Can My Forehead Scar Be Removed Through The Use Of Tissue Expanders?

Q: Dr. Eppley, I have a depressed forehead scars right in the middle of my forehead, parts of which contain pigment from a previous birthmark removal. I am desperate and need a doctor to help me. I know you are one of the best and I trust your opinion. I was researching and thought that the use of tissue expansion may be hekpful in its removal. I figured you can make the insision through my eyebrow for the flap/scar for the tissue expander. I am also interested in hair line lowering but not sure you can combine both procedures. I am open minded to ideas .I just need this fixed.

A: Thank you for sending your pictures. Your forehead scar is more vertically-oriented than circular perhaps from a previous surgical excision of a congenital nevus, hence the residual pigment. Regardless of its origin, let me clarify for you some basic misconceptions that you have about its potential surgical improvement. First, tissue expansion is a reconstructive technique that is way beyond what is needed for your scar revision. While it is a wonderful reconstructive technique for creating more forehead skin, your scar problem does not merit such an aggressive approach. In other words, the magnitude of the solution (tissue expansion) does not match the smaller severity of the problem. (scar) When such mismatches occur, other aesthetic issues arise that are usually worse than the original problem. in the case of tissue expansion, this means a larger scalp incision is needed for its placement (and an additional scar elsewhere), it requires a two-stage surgery (cost) and the inconvenience of walking around with an obvious mass in the middle of your forehead between the first and second surgery for a few weeks. (plus you have to be able to do the daily or weekly tissue expansion by needle on your own) Secondly, no access to the forehead can be obtained through the eyelid or brow area. There is a large nerve there that would have to be cut to do it giving you permanent forehead and scalp numbess. Plus an eyelid incision is neither big enough to place a  tissue expander nor is scarless in someone with substantial skin pigment. (postoperative scar hyperpigmetation)

On a more practical basis, what you need is a much simpler approach…direct scar excision with complete forehead skin mobilization (done through the scar) to alleviate tension of the forehead skin closure after the scar is revised. This could easily be combined with a hairline lowering/scalp advancement procedure.

Dr. Barry Eppley

Indianapolis, Indiana