Q: Dr. Eppley, I have a facial scar is approximately three years old completely severing lip and chin tissues. An excellent alignment repair was done at the time. But over time the chin repair changed from a raised scar to an indention. What type of scar revision procedure would be used to correct it? Will this be a permanent correction?
A: Many facial laceration repairs look great early, become raised secondarily and then eventually become wider depressed type scars over time. This is due to the different phases of healing that occur from early inflammation, intermediate collagen deposition to late effects of scar contracture and collagen/fat resorption.
Given its facial location in which it completely violates the relaxed skin tension lines of the skin, a geometric type scar revision is needed. It would be either a running W-plasty or another form of broken like type scar revision. When the scar limbs interdigitate there is less chance of recurrent widening or depression of the scar. Most facial scar revisions do end up better in the long run but it is a process that will also go through the similar phases of healing that the original injury did.
Dr. Barry Eppley