Posts Tagged ‘forehead scar revision’
Wednesday, November 2nd, 2011
Q: Dr. Eppley, I want to ask about how to get rid of a facial scar. I want to fade or remove my scar in my face on my forehead. That scar was caused by a car accident in 1998. The characteristics of the forehead scar are flat, vertically-oriented above my right eye, its size is 33mm in length and 2.5mm in width. The color of the scar is darker (more red) than surrounding healthy skin. It tends to be flat and is slightly less irregular but, when my facial skin is flexed, the edges of the scar tissue can be unified. What is the best way to repair my scar? Thank you very much.
A: Your scar description describes perfectly that it is best treated by a formal scar revision. This scar revision would include total excision (cut out) of the scar and a geometric closure. (irregular or broken line closure) The appearance of a scar that is wide and flexible can only be narrowed by total excision of the scar. Because the scar has a vertical orientation in the forehead, it runs perpendicular to its relaxed skin tension lines. This means that if a straight line closure is done after the scar’s excision, there will be a tendency for it to widen again. (although it may end up as wide as it is now) Changing the closure pattern to an irregular or broken line closure will redistribute the tension on the scar so that it will be more likely to stay as narrow as possible (less than 1mm) Also an irregular non-straight line is better camouflaged as it is harder for the eye to follow a broken line as opposed to a straight one. This type of scar revision is the best approach based on your scar’s description.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: drd barry eppley, forehead scar revision, geometric scar revision, indianapolis
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Wednesday, June 8th, 2011
Q: Dear Dr. Eppley, I wanted to send you my pictures to review. I had a childhood scar which I had revised in 1995 and the result was this elongated revision which I have not been too happy with. It has been about 16 years since then and I was hoping to find out if can have anything done to make it less visible. I am currently 30 years old and of Asian decent. If you have few minutes, I would appreciate your input on a few of the questions as it will help me be more knowledgeable.
1. I realize that the scar revision is replacing one scar with a less visible one. Would you consider the revision for this vertical midline scar to be GBLC, serial W-plasty or a simple vertical excision?
2. I know there may be a bandage or silicone gel sheet after the procedure. Any idea of how long I need to wear one and the down time in general?
3. Following the revision, would there be any additional resurfacing required? If so, would you recommend dermabrasion? And any idea of total number of follow-ups required?
A: Thank you for sending your pictures and reviwing your scar history. Your forehead is a relatively flat wide scar that runs vertically right down the middle of your forehead. In answer to your questions:
- As this scar runs completely perpendicular to the relaxed skin tension lines of the forehead, which run horizontal, any successful scar revision should nto be a straight line. Some form of irregular pattern needs to be used. Given that the scar is absolutely vertical, I would use a running or serial w-plasty type of scar revision.
- I would apply just some glued brown tapes for a week after the procedure over the sutures. Thereafter, one would apply a light antibiotic ointmnent for an additional week and then change to a topical scar gel. Scarguard is my preference.
- I suspect that some light laser resurfacing may be beneficial done once about 6 to 8 weeks after the procedure. That would depend on how the scar appears. Definitely not dermabrasion as that is too deep. With your Asian skin I would be very conservative with any type of scar treatments that use heat due to the risk of pigmentation changes.
Dr. Barry Eppley
Indianapolis Indiana
Tags: dr barry eppley, forehead scar revision, indianapolis
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Saturday, May 14th, 2011
Q: I fell and now have a depressed scar on my forehead that I think (but what do I know) should probably be cut open and resutured so it results in just a fine line. It’s about 2″ long. I have attached a picture of it for you to see what it looks like. What do you think?
A: Scar revision is ideal for those scars that have healed with a contour depression or indentation. No other method, such as injectable fillers or lasr resurfacing, can change the level of the line of original injury as well as excision and reclosure. By cutting out the scar edges and recruiting normal unscarred skin and subcutaneous tissues, the lack of volume which represents the original scar indentation is replaced. You are correct in assuming that you are trading off an indentation for a smoother fine line scar. Your scar is small enough that it can be done in the office under local anesthesia, saving the expense of the operating room and other supplies. The new scar will be finer and mor even with the surrounding skin. It will take months for its redness to go away but, in the end, its appearance will be much improved.
Dr. Barry Eppley
Indianapolis Indiana
Tags: dr barry eppley, forehead scar revision, indianapolis
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Wednesday, January 26th, 2011
Q: I have a long and wide forehead scar that I would like to be made to look better. I have attached some pictures of it for you to review. I was wondering if you think that laser resurfacing will help. I have read that it can make scars go away. What is your opinion of it?
A: The origin of your question is will any form of laser resurfacing make your forehead scar disappear. The simple answer to your question is no, no matter what type of laser resurfacing technique is used. And let me explain to you why. Your forehead scar is composed of abnormal tissue which is why it does not feel or look like normal skin. It is in fact abnormal tissue or scar but, most relevantly, that scar involves the entire thickness of your skin. In other words, the skin has been replaced by full-thickness scar. You can smooth of the surface of the scar out all you want with any form of laser resurfacing but it will always appear just as wide, just as discolored and just as obvious. Laser resurfacing only smooths out the surface of the scar, which is helpful if the scar’s main problem is surface irregularities, but it will get rid of the actual full-thickness of the scar. Only cutting it out (excision) can do that. When excision is combined with a geometric broken-line closure, the scar will become more narrow and less obvious. Secondary touch-up with laser resurfacing may be helpful but it is an ineffective treatment to do first. I realize that grasping out the hope of laser resurfacing seem appealing but it is but a treatment mirage. Formal surgical scar revision is what would benefit you the most.
Dr. Barry Eppley
Indianapolis Indiana
Tags: dr barry eppley, forehead scar revision, indianapolis, laser resurfacing, plastic surgery for scars
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Sunday, September 5th, 2010
Q: I have a wide circular scar in the middle of my lower forehead from removal of basal cell cancer in the fall of 2009. It measures 5 mm wide by 10mm long and is depressed. (atrophic) The dermotologist used the ‘scraping method’ the remove the skin cancer. As the scar is in a very prominent place, I am strongly considering scar revision to make the scar is long and narrow. What are your thoughts?
A: Whether scar revision will be helpful is determined by two primary features of the scar in question. First, what does the scar look like? Scars that have width and height issues (raised, depressed and/or wide) are prime candidates for a positive outcome from scar revision. Narrowing and leveling a scar is one of the main changes that scar revision does well. Second, what is the age of the scar? Most scars must be mature enough to allow for good tissue handling and manipulation. In general, scars should be at least 6 months old if not longer. But the most important feature, not just time, is how pliable or flexible the surrounding skin is. Soft flexible skin is important to make most scar revisions successful.
Because the scar is located on the forehead, it is also likely that simple straightforward excision and closure, while better than what currently exists, is not ideal. Most likely, some form of geometric scar line rearrangement is needed to optimize its ultimate visibility. Scar revision using non-linear closure is best for any forehead scar that is not parallel to one’s natural wrinkle lines.
Dr. Barry Eppley
Indianapolis Indiana
Tags: dr barry eppley, forehead scar revision, indianapolis, plastic surgery
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Saturday, July 3rd, 2010
Q: I was wondering if a scar on my forehead can be improved by plastic surgery. Two years ago, I fell and had a deep cut into between my eyebrows. Even though it was stitched up in an emergency room, it has still left a very noticeable scar. Because of where it is located next to my eyebrow, it always looks like I am frowning even though I am not. I am only 29 and don’t want to look like I am scowling or have wrinkles at this age. Would scar revision be helpful?
A: Scars are particularly noticeable when they are in unnatural locations. Whle most people will eventually develop some vertical lines between their eyebrows due to excessive muscle activity (expression), that is not a ‘natural line’ for a younger person. Having seen such scars in this are before, they are noticeable because they are indented along the scar line. This creates a vertical groove which can certainly look like a deep glabellar furrow or wrinkle.
Unlike expression-induced glabellar furrows, Botox is not an answer because it is caused by injury and scar. The problem is in the skin and not the muscle. Most scars in this area can be significantly improved by surgical scar revision. By cutting out the old scar and closing the line in an irregular (running w-plasty) pattern, the scar will usually become much less noticeable. Not only in the scar line no longer completely straight but it will not indent and be smoother. This simple procedure can be done in the office under local anesthesia.
While scar revision is not a magic eraser, it can reduce its appearance to be much less noticeable.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, forehead scar revision, indianapolis, plastic surgery, scar revision
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