5 Year Old Child and Scar Revision on Forehead - Now or Later? (photo)

Question

My 5yo tripped and fell into a corner 8 months ago, splitting her forehead fairly deeply. We took her to the ER and she received 12 stitches. The resulting scar is attached - it is about an inch long and straight. I'm wondering what the best course of action would be - remediate now while she is young or wait until she is older? Would she heal better if we took action now? We have been using Mederma daily and have given her bangs to physically shield the wound from sun. Thank you!

Stephen Weber MD, FACS · Answer

I agree with Dr. Winkler that this scar will likely continue to mature and improve for at least one year after the injury. You're doing the right thing using Mederma and trying to camouflage the scar while it matures. You should also consider daily sunscreen as well.
	Given the width and depressed nature of the scar, removing the scar tissue and meticulously closing the wound is the best option if you want to improve this scar. This might also be optimized with laser treatments or dermabrasion (sanding) of the scar beginning at 6 weeks after the scar revision.
	Another important thing to consider is that your five year old probably will not undergo these procedures without some type of sedation and the risks and benefits and emotional impact of this should be seriously considered. 
	Thank you for your question.Stephen Weber MD, FACS

Raffy Karamanoukian, MD, FACS · Answer

Our treatments use combination therapy to improve the epidermis and dermis for most deep scars. The options available for acne scars depend on the character of your scars, in terms of topography and contour. We see atrophic and hypertrophic acne scars, as well as scars that have hypo and hyperpigmentation. We begin each scar evaluation with an assessment of scar quality and subtype. Our main concern is rebuilding collagen and that is why we use a HIDEF protocol that includes combination therapy. Morpheus 8, scar subcision, fibrous release, fractional laser, CO2 laser, Thulium laser, PDL Vbeam laser, and fractional resurfacing can be used in addition to TCA Cross and chemical peels to further improve skin. Patients should start Melarase AM and Melarase PM for active hyperpigmentation. Always begin with a consultation to decide whether early subcision should be started.

Best, 
Dr. Karamanoukian 
Realself100 Surgeon

Andrew Winkler, MD · Answer

The timing of scar revision can be tricky.  After the injury, scars continue to change and mature for about 18 months.  Therefore, it is never wrong to wait that amount of time to see the final result.  That said, the depressed and wide appearance of your child's scar at 8 months is unlikely to improve significantly.  If you wanted the scar revised prior to your daughter entering 1st grade, for example, that would seem reasonable to me.

	Regarding the best treatment for this scar, I would start with a procedural scar revision.  This involves removing the existing scar and realigning parts of it to lie horizontal with the forehead.  This would ideally be followed by three Lux1540 Laser Treatments.  Keep it covered with sunblock and use Mederma if you like.  Using this treatment regimen and given her age, I would expect an excellent result!

5 Year Old Child and Scar Revision on Forehead - Now or Later? (photo)

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5 Year Old Child and Scar Revision on Forehead - Now or Later? (photo)

Answers (3)

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Everything you need to know about Scar Removal

Our mission is to create a world where every investment in modern beauty is Worth It.