, MD, FACS · Answer

Fractional laser is an amazing and highly effective treatment in our office. We use the laser treatment to help with acne scars, large pores, fine wrinkles, tissue collagen loss, scars, sebaceous hyperplasia, active acne, and for brightening dark pigmentation. Although there are very strong fractional lasers such as CO2 laser, we use lighter treatments for corrective skincare and maintenance of results. Our Thulium fractional laser, clear and brilliant laser, and Ultra Thulium laser are excellent options in our clinic. We also perform CO2 fractional and erbium depending on skin tone and tolerance for downtime. Patients do have to use a Melarase cream before and after treatment to help further reduce pigmentation after laser.  Melarase AM, Melarase PM, and Melapads can seriously improve surface sun damage and UV related pigmentation. Dark spots can improve with these treatments. I recommend fractional laser for incisional scars as well, especially after plastic surgery.  
Best,
Dr. Karamanoukian 
Realself100 Surgeon

Nelson Lee Novick, MD · Answer

You appear to have two separate issues here requiring two distinct approaches. Subcision, which I have been performing since 1995,  can indeed be used to elevate and smooth the Indented portion of the scar. The elevated portion of the scar can be shrunk and flattened by the use of intralesional injection of triamcionolone acetonide. In general, I have found that the silicone gels, etc are really of little to no value
You are fortunately in the critical time period of 4-12 weeks following your surgery for initiating scar improvement treatments in order to achieve optimal improvement. So, it would be wise for you seek treatment as soon as possible.by an experienced, board certified cosmetic dermatologist scar treatment specialist. Best of luck. .

Anna Chacon, MD, FAAD · Answer

I'm sorry to hear about the issues you're experiencing with your scar. Based on your description, there are a few potential options for addressing the small bump and depression on your scalp scar. However, it's important to consult with a qualified plastic surgeon or dermatologist to get a personalized treatment plan. Here are some general approaches that might be considered:

1. **Scar Revision Surgery**
   - **Excision and Re-closure**: This involves cutting out the scar and carefully re-suturing the wound to create a more aesthetically pleasing result. This can be particularly effective if the scar is causing significant contour irregularities.
   - **Z-Plasty or W-Plasty**: These are techniques that can help reorient the scar and potentially make it less noticeable.

2. **Minimally Invasive Procedures**
   - **Subcision**: This technique involves using a needle to break up the fibrous bands beneath the scar, which can help elevate the depressed areas.
   - **Steroid Injections**: These can help flatten raised scars (hypertrophic or keloid scars). They may not be as effective for depressions but can be part of a combined approach.
   - **Fillers**: Injectable fillers can be used to elevate depressed scars, providing a more even skin surface. The effect is temporary and would need to be repeated periodically.

3. **Non-Invasive Treatments**
   - **Laser Therapy**: Fractional laser treatments can improve the texture and appearance of scars by promoting collagen remodeling.
   - **Microneedling**: This involves tiny needles creating micro-injuries in the skin, stimulating collagen production and potentially improving the appearance of the scar.

4. **Topical Treatments and Ongoing Care**
   - **Silicone Gel/Sheets**: Continuing with silicone treatments can help in the long-term management of scar appearance.
   - **Massage**: Regular massaging can help soften the scar tissue, although it seems you've already been doing this.

Next Steps
Given that your original surgeon is no longer available, I recommend the following steps:
1. **Consult a Specialist**: Seek out a board-certified plastic surgeon or dermatologist with experience in scar revision. They can provide a thorough evaluation and recommend the most appropriate treatment.
2. **Get a Second Opinion**: If possible, consult with more than one specialist to understand the range of options and choose the one that best suits your needs and expectations.
3. **Discuss Expectations**: Make sure to discuss your goals and what you hope to achieve with the revision, as well as any potential risks or complications.

While there are multiple options for addressing your scar, the best approach will depend on a detailed evaluation by a qualified professional. They will be able to tailor a treatment plan based on the specific characteristics of your scar and your overall skin condition.

Small scar revision on scalp? (Photo)

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Small scar revision on scalp? (Photo)

Answers (3)

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